JCAHO rewrites the book

Thursday, July 31, 2003

OAKBROOK TERRACE, Ill. - Several months after JCAHO announced far-reaching changes to the way providers achieve accreditation, the organization is condensing its standards in an effort to reduce paperwork and renew focus on the way providers deliver patient care.

Starting Jan. 1, 2004, all providers - including HMEs - will comply with standards that are both fewer in number and less specific than those currently on the books. Although JCAHO cannot quantify the reduction for HMEs, hospitals will have to comply with 56% fewer standards next year.

Here’s a general example of how the standards have changed: While JCAHO has previously been very specific about the content of contracts, in 2004 the new standard will simply look to see if there is a written agreement between two parties.

“The standard is still there but we have really allowed the organization more freedom to determine what they need to have in that agreement,” said Maryann Popovich, executive director of JCAHO’s home care accreditation program. “When we come to survey the agreement, all we are going to look to see is that there is an agreement, not the specifics we looked for in the past.”

Providers have long been discouraged by standards they believed were outliers. Dennis Trach, regulatory compliance officer at Associated Healthcare in Amherst, N.Y, was particularly galled by a standard that wanted a policy and procedure to govern the company’s utilities.

“In other words, did we turn our lights off at night?” said Trach. “Who cares? What does that have to do with patient care?”

Trach hesitates to celebrate standards that are less specific because that could mean they are more vague. Part of what he likes about the standards put out by ACHC (Associated is accredited by ACHC and JCAHO) is specificity. But he does admit that there’s been a vast change in JCAHO recently.

“The people I’m talking to are saying JCAHO is getting better,” said Trach. “They are helping you comply with the standards, not trying to catch you not doing something.”

News of the revamped standards comes several months after JCAHO announced that it would begin to conduct unannounced surveys in 2006, and about six months after the company said it would do away with scores, seek consistency among JCAHO surveyors and implement a self-survey at the 18-month mark of a triennial survey.

JCAHO has been accrediting HME companies since 1988. The organization now counts 2,400 different companies in its home care section that provide home medical equipment.

JCAHO has changed standards in the past, but Popovich characterizes these changes – for HME dealers - as the most significant ever because the Joint Commission has completely overhauled the format.

“In all the previous editions [of supplier manuals], we stated the standard and then we had an intent,” she said. “In 2004, the format still states the standard, but now, under the standard, we may have a rationale, which is not an intent. It just states why the standard is important and may state some understanding of the standards.”

Surveyors will measure companies’ performance by scoring them on elements of performance. The degree to which a company complies or does not comply with the various elements will determine whether the standard has been met.

While surveyors will spend less time in providers’ file cabinets, JCAHO wants them to spend more time in dealers’ warehouses and trucks. Trach said JCAHO has been talking about doing more fieldwork for years. But Popovich said it’s happening, and has happened at the three undisclosed HME sites that have piloted the new standards.

“That’s the essential quality of the business,” said Popovich. “Is the right equipment being delivered to the right patient, in the right time sequence, with the right instruction for follow-up and is there appropriate quality follow-up of that equipment, including maintenance and responsiveness to the patient?”