Review other posts submitted by your classmates. In your responses, respectfully disagree with the conclusions drawn by the original posters. What factors did you weigh differently than the original poster and why? What strikes you as particularly persuasive regarding when governments should retain or outsource accreditation?
Response post #1
Accreditation is a comprehensive evaluation process in which a health care organization’s systems, processes, and performance are examined by an impartial, external organization to ensure that it is conducting business in a manner that meets predetermined criteria and is consistent with national standards (Teitelbaum & Wilensky, 2017). The various organizations in the United States that perform accreditation establish standards for healthcare delivery. These agencies, such as the Public Health Accreditation Board (PHAD), The Joint Commission, and the Agency for Healthcare Research and Quality (AHRQ), to name a few, play essential roles in ensuring the quality of healthcare. Accreditation programs with meaningful quality measures help foster continuous quality improvement by health plans and are a necessary complement to rigorous state and federal regulation of health plans (Wickersham & Basey, 2016).
Accreditation bodies or entities evaluate and rate a wide variety of health care organizations, including care management companies, health insurance plans, pharmacy benefit managers, utilization review organizations, wellness organizations, and other health vendors, both in the commercial sphere and through government programs such as Medicare and Medicaid (Dunlap et al., 2016). Within the ACA, accreditation serves as a recognized component to states and state legislators to implement health reform and address health care issues. Many state laws already include accreditation standards for health care management, health care operations, and health information technology and pharmacy quality management activities as a quality assurance tool (Bauchner, Fontanarosa, & Thompson, 2015).
Later, for hospitals and other health care institutions, the federal government and states used private accreditation as evidence of compliance with Medicare conditions of participation and state licensure laws, respectively. In so doing, the government effectively delegated regulatory responsibility for assuring that health care institutions meet the requisite quality standards for participation in their respective programs. When government relies on private accreditors to perform this vital function, questions arise about whether all the legitimate interests of the public served by public health insurance programs are adequately protected and promoted (Bauchner et al., 2015).
By outsourcing, hospitals and health systems can alleviate the numerous, complex responsibilities of an understaffed, unqualified internal department. Instead, they can entrust the credentialing and privileging tasks to a qualified partner that uses improved and integrated processes and industry-leading best practices. Additionally, outsourcing can be an effective strategy for hospitals and health systems seeking to control spending while preparing for significant changes in their practitioner relationships (Jaafaripooyan, Agrizzi, & Akbari-Haghighi, 2011).
Types of factors that policymakers should consider when discussing whether to outsource accreditation to private accrediting bodies include the comprehensive and multidisciplinary nature of the assessment, the fit of the assessment method to the unique features of healthcare, the inclusion of improvement as a goal of the evaluation, and the use of highly trained surveyors with experience in healthcare (Bauchner et al., 2015). Outsourced accreditation could be evaluated in the following ways by assessing the impact of accreditation on the quality and safety of healthcare delivery, assessing the efficiency of accreditation tools and systems for providing feedback with reliable information both to the accreditation organizations as well as all key stakeholders, and by evaluating the impact on the capacity development of systems (Dunlap et al., 2016).
Accreditation has undeniably been an effective mechanism for protecting society to safeguard public access to quality and safe healthcare. Different stakeholders may rely on accreditation results in their decision-making. A growing number of state-run accreditation programs could allude to the increased reliance of governments on accreditation results to safeguard the public access to quality healthcare (Jaafaripooyan et al., 2011).
Bauchner, H., Fontanarosa, P. B., & Thompson, A. E. (2015). Professionalism, governance, and self-regulation of medicine. JAMA, 313(18), 1831-1836. doi:10.1001/jama.2015.4569
Dunlap, N. E., Ballard, D. J., Cherry, R. A., Dunagan, W. C., Ferniany, W., Hamilton, A. C., … & Sears, A. (2016). Observations from the field: Reporting quality metrics in health care. Retrieved from https://nam.edu/wp-content/uploads/2016/07/Observations-from-the-Field-Reporting-Quality-Metrics-in-Health-Care.pdf
Jaafaripooyan, E., Agrizzi, D., & Akbari-Haghighi, F. (2011). Healthcare accreditation systems: further perspectives on performance measures. International Journal for Quality in Health Care, 23(6), 645–656. doi: https://doi.org/10.1093/intqhc/mzr063
Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd ed.). Burlington, MA: Jones & Bartlett Learning
Wickersham, M. E., & Basey, S. (2016). Is accreditation sufficient? A case study and argument for transparency when government regulatory authority is delegated. Journal of Health and Human Services Administration, 39(2), 245. Retrieved from http://eds.a.ebscohost.com.ezproxy.snhu.edu/eds/pdfviewer/pdfviewer?vid=2&sid=004c1f57-51e7-4570-927e-2e9395ef4ddb%40sessionmgr4008
Response post # 2
Accreditation is a process of review from outside sources for organizations to demonstrate the ability to meet regulatory requirements and standards set forth (ACHC, n.d.). For example, one of the most well-known and sought after accreditations is Joint Commission, who is a globally recognized leader for healthcare accreditation performing unbiased assessments of patient care, quality and safety based on standards set by the Centers for Medicare and Medicaid Services (CMS) (The Joint Commission, 2020). Other accreditations include Agency for Healthcare Research and Quality (AHRQ), National Committee for Quality Assurance (NCQA), Nursing Care Center Accreditation (NCCA), and Healthcare Facilities Accreditation Program (HFAP) as just a few examples as there are a multitude of accreditation options depending on the healthcare organization and specialties. Accreditation essentially has two fundamental purposes: to assure the quality of care provided and aid in improving the organization. While accreditation is voluntary, this type of achievement sets forth a perception that the organization strives for greatness in safety and quality and can meet objectives for high-performing health care organizations through evidence-based criteria.
As a provision within the Affordable Care Act (ACA), requirements were set forth indicating all health plans offered through the insurance exchanges must be accredited with respect to performance on clinical quality measures, patient experience ratings, access to care, utilization, provider credentialing and network adequacy (National Conference of State Legislatures, 2017). Another provision added required the Secretary of Health and Human Services to recognize accrediting bodies as well as requiring all health plans to provide external review processes ensuring accreditation and compliance with standards in federal ACA and NAIC state models (National Conference of State Legislatures, 2017). Regardless of changes affected by the ACA, the government, both state and federal will continue to supplement oversight activities with data presented by private accredited reviews. That being said, accreditation acts as a supplement to government regulations and standards set by CMS, but also can serve as a substitute for public regulation. Areas such as higher education are accredited by private agencies as the government does not regulate accreditation for these entities, rather sources out to other appointed agents. On the contrary, Joint Commission hospital accreditation acts as an alternative to state certifications, using Medicare’s federal regulatory standards; therefore, JCAHO accreditation replaces Medicare certification as the facility is deemed to meet federal standards and eligible to participate in Medicare (Institute of Medicine, 2001).
Policy makers should consider a variety of factors when considering whether to outsource accreditation to private entities. Accreditation is a process that identifies best practices and promotes quality improvement strategies and evaluation of standards should be routinely analyzed and improved to keep up with current trends and best practices. In the commercial health insurance market, accreditation is generally used to comply with state requirements. In this case, policy makers should ensure whoever is responsible for the accreditation process is focusing resources on problematic areas, contributing unbiased evaluations and providing reputable feedback on accreditation processes and outcomes. Furthermore, when the government relies on outsourced accreditation agents, the legitimate interest of the public should be adequately protected and promoted with nothing to gain pending the outcomes of the survey. In other words, there should be no conflict of interest when deciding whether to outsource or not and whoever is providing the assessment should not have a conflict of interest with the organization, thus aiding in determining whether the accreditation can be observed from the government or another outsourced agency. This decision will provide safety to patient standards, hold the organization accountable for actions and give the public peace of mind that the survey results remain unskewed and unbiased.
ACHC. (n.d.). About accreditation. ACHC.org. https://www.achc.org/about-accreditation.html
Institute of Medicine. (2001). Preserving public trust: Accreditation and human research participant protection programs. National Academies Press. https://doi.org/10.17226/10085
The Joint Commission. (2020). Why the Joint Commission. Leading the Way to Zero | The Joint Commission. https://www.jointcommission.org/accreditation-and-certification/why-the-joint-commission/
National Conference of State Legislatures. (2017, January). Accreditation to approve health plans and providers. NCSL.org. https://www.ncsl.org/research/health/accreditation-to-approve-health-plans-and-provider.aspx