Standards

WASHINGTON — The 'gotcha' culture that sparked an exodus of HME providers from the Joint Commission on Accreditation of Health-care organizations (JCAHO) in recent years may be on the verge of extinction. JCAHO last month announced a complete re-engineering of the way it goes about accrediting healthcare organizations, including HME providers. Russ Massaro, MD, vice president of accreditation operations at JCAHO, said the changes are the most significant at JCAHO since 1994. "It's a 180-degree reversal of the paradigm from the past," said Massaro. The reengineering — presented by JCAHO as "Shared Visions - New Pathways" — does away with JCAHO's scoring system. It seeks consistency among its surveyors; and it adds a crucial new self-assessment process at the 18-month point of a three-year accreditation cycle. The new process will be implemented in January 2004, but already JCAHO-accredited providers are saying the accreditation culture has changed. "We just went through our triennial in the last two weeks, and I believe it was more interactive and less standard specific," said Hal Freehling, vice president of support services at O.E. Meyer in Sandusky, Ohio. "They were looking at how we are performing from the beginning — from taking an order, to delivering the equipment, to following up on that equipment." Historically, JCAHO surveys have earned a notorious reputation, so much so that companies such as Lincare, Pediatric Services of America and Walgreens, as well as scores of other HME providers have pulled up stakes in JCAHO's camp and beat a quick path to the competition. Much of that ire is a consequence of surveyor inconsistency. In the past, say providers, surveyor analysis seemed more peculiar to the individual surveyor than to the accrediting body they represented. "This new process specifically targets that," said Massaro. Starting last January, JCAHO surveyors were required to complete a first-ever surveyor certification exam by correctly answering 120 of 150 exam questions. Supervisors will conduct field observations and feedback reports will profile surveyor performance. Keeping surveyors from focusing on different things is part of what's gone into the reengineering, said Massaro. Now, JCAHO runs all of its pre-survey data through what he calls a "rules-based algorithm," known inside JCAHO as the PFP (priority focus process) which identifies the top four or five critical processes in a given organization. "Now any organization that looks like yours will have the exact same focus, and it won't be because we've asked individual surveyors to interpret but because we've run the data through the same machine, with the same rules. That is going to lend consistency," said Massaro. Since JCAHO will no longer trumpet scores, HME companies should no longer feel the anxiety that attends testing at the highest percentage levels. Scores won't be published, nor will providers who've had deficiencies and been made to idle for weeks or months in a conditional accreditation category. "In the future, no final decision will be rendered or accerditation category published in the public domain until you've had a chance to correct the deficiency found on site, within a 30-day period. It's a big difference," said Massaro. Perhaps the most interesting twist on the new JCAHO process is the 18-month assessment. At this point, providers will judge how they measure up to the standards and report that assessment — the good, the, bad and the ugly — to JCAHO. This new approach to maintaining accreditation has left some HME providers scratching their heads. Historically, providers have been loathe to let JCAHO know they had problem issues, especially when providers weren't quite sure what kind of a surveyor was going to show up on their doorstoop. Those memories don't die easy, and Dennis Trach, director of regulatory compliance at Associated Healthcare in Amherst, N.Y. says the self-assessment protocol won't be an easy sell to HME providers. "Most people are law-abiding but you don't walk into the police station and say I sped seven times yesterday," said Trach But Massaro says the self-assessment is penalty-free. The HME defines the problem and sends it electronically to JCAHO. A JCAHO standards interpretation specialist reviews the self-assessment, approves a corrective action plan and JCAHO then tracks the issue during the 12 months leading up to the next triennial. "The future accreditation process is to work together, to find and share things with us and try to fix them together in a continuos fashion," said Massaro. HME