- A new Harvard University study casts doubt on the benefits of U.S. hospital accreditation by independent organizations.
- Researchers looked at patient outcomes at 4,400 U.S. hospitals, 3,337 of which were accredited by the Joint Commission and 1,063 that underwent state-based review between 2014 and 2017. The study included about 4.2 million patients aged 65 and older who were admitted for 15 common medical and six common surgical conditions, as well as patients who completed the HCAHPS patient satisfaction survey.
- While patients treated at accredited hospitals had slightly lower 30-day mortality rates than patients at state-reviewed hospitals (10.2% versus 10.6%), mortality rates for the surgical conditions were identical (2.4% versus 2.4%). Readmission rates for the medical conditions were significantly lower at accredited hospitals (22.4% versus 23.2%), but were slightly higher for the surgical conditions (15.9% versus 15.6%). The study was published online by BMJ.
To ensure a high level of quality care, CMS requires that all hospitals that participate in Medicare be accredited by a federally approved accrediting organization or undergo review by a state survey agency. About three-fourths of participating hospitals have chosen accrediting organizations, powering a multimillion-dollar industry, according to the study. The Joint Commission commands about 80% of that market.
The Joint Commission has been credited with spurring improvements in patient care and safety by holding hospitals to a high standard and raising awareness of issues like alarm fatigue, which can lead to medical errors. However, a Wall Street Journal investigation in 2017 found the organization rarely revokes or alters accreditation of hospitals singled out for safety violations by state or federal inspectors.
This study suggests that what's held up as the gold standard for hospital quality may not be as meaningful as industry and the public would like to believe.
It could have important implications for healthcare policy.
"Hospital accreditation is a central element of the quality strategy for many countries and is thought to be an important component of maintaining quality and safety of care delivered," the researchers write. "However, given the minimal benefit seen with accreditation in this study, it raises the question of whether our national efforts need to emphasize accreditation as much as they do."
They add: "If we continue to use accreditation — and spend the substantial sums of money they require — then we should consider substantially rethinking our accreditation process. Given the resources that accreditation requires, ensuring that it leads to better care seems to be a minimum goal of the process."
The study comes as CMS is changing up some of its oversight of hospital accrediting bodies, including making more information available to consumers online and piloting direct observation of surveys in lieu of state validation visits. Last year, the agency dropped plans to make public reports from private accreditors, citing concerns it could be seen as an attempt to skirt federal law barring release of third-party audit results.