Joint Commission Snubbed

This past week, for this health care provider, the unthinkable happened: a hospital rebelled,  and refused further accreditation review by the long-dominant and supremely influential arbiter of hospitals and their national rankings. The Joint Commission for the Accreditation of Healthcare Organizations is, as far as I know, an independent organization that has been around since before I ever dreamed of becoming a physician. To say any more about its history, development, and evolution would reveal my ignorance unless I scurried off during the writing of this post and did some hours of Internet search engine based research…

The story line is that the state of South Dakota has taken the unprecedented stand of declining having the Joint Commission to review and help the state reinstate the accreditation for the state psychiatric hospital of South Dakota!

The “Joint Commission,” or “JACHO” [pronounced Jay-coh] as it is called by all in the various healthcare fields reigns supreme and that is no exaggeration. It typically conducts every three reviews of all hospitals in this country, private and public, hospital clinics, outpatient surgery centers, dialysis centers and on and on. My hospital where I work is gearing up for its JCAHCO review later this year and we are all, top to bottom, brushing up on policies, emergency procedures, taking care with our documentation and generally staying on our toes we ready ourselves for the review. Everyone dreads them as the ‘reviewees’ never know what the ‘reviewers’ are going to emphasize in their on-site tours, chart reviews, interview/grillings of any hapless employee or health care provider that gets snagged for the equivalent of a high school or college unannounced pop test in math. On a lighter note, the first JCAHCO review that I participated in decades ago as a senior staffer, glumly and apprehensively having drawn the assignment to usher/escort the psychiatric review team around an ancient state hospital campus and its many buildings, experienced a unique event which traumatized me almost as much as the reviewer.

On a lighter note, the first JCAHCO review that I participated in decades ago as a senior staffer, glumly and apprehensively having drawn the assignment to usher/escort the psychiatric review team around an ancient state hospital campus and its many buildings, experienced a unique event which traumatized me almost as much as the reviewer. In the bowels said old stately hospital, I was escorting a somewhat older psychiatric lady reviewer, along with my hospital child psychiatry director, down a back stairway. It had guardrails, nice scuff surfaced steps to prevent slips and such. In spite of all our safeguards, this lady reviewer was going too fast down the stairs, fell…I can remember the helpless, aghast, horrible feeling I had as I reached for her in front of me and…..missed. The lady reviewer ended up having a fractured ankle which was immediately obviously after she virtually splattered on the stairs landing. My director and I were just beside ourselves. We immediately both realized it would take many minutes for the emergency team to get to us on the stairs, and take her to the nearest medical center ER almost 20 miles away. We were able to stabilize her ankle with the hospital’s “EMS” on call crew, give her morphine as she was in acute pain, to say the least. Then after the ambulance left with lights flashing, siren wailing and the local NASCAR wannabee driver lead footing it to Duke in Durham down the Interstate, we turned to each other with the same illogical but unavoidable dread that our Joint Commission on-site review had just been screwed and we were in big trouble, i.e., the hospital would lose accreditation forthwith for safety violations or something like that. Later, we learned by receipt of an official letter from the JCAHCO headquarters, that the completion of the site review would be accomplished in a few months’ time. That news filled us with dread. Some of the hospital wags, myself included, joked about putting tacky glue or something on all the steps of the various stairwells to prevent another reviewer fall and fracture. All our fears were for naught. The same older but not quite elderly lady psychiatric reviewer showed up, and apologized for her fall and stated that she had wished to heal and come back and was determined to finish her assignment. She was very gracious and professional but the remainder of our site review was every bit as thorough as one would expect. But we passed.

Accreditation is very important to hospitals. When a hospital is dis-accredited, it usually loses federal funding such as Medicare and Medicaid dollars. This has been known to bankrupt some smaller hospitals that are not richly capitalized by large wealthy multi-hospital chains. Sometimes billing irregularities and other shady or shoddy practices are revealed and are in the modern vernacular, “very bad PR,” that can stain a hospital’s public reputation for long periods of time. Doctors and practice groups can pull out, disaffiliate and give up their privileges, switch hospitals and cost defrocked hospitals much “business,” as after all, doctors still are the prime referrals portals for patients to hospitals. THe Joint does provide very detailed lists of out of compliance issues and gives hospitals every opportunity to correct them, and often set timetables for so doing, and schedule return site reviews in timely intervals as it is often in no one’s interest to have a hospital crippled and crimped in its ability to render ongoing routine and emergent health care to an area anywhere.

But the news out of South Dakota in the above referenced and linked article is almost nothing short of astounding. I may be forgetting instances where hospitals have refused Joint Commission surveys and accreditation but in racking my brain and memory since coming across this article, I can NOT think of a single instance in my 40 years or so of practice. None. Nada. I also am dumbfounded by this event. I rack it up perhaps to the West’s penchant for engaging in state’s rights like the grazing squabbles in western states with the federal parks lands and such. In any case, the quote that struck me was this: “State leaders are resisting, though, holding that self-monitoring based on compliance with federal oversight is sufficient and that independent accreditation is both too expensive and redundant.”

What if oversight of airlines’ engine maintenance were done away with? What if sewage treatment facilities all over this country were permitted to set their own standards and practices? Some would be honest and honorable and maintain good and safe practices, but what happened in Flint Michigan where money was saved, substandard practices were instituted city wide and now lead poisoning is endemic if you drink the water, does not inspire confidence.

This story of South Dakota’s stance of refusing Joint Commission review of its state hospital bears watching and I for one, do not think this will be a happily ever after story.



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