Value of hospital JCAH accreditation is questioned

For years, critics have questioned the value of voluntary accreditation of hospitals by the Joint Commission on Accreditation of Hospitals (JCAH).  The organization is created by, funded by, and governed by hospitals and merely encourages hospitals to comply with voluntary standards.  A book entitled the Great White Lie published more than a decade ago explained that the JCAH was essentially a toothless tiger that threatened sanctions only after a hospital was closed by the government.  In recent years, as the cost of health care has continued to  mushroom, federal and state governmental agencies have taken a closer look at the JCAH to assess whether its accreditation means anything at all:  most have concluded it means nothing, and have sought a more meaningful alternative.

The Fort Worth Star-Telegram published an article on September 8, 2008, detailing why the JCAH has fallen from favor among governmental regulators.  Among the problems listed were these:

1.  The agency is run by and funded by the hospitals themselves, and relies upon voluntary compliance and voluntary disclosure of information.  Dr. Sidney Wolfe,director of Public Citizen's Health Research group asked "What's the point of having a regulator that's a cheerleader over the institution they are supposed to be regulating."

Nearly the entire board of the JCAH is apparently composed of member hospital administrators and practitioners.

While the Centers for Disease Control report that almost 100,000 Americans die each year of so-called  nosocomial or hospital-acquired infections, the JCAH lists only 105 such "sentinel" events IN THIRTEEN YEARS.  tThere are many similar examples of inadequate self-reporting.  "If these sentinel events weren't so misleading to the public, it'd be laughable", commented Lisa McGiffert, senior policy analyst at Consumers Union, which publishes Consumer Reports.  "The public has this belief that someone else is watching and making sure that hospitals are safe, and they are mistaken.  Nobody is watching."

2.  The agency does not publish its reports and only "encourages"  inspection subjects to publish reports.  In  fact, in an age when the government wants to encourage informed consumer medical choices, none of the negative information gleaned by the JCAH sees the light of day.

3.  Several highly publicized institutional failures have come on the heels of JCAH inspection and approval (in some cases, its highest honor--the Gold Seal).  For example, it did not decertify the accreditation for the Drew Medical Medical Center in Los Angeles (to whom it had awarded a Gold Seal) until a year AFTER the Hospital was overwhelmed by bad publicity and negative government inspections.  The John Peter Smith Hospital in Forth Worth received a similar Gold Seal the year before an independent consultant documented pervasive life-threatening problems.

4.  The Office of the Inspector General of the Department of Health and Human Services issued a "scathing" report on the JCAH in 1999, describing its inspections as "superficial" and unlikely to uncover safety-related problems.  The American Nurses Association has also urged the government to change from "self-regulating, voluntary "peer-review" under the JCAH to true, effective regulation.

In the meantime, 88 percent of the nation's hospitals are regulated only by a puppet which they have created and fund, and which relies upon member entities to voluntarily seek higher quality standards in a private setting.  Given the importance of these issues and the cost we pay for health care, this antiquated approach is long-overdue for change.