Surprise! JCAHO says expect the unexpected

OAKBROOK TERRACE, Ill. — Starting in 2006, JCAHO will begin to conduct its surveys on an unannounced basis. In 2004, JCAHO will pilot-test the new survey protocol with hospitals; in 2005, the organization will pilot-test all other providers. The transition from unannounced to announced surveys is bound to cause some new operational anxieties for HME providers who typically ramp up for the triennial survey, and then ramp back down when the pressure of a JCAHO survey is over. “We'll never be more prepared than we are a week before they come,” said Don White, a JCAHO-accredited provider and president of Associated Healthcare in Amherst, N.Y. “We bring in the guy to clean the carpets and make sure the place is orderly. We spiff it up to make sure it looks good. The warehouse shelves are dusted.” Without adequate preparation on the provider side, White believes JCAHO will find more problems, and ultimately those problems will require repeated site visits from JCAHO surveyors and thus, increase the cost of accreditation. “Some believe you should be as well prepared everyday,” said White. “In theory, that's great. But in the real life of business, there's ebb and flow.” Under its new accreditation process, called Shared Visions - New Pathways, JCAHO hopes that the real life of business, including that of HME providers, will change appreciably and pre-empt the kind of concerns raised by White. Late last year, JCAHO began implementing the most significant overhaul in its accreditation process in a decade. The new “vision” does away with JCAHO scores, seeks consistency among surveyors and adds a new self-assessment process at the 18-month mark of a three-year accreditation. Those changes go live in January 2004. By compelling clients to self-assess, JCAHO believes it will foster a climate of continuous quality improvement that should remove some of the anxiety that attends a Joint Commission-survey. “That's the goal — to foster continuous compliance so there isn't ramp-up three months before, or six months before, but to keep that level of compliance consistently throughout the accreditation period,” said JCAHO spokeswoman Charlene Hill. Some HME providers already know the ropes when it comes to unannounced surveys. When CHAP brought on Lincare and Pediatric Services of America recently, the companies agreed to submit to unannounced surveys, said former CHAP CEO Jerry Cohen. Since CHAP would not visit every chain location, the unannounced visit to any location at any time was one strategy for ensuring that every location was performing up to standards. For other, smaller HME companies, CHAP schedules its surveys. Until CHAP began accrediting HME companies in greater numbers several years ago, all of its surveys were unannounced. But there was some pressure from the HME industry, as CHAP began selling itself as a JCAHO alternative, to begin scheduling surveys. Cohen believes the unannounced survey makes more sense. “It will give the industry more credibility,” he said. “If you are saying you are providing quality care, there shouldn't have to be any preparation.” White's company began to prepare for its 2003 triennial last year. A manager is making site visits; continuous quality improvement (CQI) evaluations are conducted quarterly. Nevertheless, he fears that unless JCAHO makes some allowance for a distinction between how a company performs when it expects a surveyor and when it does not, there will be problems. “We're glad that these things (CQI evaluations, HIPAA compliance, JCAHO surveys) are staggered because they could bring your business to a stand still as your manpower tries to focus on it all,” said White. “My feeling is this is not a very good idea.” HME