WSJ: Hospitals often retain accreditation despite safety violations
- The Joint Commission accredits nearly 80% of U.S. hospitals, but rarely revokes or alters accreditation when state or federal inspectors identify safety violations, The Wall Street Journal reported.
- According to a Journal analysis of hundreds of inspection reports, about 350 hospitals maintained accreditation in 2014 despite Medicare deviations, and more than a third of those had further violations in 2015 and 2016.
- In one case, the Joint Commission allowed Cooley Dickinson Hospital in Northampton, Mass., to continue claiming full accreditation despite being out of compliance with Medicare safety requirements. CMS had threatened to cut off Medicare funding after a pregnant woman with pre-eclampsia died when she wasn't treated for high blood pressure, and two infants died six weeks apart — all during late 2013 and early 2014.
Mark Chassin, president and chief executive of the Joint Commission, told the Journal the organization’s aim is to prevent problems rather than punish hospitals by withdrawing accreditation. Sen. Chuck Grassley (R-Iowa) has promised to look into ways to improve the system, the newspaper says.
Many people look for Joint Commission accreditation as a sign that a hospital has high standards of patient care and safety. If a hospital is out of compliance with regulatory requirements but still carries the Joint Commission seal of approval, patients may not be aware of potential risks.
Hospitals have often been at odds with government agencies and the public when it comes to balancing concerns of safety with those of privacy. To the dismay of some, CMS dropped plans to make reports by public healthcare accreditors publicin its 2018 patient payment final rule. The agency had proposed that all accreditors publicly report findings from hospital inspections to ensure patients know of problems, but withdrew the plan because federal law bars agencies from revealing third-party audit results.
Last month, United Medical Center refused to address safety concerns and reports of dangerous staff errors that prompted District of Columbia officials to close the hospital's obstetrics ward. Often the disagreement hinges on the level of detail. The American Hospital Association says it supports making hospital quality data public, but not necessarily detailed inspection reports that the public may not easily understand.
Still, the move toward value-based care has often included a push toward more transparency, and that has spurred some healthcare organizations to publish patient feedback — both praise and complaints. Geisinger, for example, began making patient reviews available to its physician network in mid-2015. The health system began airing the data for all to see later that year. Greg Burke, chief patient experience officer at Geisinger, told Healthcare Dive in November patient stories make a greater impression on clinicians than patient survey data, though.
As the examples of Cooley Dickinson Hospital and United Medical Center show, hospital quality issues can be life and death matters. According to a study in PLOS One, patients admitted to low-performing hospitals are three times more likely to die and 13 times more likely to experience complications than patients in high-performing facilities. Some of the best performing hospitals served low-income and minority populations, while some of the worst performers served high-income, white communities. The results pointed to the need for greater transparency on quality in healthcare.
While problems persist, programs like CMS’ hospital star rating system have focused a beam on quality. A November 2016 Joint Commission report cited significant strides in hospital quality and safety, noting so much improvement that 20 accountability measures had been retired, reducing to 29 the number the group tracks. The report detailed the results of more than 3,300 Joint Commission-accredited hospitals’ 2015 performance on individual measures of patient care.
- The Wall Street Journal Hospital Watchdog Gives Seal of Approval, Even After Problems Emerge