Sunday, September 11, 2011

Time to make Joint Commission surveys public

Can anyone doubt that the recent kerfuffle faced by Parkland Memorial Hospital in Dallas would have had a greater chance of being avoided if earlier reviews by the CMS-designee, the Joint Commission, would have been made public?  Yet, JC surveys are held in confidence.  This is a matter of federal law.

Currently, the results of hospital accreditation surveys cannot be accessed by the public under Section 1865 [42 U.S.C. 1395bb] (b) of the Social Security Act, which reads as follows:

"(b) The Secretary may not disclose any accreditation survey (other than a survey with respect to a home health agency) made and released to the Secretary by[615] the American Osteopathic Association[616] or any other national accreditation body, of an entity accredited by such body, except that the Secretary may disclose such a survey and information related to such a survey to the extent such survey and information relate to an enforcement action taken by the Secretary."

When I was CEO of a hospital, we voluntarily made our JC surveys public, posting them on our corporate website.  We felt that it was important for all staff in the hospital to have the chance to review the findings and act on them, and we also felt that public confidence in our hospital would be enhanced by this kind of transparency.  While this practice has spread somewhat, most hospitals still do not make their surveys public.

Recently over 50 of us patient advocates, led by Dr. Kevin T. Kavanagh of Health Watch USA, wrote to Senator Tom Harkin, Chairman U.S. Senate Committee on Health Education Labor & Pensions, to ask for a repeal of this provision of the law.  Here's an excerpt of the letter:

We believe it is in the public's interest to have all accreditation survey findings of The Joint Commission and other bodies accessible to the public. This includes initial survey findings as well as follow-up survey findings which takes place weeks later after remedial action may have been taken.

Hospitals have a choice. They may choose to be surveyed by state agencies in lieu of accreditation by The Joint Commission or other entities. Only a small minority of hospitals elect this option.

In your home state of Iowa, state accreditation surveys are performed by the Division of Health Facilities, Iowa Department of Inspections & Appeals. These survey results are available to the public. The survey results from The Joint Commission are not available to the public.

We believe that the public has a right to information irrespective of the entity that conducts the surveys. The present situation creates a double standard. It also raises the question as to why the federal government allows two different standards.

In comparable public services sectors such as public health and education, inspections of restaurants and performance of schools are transparent to the public. Hospitals should be held to the same standard. Their performance should no longer be shielded from the public.

Really, isn't it time?


Pat Mastors said...

Yes, really, it is.

You probably saw Parkland squeaked out of losing CMS funding:
The dual reality is that while there seem (or seemed) to be egregious problems at Parkland (and continue to be in the ER), the community by all accounts needs this facility for trauma and burn care. Cuts in funding would be devastating. Nothing is simple, is it?

Kudos to Kevin Kavanagh for crafting this letter and making it part of the national dialogue.

Anonymous said...

Perhaps you should speak to this business owner:


Anonymous said...

With the JC as CMS' deemed accreditation agency for approximately 80% of US hospitals, it can no longer afford to act like the management of a private club. The JC itself should be lobbying the government for repeal of this law. Any other position smacks of profiteering (from the lucrative fees it collects from member hospitals) and cronyism to an increasingly skeptical public.
And don't bother trotting out the old arguments about confidentiality promoting honesty from the member hospitals - Parkland alone gives the lie to that contention. Parkland is still convinced these are 'technical' deficiencies. Perhaps having their problems held up to outside public review earlier would have forced them out of their fantasy world.

nonlocal MD

Anonymous said...

Here! Here!

And if all reviews were public, we'd stop looking at these events and institutions as anomalies in the headlines. It would quickly change the landscape of conversation around patient harm and quality to be one of huge national public health significance. And I think that most communities - and boards of hospitals - would be shocked to learn how dangerous their favorite institutions may actually be.

If a superbug evolves in a hospital (it has), and migrates to the public sphere (it has), what is the responsibility of the JC? Who are they charged to protect? It is time for an examination of their incentives.