The Joint Commission (TJC) is not responding to a prominent newspaper investigation that questioned the value of its accreditation, leaving hospital leaders to assess the allegations.

One quality professional says the report may have raised some valid concerns, but also misrepresents how TJC accreditation works.

The Wall Street Journal based its conclusions on database analysis of hundreds of inspection reports from 2014 through 2016. The article notes that, though it is a private organization, TJC has a quasi-governmental role as the accrediting organization for almost 80% of U.S. hospitals. Twenty of The Joint Commission’s 32 board members are executives at health systems it accredits or parent organizations of accredited health systems, the newspaper reports. Other board members are named by healthcare lobbying groups, such as the American Hospital Association and the American Medical Association. (The Wall Street Journal article is available online for a fee at: http://on.wsj.com/2jaIpYY.)

The following are two key allegations in the article:

• TJC typically takes no action to revoke or modify accreditation when state inspectors find serious safety violations. The database analysis indicated that about 350 hospitals in violation of Medicare requirements had Joint Commission accreditation at the time. More than one third with accreditation went on to have additional violations later in 2014, 2015, and 2016.
• In the time period studied, hundreds of hospitals with safety problems continued to display a “Gold Seal of Approval” and actively promote their accredited status. TJC did not take action to stop them.

TJC Media Relations Manager Elizabeth Eaken Zhani tells HPR that the organization has no comment on the newspaper article and declined our requests for a TJC representative to address some of the issues raised. Hospital leaders with concerns and questions about the article can contact their assigned TJC account executive, Zhani says.

Role of TJC Confused

The newspaper report attempted to illustrate valid concerns about the TJC accreditation process but at least partially misconstrued the role of TJC, says Donna Fraiche, JD, senior counsel with the law firm of Baker Donelson in New Orleans. She has spent most of her career representing hospitals with credentialing and peer review issues, especially compliance related to TJC accreditation.

The criticism of TJC in the article suggests the newspaper confused the roles of TJC and the Centers for Medicare & Medicaid Services (CMS) regarding accreditation and compliance, Fraiche says.

“Those are entirely different roles, and that seems to have been lost in the article,” Fraiche says. “In the early days it was more of a self-policing situation, with hospitals volunteering to have The Joint Commission police them and ensure compliance with standards. In later years that has changed, and I think for the better.”

That earlier approach was seen as sort of a closed system with hospitals keeping the information to themselves, whereas TJC has now evolved to more of an open system through which hospitals can publicly pledge to meet established quality standards, Fraiche says.

“Now we see hospitals much more willing to report when there is a problem, and that’s what you want,” she says. “One of the things the article was rough about was what the author perceived as a lack of transparency by The Joint Commission. I’m not sure what the author meant by that because there is an awful lot of transparency. I suppose if you’re a plaintiff’s lawyer and you want someone else to do all the homework for you and turn over all the dirt for you to exploit, then you could say there’s not enough transparency.”

Transparency in Question

Fraiche notes that some of that desire for more transparency probably comes from the fact that hospitals are allowed to investigate their own problems before TJC comes in to study the issue and makes information public. That is a good policy, she says.

“If you put everything in sunshine prematurely, before you allow hospitals and accreditation agencies to investigate what procedures were in place to address the issue and whether they were sufficient, you discourage real improvement,” Fraiche says. “If you don’t have the freedom to look in your own backyard before somebody comes in with a microscope, you miss the opportunity to have hospitals learn from their mistakes and you discourage them from reporting problems. Then, you will only hear about the dramatic cases and not the day-to-day things that are caught before they become serious problems.”

Fraiche disagrees with the article’s suggestion that The Joint Commission is lax or that CMS should take over its operations. Both compliance tracks are necessary, she says.

When CMS surveys a hospital, it does not focus on whether the hospital complied with TJC accreditation efforts because it has its own standards that, though similar and parallel, are not the same, Fraiche notes.

“CMS has taken the position before that if you have Joint Commission accreditation they won’t come in for unannounced surveys without cause, taking that accreditation as a seal of approval. But that’s not a formal policy, and in recent years we’ve seen more of a competition between how tough The Joint Commission can be and how tough CMS can be,” she says. “That leads to The Joint Commission having to answer to criticism by CMS about how they monitor hospitals, and I think that could mean we will see The Joint Commission coming down harder on hospitals in the future.”

TJC Consulting Necessary

The Wall Street Journal article also questioned the propriety of TJC having a consulting arm that charges hospitals for compliance assistance, but Fraiche says the complexity of accreditation compliance necessitates having assistance available from people who thoroughly understand the system.

It’s becoming more and more expensive for hospitals to comply with the plethora of regulatory responsibilities, and compliance officers are very busy both with day-to-day concerns and long-range efforts, Fraiche says.

“A reporter looking in from the outside may say this is the fox guarding the henhouse, but I don’t see it that way at all,” Fraiche says. “I see it as a helpful resource you can use or not use. You can use private consultants or none at all, but it’s perfectly reasonable to need that kind of assistance.”

SOURCE

• Donna Fraiche, JD, Senior Counsel, Baker Donelson, New Orleans. Phone: (504) 566-5201. Email: dfraiche@bakerdonelson.com.