Is The Joint Commission Too Conflicted?

Continued pressure on The Joint Commission (TJC) is calling into question whether or not the non-profit organization best known for its hospital accreditation services is too conflicted to provide high quality accreditation surveys. The Centers for Medicare and Medicaid Services (CMS) is weighing a decision to allow accreditation organizations that also have consulting arms to continue to provide accreditation services on its behalf.

As part of the inquiry, CMS is requesting the TJC and the other major accreditation organizations with consulting arms to provide information on how they sell consulting services to hospitals and how the benefit financially from these transactions. As this article by Maria Castellucci at Modern Healthcare notes:

“The hospital accreditation industry has been under heightened scrutiny since last year when an investigation from the Wall Street Journal found that the Joint Commission, which accredits nearly 80% of U.S. hospitals, rarely pulls accreditation for providers even when violations of Medicare requirements are found. The paper found that just 1% of facilities not in compliance in 2014 lost accreditation.

The CMS has faced pressure to address the concerns that the Joint Commission and other accrediting agencies engage in conflicts of interest by acting as both an enforcer of Medicare rules for hospital participation while taking on hospitals as clients to improve their performance. In its annual report to Congress in October, the CMS announced it would publicly post quality-of-care deficiency findings from surveys at facilities accredited by such organizations. It would also provide a list of providers determined by the CMS to be out of compliance.

The Joint Commission’s not-for-profit consultancy arm, called Joint Commission Resources, offers a substantial income stream for the organization. In 2016, Joint Commission Resources reported more than $6 million in profit on revenue of $63.5 million, according to its Internal Revenue Service Form 990 on The Joint Commission’s accreditation division reported $10.6 million of profit on revenue of $164 million to the IRS in 2016.

Maureen Lyons, a spokeswoman for the Joint Commission, said the commission is currently reviewing the CMS’ request for information. She added that its consultancy division, Joint Commission Resources, is separate from its accreditation division.

“The Joint Commission recognizes the importance of assuring the integrity of the accreditation process, which we accomplish by prohibiting any sharing of information about consulting services for individual organizations with anyone involved in accreditation … The Joint Commission enterprise has long-standing firewall policies, practices and procedures in place that assure that this goal is achieved,” Lyons said.

In an interview last year with Modern Healthcare, Joint Commission CEO Dr. Mark Chassin defended its tactics, arguing it’s in the public’s interest for the Joint Commission to help organizations with deficiencies improve. “If we abandon them, nobody’s going to help them improve and then the likely event is the organization closes, and access gets to be a problem for a lot of communities,” he said.

The CMS already requires accreditors to disclose its policies and procedures to avoid conflicts of interest, but the agency said, “we are seeking ways to enhance this oversight and review process.”

Along with information about the consultancy services accreditors offer, the CMS would also like them to provide how their revenue and operations may be affected if the CMS were to prohibit consulting services. “We are specifically looking for cost impacts, detailed accounting, and potential business risks for accrediting organizations,” the CMS said.”

Read the entire article here: CMS probes Joint Commission and other accreditors on conflicts of interest

One possible result of this probe may be that hospital inspection reports will be made public in order to give additional information to consumers regarding their choice of healthcare providers. Is your hospital ready for your inspection reports to be made public? To prepare, hospitals have to make sure that they are following all of their detailed processes all of the time. Any breakdown in your processes would be made public via an inspection report, putting your hospital’s reputation and finances at risk. Consider automation tools that help track the processes that The Joint Commission and other accreditation agencies focus on during their inspections. Systems such as iRIScope and iRISecure have been developed to ensure that processes and protocols are being followed since your managers can’t watch over every step of the way.