If you've worked in U.S. healthcare for any length of time, you've no doubt lived through a period of impending 'inspection' by the Joint Commission at your hospital or healthcare organization. Stress levels amongst all staff inevitably rise in the runup.
Everyone needs to look sharp, have their protocols down, and most importantly, know where to find organizational policy information if it's not available by quick memory retrieval.
One of the 800 lb. gorillas of the U.S. healthcare world, the JC (as it's known) audits, inspects, and accredits nearly twenty-one thousand U.S. healthcare enterprises.
I was always under the impression that the JC had a complete monopoly in its market—that is, if your healthcare organization wanted to be accredited (the vital 'seal of approval' for your organization's public relations and safety standards, but also key for reimbursement through CMS) then you had to play ball with them.
In 2012, one of the hospitals at which I worked decided to go in a different direction, choosing instead to work with the accrediting agency DNV, which has its origins in the world of Norwegian shipping. For real. As in, ocean liners need a ton of regulation and safety standards so that they don't run into each other and sink. We're always comparing healthcare to airlines, right? Maybe it's not such a big stretch after all.
Like most of my physician colleagues who lived through years of JC audits, we were a bit flabbergasted. "You mean the JC actually has competition?" As it turns out, the JC only controls a mere 80% of the market. Turns out it's only a 785 lb. gorilla.
Even though this whole issue is a little bit 'inside baseball," I wrote an essay about it for NPR. My reasoning was that there's always value in questioning monolithic conformity. And I had been really surprised to learn that there was actually competition to the JC.
Now comes a study in BMJ, led by Harvard researcher Ashish Jha. The study compared more than 4,000 U.S. hospitals and the outcomes generated for 15 common medical conditions and six common surgical conditions between the years 2014-2017 in a Medicare population data set of more than four million patients.
What did the study find? Interestingly, there was no statistical difference in 30-day mortality or readmission rates in the patients that were seen at JC-accredited hospitals vs. those at hospitals accredited by 'other independent organizations.' There was a slight but not statistically significant benefit in mortality and readmission rates for JC-accreditation vs. hospitals reviewed and accredited by state survey agencies.
The study raises the reasonable question: If there aren't patient outcome differences in hospitals accredited by JC vs. those accredited by either state review (government) or other independent agencies (other privates), then should the JC enjoy such a massive industry dominance?
After all, many healthcare leaders cite the JC's regulatory and inspection processes as burdensome and argue that the whole preparation game and citation-fixing business is expensive and distracting from the core mission of hospitals: taking care of patients.
Other JC critics cite the fact that the organization is less than optimally transparent, electing to keep its inspection reports private, despite the fact that many healthcare enterprises flagged for violations are able to stay accredited.
Congress has even begun an investigation into possible lax oversight.
Apparently, Jha's work has struck a chord, as there was some notable media coverage about the BMJ piece. For one, the Wall Street Journal ran a story on it (kept behind its paywall), noting that hospitals pay on average $18,000 for an inspection and annual fees of up to $37,000 to the Commission.
Cardiologist and prolific blogger John Mandrola also wrote an opinion piece titled "Joint Commission Accreditation: Mission Not Accomplished." In this piece, Mandrola compares JC accreditation to medications or surgeries that fail to live up to evidence-based standards and subsequently fall out of practice. He concludes the piece: "If the JC's brand of accreditation can't show benefit then it too needs to be de-adopted."
Having learned that there's an emerging marketplace of agencies equipped to inspect hospitals and healthcare enterprises, it seems there's an opportunity here: Perhaps the agency offering the greatest value in terms of cost, reporting, and public accountability will triumph against a behemoth that seems too complacent and entrenched in its ways.
Dr. John Henning Schumann is an internist and a 2018–2019 Doximity Author.