To be or not to be accredited...that is the question...
that many home care and hospice organizations are exploring.
Should a home care or hospice organization be accredited in the new millennium?
The changes and complexity of issues facing the home care industry today are unprecedented. In these days of cost containment, reduced levels of reimbursement, and trying to do more with less, the issue of whether an accredited organization realizes the benefits of accreditation (e.g., financial, operational, and clinical) versus the cost of maintaining accreditation (e.g., direct and indirect) is critical and complex.
Simply put, many home care and hospice organizations can't afford the cost of becoming accredited or maintaining their accreditation. FIGURE
Accreditation Cost Versus Value
Regardless of which accrediting body a home care or hospice organization chooses to survey their organization or grant them the "Seal of Approval," there will be a direct cost to the organization in terms of application fees, survey fee, etc.
One of the accrediting bodies-The Joint Commission on Accreditation of Healthcare Organization-has recently instituted a mandatory data reporting system that will require larger home care organizations to submit data to a listed performance measurement system. This data-driven approach to accreditation (ORYX) is a forward thinking, progressive approach to monitoring a home care organization's performance in between onsite surveys.
This new evolution in accreditation focuses attention on the actual results of care provided versus compliance with standards. However, some Joint Commission-accredited home care or hospice organizations must incur an additional cost to submit their data to a listed performance measurement system.
The cost to submit data to a listed performance measurement system can vary from several hundred dollars per year to thousands of dollars per year. Added to that figure is the staff's time to collect, aggregate, and submit the data to the listed performance measurement system.
These new accreditation requirements come at a time when Medicare-certified home health agencies must collect OASIS data and submit this data to their state department of health. The same data that is collected to meet Medicare's requirements can be used again to submit to the listed performance measurement systems for the Joint Commission's use. However, a Medicare-certified home health agency must still incur the cost of contracting with a listed performance measurement system that will submit their data to the Joint Commission for ongoing review.
Currently, the Joint Commission is the only voluntary accrediting body that requires data be collected and submitted externally to a listed performance measurement system. Although the Joint Commission may be the largest accrediting body, it is not the "only game in town." Several other reputable accrediting bodies have similar home care standards and survey processes.
Accreditation Options
Because of additional Joint Commission accreditation requirements (i.e., ORYX) and its related costs, many home care and hospice organizations are exploring accreditation options with other voluntary accrediting bodies. These options are now available to Joint Commission-accredited hospitals or other healthcare providers that have hospital-based or affiliated home care or hospice organizations within their corporate structure.
Previously, a home care organization that was hospital-based had to be accredited by the Joint Commission because of the Joint Commission's tailored survey policy. The tailored survey policy has not changed; however, the home care department now has the choice of having the Joint Commission or the Community Health Accreditation Program (CHAP) survey their home care or hospice organization. The Joint Commission now recognizes CHAP accreditation as meeting the Joint Commission's home care accreditation standards. For example, the Joint Commission could survey the hospital and CHAP could survey the home care department and the hospital would have met the intent of the Joint Commission's tailored survey policy. This new focus on collaboration and the reduction of duplicative external review activities (if the organization wants to be accredited by CHAP) has resulted in choices for accreditation.
The Future of Accreditation
Even with the additional financial and operational pressures on home care and hospice organizations today, the concept of accreditation will remain strong well into the new millennium. The number of patients who will need home care and hospice services is projected to grow in the next decade and beyond.
Managed care organizations and other third-party payers will continue to need some assurance that their healthcare dollars are being spent wisely and that the patients are receiving care from a "quality" provider. Home care and hospice organizations will still need the "Seal of Approval" that accreditation brings to be awarded some contracts with managed care providers and other third-party payers.
From personal experience, accredited home care and hospice organizations overall provide quality patient care. Just because a provider is not accredited does not mean that they provide substandard care or that the quality of their patient care does not meet or exceed that of an accredited provider.
Until some other method is established to objectively evaluate the quality of the care provided, accreditation is here to stay and the home care nurse plays an ever-important role. The cost and value of accreditation is a complex issue and one that will continue to be discussed and evaluated well into the new millennium.