How will you measure up to the new CARF accreditation standards?
CARF wants to see corporate citizenship, credible budgets, yearly reports
Starting July 1, all organizations accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) must meet a new set of standards, regardless of what area of rehabilitation they are involved in. The new standards put a greater emphasis on business practices such as risk management, insurance, and performance issues, as well as on corporate citizenship.
"We’re trying to address the arena of good business practices for the rehabilitation continuum," says Christine MacDonell, managing director of medical rehabilitation and emerging markets for the Tucson, AZ-based CARF. "People go into rehab because they’re good caregivers, and not necessarily because they’re good businesspeople. The new standards would actually be a great template for people just starting a business."
Previously, each type of rehab organization — from medical rehabilitation to assisted living to behavioral health to adult day services — had its own specific standards manual. "It was sometimes difficult for providers who cross over into multiple areas CARF accredits because they had to blend a lot of the standards. It was confusing and it often required a lot of man-hours," MacDonell says. "The new standards are clear, very practical, and they should be very helpful to the organizations."
In the works since 1999, the new standards were written with input from rehab providers and with an eye to ISO 9000 and Baldridge quality standards, MacDonell says. CARF hopes the practical nature of the standards will make it easier for organizations to commit to using them on an ongoing basis. "We want providers to use the standards all along rather than panic six months before the survey," MacDonell says. "There really shouldn’t be so many peaks and valleys, but more of an ongoing look at whether the organization is continuing to meet the goals."
To encourage continuous use of the standards, CARF will begin this year to use the nine business practices criteria as the basis for interim quality reports to be completed each year on the anniversary date of the organization’s accreditation. CARF already requires that organizations use the standards for a minimum of six months before the survey, that surveyors have access to all data they need while on site, and that the organization sends CARF a quality improvement plan that addresses the surveyors’ recommendations within 90 days of accreditation. The new yearly quality report now will be the fourth condition of accreditation.
The new standards manuals have enhanced information on risk management plans and insurance packages (Criterion Nine, Standards 57 and 58), MacDonell says. "We wanted to move in this direction because so many providers are getting difficult allegations in these areas, and they need to learn to be better prepared to handle risk effectively," she says. "You have to stay focused on the fact that you’re there because of the people you serve, but the reality of running a rehab program is that it’s difficult some days to remember that. When you have a managed care company that’s not paying you, a personnel issue, or some other such issue, it detracts from the reason you’re in business. The standards bring you back to your purpose and serve as a gentle reminder to focus on your patients so that both of you can be truly successful."
Good corporate citizens get long-term results
Another new emphasis is an item added to Criterion Seven: Leadership that deals with corporate citizenship (Standard 43g). "We’ve always had standards on corporate responsibility and ethical codes of conduct, but we haven’t singled out the idea of corporate citizenship before," MacDonell says. "We want to see how the organization is performing in its community. If you’re going to be successful in meeting the needs of the community, you’ve got to know what those needs are."
CARF defines corporate citizenship as "an organization’s efforts, activities, and interest in integrating into, contributing to, and supporting the communities where it delivers services to better address the needs of the persons served." The standards manual lists several examples of these types of efforts, including educational events for schools on safety issues, active involvement in community organizations and service groups, and positions on local boards that address such issues as accessibility and housing.
"In a pediatric program, for example, if you’re not advocating for those individuals and pushing for long-term changes, then the environment they go home to won’t be supportive," MacDonell says. "If you can get that child well enough to go back to school but they can’t go to the park because there’s no disability access, then have you really accomplished your goal? Or if you can get someone back to work but they don’t have accessible transportation, then their life really hasn’t changed. Good corporate citizenship makes sure there’s a durability to what rehab providers do. Anyone can be successful in a protected environment, but it’s when the patients get back to the community that really counts."
Another change made under Criterion Nine: Financial Planning and Management could easily be missed but shouldn’t be, MacDonell says. "We added the word credible’ to the item [Standard 48] on preparing budgets with projections of revenues and expenditures," she says. "It’s one thing to present a budget during a CARF survey, and quite another to make it actually happen after we leave."
New items also have been added to the list of corporate responsibility efforts (Standard 43), including policies on waste, fraud, abuse, and other wrongdoing that include a "no reprisal" approach for personnel reporting and time frames for investigation, as well as demonstrated corporate citizenship.
CARF-ese’ removed from standards
Rest assured that the new standards should make things easier in the long run, says Bonnie Breit, a CARF surveyor and president of BRB Consulting in Media, PA. The new standards are presented in a more logical format, and much of the "CARF-ese" has been removed in favor of businesslike language that’s easier for a lay person to understand, she says.
"Looking at your business practices like this is going to keep you on the cutting edge," Breit says. "You need to be aware of the business side of delivering care. That’s one of the benefits of CARF accreditation and this particular new standards manual. Organizations know they should look at how they’re doing, but they’re not always clear on how they should do it. If you’re not doing the business piece, you’re not going to be here to deliver the clinical piece. The effort spent on the new standards speaks highly of CARF’s commitment to help organizations stay on the cutting edge so they can keep being here."