Since the Affordable Care Act (ACA) came into force, healthcare providers have been under immense pressure to improve the quality of care that they offer. Among the steps that the providers are taking to comply with the provisions of this act include minimizing errors and reducing the cost of care. Seeking accreditation is yet another strategy that the providers have adopted as part of their efforts to improve quality. The Joint Commission has historically been the preferred accrediting body. It is important to note that there are other organizations which challenge providers to invest in quality improvement by conducting thorough evaluations of the operations and the quality of care that the providers deliver.
The role that accreditation plays in healthcare delivery cannot be overstated. Through accreditation, providers make it clear that they are committed to offering high quality services that satisfy standards and are in line with applicable legal guidelines (Bogh et al., 2017). As they seek to partner with accrediting organizations, it is critical for healthcare providers to ensure that these bodies satisfy the conditions that the Centers for Medicare and Medicaid Services (CMS) has outlined for participation in its programs. Among these conditions include the requirement that a provider must satisfy include securing sensitive and personal patient information, ensuring data accuracy, educate patients about their rights, protect patients against all forms of abuse, and seek patient consent (CMS, 2018). These provisions are designed to safeguard the interests of the patients. In addition to these requirements, the CMS also demands that providers must resolve patient complaints, involve duly registered nurses and other practitioners, conduct assessments by ensuring that services offered are aligned with patient goals, strengths and preferences, and offer high quality care, among many other conditions (CMS, 2018). These conditions are important as they challenge providers to work with accrediting agencies which understand the importance of the conditions.
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In the case study, it is noted that the hospital is looking to establish a partnership with a new accrediting agency and is ending its relationship with the Joint Commission. There are various agencies and programs that the hospital could consider. The National Committee for Quality Assurance (NCQA) is among the bodies that provide accrediting services. In addition to accrediting providers, this body also offers certification for such initiatives as disease management (“National Committee for Quality”, 2015). Furthermore, it collaborates with physicians to improve the quality of care. The NCQA is also involved in challenging providers to invest in the improved management of such conditions as Diabetes, cardiovascular diseases and back pain. What makes NCQA a strong candidate is the fact that its accreditation process focuses on all critical aspects of care. Patients, practitioners and providers all benefit from the accreditation process.
The Utilization Review Accreditation Commission (URAC) is another body involved in healthcare accreditation. In addition to the conventional accreditation, URAC also advises providers to place patients at the center of their operations (“About URAC”, n.d). Furthermore, this body considers the concerns of providers and encourages the adoption of sustainable and locally-sourced healthcare interventions. Additionally, URAC places focus on continuous quality improvement (“About URAC”, n.d). As is the case with NCQA, URAC also benefits the main stakeholders in the healthcare system. Patients receive improved care, practitioners have their voices heard, and providers improve their service delivery processes.
The third agency that the hospital can work with for accreditation is the Accreditation Commission for Healthcare (ACHC). What distinguishes this agency from other accrediting entities is the fact that it has received deeming authority from the CMS (“About Accreditation”, n.d). This means that this agency works with hospitals to ensure compliance with the requirements that the CMS has established for participation. The fact that it employs highly competent surveyors and helps hospitals to improve quality of care are other benefits that this organization presents to hospitals that seek its accreditation. This agency has also set up standards that allow providers to assess their performance in specific service areas. In addition to benefiting providers and practitioners, the accreditation process of this agency also presents positive outcomes for patients who enjoy improved care.
The discussion above has given focus to the benefits that patients, providers and practitioners will enjoy when the hospital chooses to work with the three accrediting agencies. As it contemplates on the accrediting agency to work with, the hospital should consider the costs. The main cost that will be incurred regardless of the agency selected involves exposing the hospital’s operations to scrutiny. This hospital will be forced to give up some control as it allows the selected accrediting agency to monitor and assess its operations to ensure that it meets the set standards and guidelines. Practitioners will share in meeting this cost as their operations and conduct will also be scrutinized. Higher fees are the main cost that patients are likely to incur. Suppose that as part of its efforts to obtain accreditation, the hospital institutes costly initiatives. It may decide to pass the costs onto its patients.
Above, three agencies that offer accreditation services have been identified. All of these agencies would be ideal partners for the hospital. However, it may be impossible for the hospital to seek accreditation from all the three agencies. It is therefore important to develop a rank. The conditions for participation outlined by the CMS serve as a criterion for determining the suitability of the three agencies. As noted earlier, focus on meeting the needs of patients and respecting their rights is among the key requirements that CSM demands that hospitals should comply with. As regard this requirement, all the three agencies are in compliance. This is because they all help hospitals to improve the quality of care that their patients receive. Given that it offers a wider range of services, URAC emerges as the best accrediting agency. ACHC occupies the second position since it has been authorized by the CMS to promote quality improvement. The third position is taken by NCQA. It should be noted that the hospital is not bound to necessarily work with URAC. It can join forces with any of the other agencies as they have a track record of commitment to quality care.
In conclusion, continuous quality improvement is a goal that many providers continue to strive to accomplish. The accreditation process is among the resources that facilitate the achievement of this goal. By applying for accreditation, hospitals remind themselves of the need to invest in quality care. There are various accrediting organizations whose endorsement hospitals could seek. As has been shown in the discussion, URAC is the best agency from which hospitals should apply for accreditation. As it embarks on the accreditation process, the hospital should be willing to take all necessary steps to demonstrate that its commitment to quality is unwavering.
References
About accreditation. (n.d). ACHC. Retrieved February 18, 2019 from https://www.achc.org/about-accreditation.html
About URAC. (n.d). URAC. Retrieved February 18, 2019 from https://www.urac.org/about-urac
Bogh, S. B., Falstie-Jensen, A. M., Hollnagel, E., Holst, R., Braithwaite, J., & Johnsen, S. P. (2017). Improvement in quality of hospital care during accreditation: A nationwide stepped-wedge study. International Journal for Quality in Health Care, 28 (6), 715-720.
Centers for Medicare and Medicaid Services (CMS). (2018). Home health agency (HHA) interpretive guidelines. CMS. Retrieved February 18, 2019 from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO18-25-HHA.pdf
National Committee for Quality Assurance (NCQA). (2015). Agency for Healthcare Research and Quality. Retrieved February 18, 2019 from https://www.ahrq.gov/professionals/quality-patient-safety/talkingquality/resources/initiatives/ncqa.html
