Home Health & Hospice Week

HHAs protest revocation of cooperative accreditation agreement with CHAP.

If you're a hospital-based provider accredited by the Community Health Accreditation Program, you're in for a big change.

That's because the Joint Commission on Accreditation of Healthcare Organizations has revised its cooperative accreditation agreement criteria.

The cooperative agreements with other nationally recognized accrediting bodies "reduce the cost and duplication of survey and inspection activity experienced by hospitals and other health care organizations," Oakbrook Terrace, IL-based JCAHO says in a May 2005 newsletter.

But the Joint Commission has tightened up its criteria for the cooperative agreements, explains Mark Crafton, JCAHO executive director for state and external relations. It now requires cooperative partners to accredit at least 100 organizations that are currently components of a JCAHO-accredited organization.

JCAHO made the change because it was expending a lot of resources to keep up with the cooperative agreements, Crafton tells Eli.
 
For example: The accrediting body had to monitor new standards for both organizations to make sure CHAP-accredited agencies still met JCAHO requirements. The Joint Commission also had to continually observe CHAP surveyor training, including conducting "observation surveys" of CHAP surveys, to maintain the agreement, Crafton says.

JCAHO's Board of Directors decided that if fewer than 100 of its 4,000 hospital members were using a cooperative agreement, it wasn't worth keeping up with it. "We were troubled that fewer than 20 hospitals were taking advantage of the cooperative agreement with CHAP," Crafton says.

The result: The change in JCAHO's criteria means providers accredited by smaller organizations that don't meet the 100-organization quota will have to switch back to JCAHO accreditation.

The timeline: JCAHO sent CHAP and one other accreditor of ambulatory organizations letters in 2005 saying their cooperative agreements would expire at the end of that year, Crafton says. JCAHO retained cooperative agreements with two laboratory accrediting bodies that exceed the 100-organization limit.

But as a courtesy to accredited hospitals, JCAHO is allowing those hospitals' HHAs to keep their CHAP accreditation until it expires, Crafton notes. When the agencies are up for a re-survey, they must obtain it through JCAHO. That means agencies will be making the switch in 2006 and even into 2007 if they were accredited shortly before the 2005 expiration of the cooperative agreement.

Hospital-based agencies may choose to continue CHAP accreditation on top of JCAHO accreditation, Crafton offers.

HHAs Incur Extra Costs

CHAP-accredited agencies aren't happy about the policy change, says Gene Tischer with the Associated Home Health Industries of Florida. Many are just now finding out about it due to their three-year accreditation cycles.

The change means years of work will go out the window, complains one hospital-based HHA that requested anonymity.

This agency, which was previously accredited by JCAHO in the 1990s, switched to CHAP accreditation because it was more cost effective and more focused on the community versus institutional setting, its administrator tells Eli.

The agency has been preparing for its next CHAP survey for more than two years, but now it's "starting from scratch again" to gear up for a JCAHO survey instead. "It's not cost effective," the administrator criticizes.

Another agency was told by its hospital parent only two months beforehand that it would have to be surveyed by JCAHO instead of CHAP, its administrator tells Eli. The agency had switched to CHAP accreditation in 2003.

Getting the message: JCAHO informed providers of the change in a May 2005 newsletter but didn't include specific information on which accrediting bodies would be excluded under the new policy.

In December 2005, JCAHO sent letters to hospitals with home care units accredited by CHAP, notifying them of the change, Crafton says. The accrediting body hasn't heard any complaints about the policy from its members. "It's been very quiet," Crafton tells Eli.

Justice Department May Get Involved

Tischer reports that the Department of Justice is looking into an anti-trust complaint filed against JCAHO over the policy change. The HHAs have spoken with DOJ officials in confidence about the matter, they tell Eli.

But a DOJ spokesperson can't confirm that an anti-trust complaint was filed. JCAHO spokesperson Charlene Hill says the Joint Commission has received no official notification of a complaint from the DOJ.

CHAP officials didn't respond to requests for comment for this story.

Rest assured: Providers that contract with JCAHO-accredited hospitals and their components don't have to worry about the cooperative agreement expiring, Crafton says. The agreements don't affect the standards for subcontracting that are contained in JCAHO manuals.