# 1 HOSPITAL ACCREDITATION AND THE ROLE OF THE CONSUMER

FALL 1973

This groundbreaking issue set the tone for the following Quarterly issues on this and related subjects. It started with simple information about changes in federal which impacted on accreditation policies and practices. Then it detailed those changes and the confidential nature of the interrelationship of the hospitals, JCAH and the federal government Department of Health, Education and Welfare (HEW and now HHS). But the piece de resistance was the new opportunity for consumers to contact the Secretary of HEW to voice concerns about the nature and quality of care provided by any hospital. Based on the Secretary’s decision, the local state certification/licensing authority, usually a state health department, would be required to conduct its own survey of a hospital. This provided a limited balance against the monopoly of the JCAH, a private sector and provider dominated and owned organization, to conduct accreditation surveys for a hospital to become a Participating Provider eligible for Medicare payments.

This Quarterly described how consumers could participate in accreditation by (1) writing to the Secretary, HEW and (2) requesting a Public Information Interview (PII). Letters to HEW as described could trigger a state survey using state standards. Requests for a PII required JCAH to schedule a meeting where the public and consumers may comment about the quality of care and violations or deficiencies related to JCAH standards. JCAH staff then was notified of the consumer statements.

The problem pointed to in this issue is the confidentiality of all JCAH, state agency findings and communications. As Don said at the time, “The public pays and is denied access to data to make informed personal decisions or to know how the public money is spent.” This Quarterly also mentioned that JCAH standards could be requested by the public. JCAH would then bill the requesting party a fee. This Quarterly mentioned that the JCAH surveys were scheduled in advance and the schedule was available to the public on request. A list of New York area hospitals scheduled for surveys for upcoming months was included.

Disclosure now referred to as transparency is a hot button in this century. Efforts to reveal measurement of quality, conflicts and efficacy of payments were resisted and only indirectly and inconsistently successful. Based on public and payer outcries and as a matter of good taste and public relations, transparency is now advocated and accepted even when not legally required by many recent state laws as well as in the federal Affordable Care Act (ACA). But disclosure made voluntarily can be honest or scripted. Transparency unfortunately has become another tool to convince vulnerable public officials and individual consumers to not demand full disclosure as a matter of law which simultaneously blunts any effective enforcement leading to substantial penalties.

The JCAH and the New York State agencies responsible for accreditation did not review individual records to evaluate the appropriateness and quality of the medical care received by patients. JCAH surveys, findings and follow-up were predicated on collegial exchanges of information based on standards affecting general operations, policies and procedures. New York State surveyors followed violations of laws and regulations based on those laws. Since the privacy of a patient’s medical and mental conditions and the primacy of the physician-patient relationship were sacrosanct, State agencies focused on building codes and general regulations. JCAH and New York State surveyors therefore were necessarily directed away for the quality of care. This deficiency was corrected by the development under federal laws which called for doctor controlled agencies in each state to evaluate individual medical care received. The first new entity was the New York State Professional Review Organization (PROs) which became Independent Professional Review Organizations or IPROs. The findings of each were confidential.