Accreditation is a Key Differentiator in the Competitive Surgical Marketplace

As an owner/operator of an outpatient healthcare facility, accreditation of your center may be something you have put off, but this process can pay invaluable dividends. SurgiStrategies asked leaders within the three major accreditation agencies to share their insights:

• Michael Kulczycki is executive director of the Ambulatory Care Accreditation Program at The Joint Commission (TJC).
• Carolyn Kurtz is senior counsel and director of government/public affairs at the Accreditation Association for Ambulatory Health Care (AAAHC).
• Lawrence S. Reed, MD, a board-certified plastic surgeon in private practice at The Reed Center for Plastic Surgery in New York, is president of the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF).

What would you say to owners/operators of outpatient facilities who believe that accreditation won’t benefit their facility, either be cause they believe it is too costly or requires too much upfront labor for survey preparation?

Kulczycki (TJC): Owners and operators are looking for peace of mind that if their mother were to receive treatment locally at one of their ASCs, they would feel comfort at the level of quality and patient safety provided. This is increasingly a factor as more than one-third (37 percent) of all ASCs now are owned, managed or leased to chain firms, a number rising since 2006. This assurance of patient care is increasingly being provided by private accreditors, such as The Joint Commission (TJC) — particularly since ASCs can no longer reliably depend on the Medicare certification process administered by state certification agencies, which may resurvey an ASC facility every five or eight years. Even for owners/operators of ASCs at a local level, a surgeon may only practice at the ASC three to five times monthly. Accreditation can provide review by an outside evaluator to assure systems and processes are in place, contributing to risk management, prevention of infections, working alarms and devices related to fire and equipment safety, etc. As to the costs of accreditation, in travels around the country, I am frequently approached by owners/operators about the “high costs” of accreditation. I typically respond by asking what is their perception of the costs, and their answer is at least two times the actual fees. ASCs pay less than $10,000 for accreditation services from TJC, which covers their “all in” fees over the three-year accreditation period, including all surveyor travel, annual standards manuals, and no additional fees for applying or using the deemed status option available. This works out to less than $9 per day for the average ASC. And TJC is the only ambulatory accreditor that allows ASCs to pay these costs across the three years of accreditation services. As to the preparation for survey, many of TJC’s standards reflect the basic systems and processes in place at any well-run ASC. Quite often, organizations can successfully achieve accreditation within four to six months of expressing interest in the process. TJC also provides a number of resources to aid an ASCs preparation process, including free standards advice from experts in ambulatory care; a self-evaluation process as part of the extranet system for communicating with TJC; a fully electronic standards manual which is fully searchable and contains the standards only applicable for the ASC settings; and other print and educational resources from our affiliate, Joint Commission Resources.

Kurtz (AAAHC): The initial preparation and documentation required to become accredited can be time-consuming, however, most of our accredited organizations would agree that the long-standing results make it worthwhile. AAAHC standards are designed by healthcare professionals with extensive experience in the ambulatory arena, so our standards are relevant to the everyday provision of quality care for patients. Preparation for the accreditation survey introduces new policies and procedures that can reduce risk to both the patient and healthcare staff, and enhance the quality of care. During the AAAHC accreditation survey, organizations are reviewed by surveyors who are actively involved in ambulatory healthcare and who bring their expertise and knowledge of best practices to the organization. While the initial preparation may seem daunting, AAAHC often hears that accredited organizations not only achieve their goal of improving the standard of care for their patients, but also find additional benefits in achieving other organizational goals as a result of going through the AAAHC peer-based accreditation process.

Reed (AAAASF): Accreditation benefits facilities in ways even the most conscientious physician may never think about, which is at the heart of patient safety. Yes, accreditation represents a financial investment, but the benefits are improved patient safety. If you look at the statistics in terms of patient safety and infections, accredited facilities are far superior. Accreditation encourages you to practice a safer form of medicine, which is evidence-based and better for your patient. The fewer problems, complications and mortalities your facility has, that ultimately goes toward significant cost savings. In New York, it is mandatory for every physician’s office that uses moderate or heavy sedation to be accredited by one of the three agencies. There was an initial outcry amongst doctors against this additional expense and level of regulation, but many later told me unequivocably that they were glad they went through the accreditation process because they realized there were potential pitfalls and slippery slopes they didn’t recognize. It made them realize they should have had these drugs on hand, or they should have had better equipment, or had the assurance of better levels of sterility of instruments ... things they took for granted before accreditation. The truth is, doctors are businessmen. At the end of the day they have to pay their rent; doctors have to make a living, too. They’re being killed by malpractice. They have decreasing reimbursements and increasing costs, and that’s not a good business model. Accreditation is perceived as yet another burden, but how can a physician look the other way when patient safety is involved? Doctors must not skimp on patient safety. I think accreditation is important because it keeps patients safe, and eventually it improves your profitability, if only by keeping you out of the courts and away from expensive malpractice suits.

How specifically can accreditation of an outpatient facility serve as a quality indicator to highly discerning patients and potential physician partners? And can accreditation serve as an advantage in a competitive surgical market?

Kulczycki (TJC): ASC physician partners are typically practicing partly in hospital-based settings, and as such are familiar with the Gold Seal of Approval.™ In addition, payors across the country regularly use JC accreditation as a screen for participating in networks and often as a substitute for an onsite review. Currently, JC accreditation in ambulatory environments is recognized by 50-plus payors for over 140 settings. We also have a payor advocacy program that identifies and adds additional recognitions annually. In this era of consumer-directed healthcare, patients are increasingly researching and identifying comparative performance about healthcare providers. TJC provides a free service, “Quality Check,” to help patients identify if their provider is referring them to a JC-accredited facility. Quality Check is currently used by over 200,000 consumers monthly. All ASCs accredited by TJC receive a listing on the Quality Check Web site. TJC is the only ambulatory accreditor that has identified a linkage between accreditation and liability coverage by national providers. Recognition of accreditation by liability insurers is an additional value-added benefit of an organization’s commitment to quality and safety, and TJC has identified six providers who provide financial differences based on accreditation status. For more information, click HERE.

Kurtz (AAAHC): Patients are becoming better educated as to the quality of care they receive. Accreditation is often one of the first indicators a discerning patient will look for in choosing an ambulatory healthcare facility. Patients and potential physician partners know that AAAHC-accredited organizations have measured the quality of their services and performance and demonstrated their commitment to provide safe, high-quality services to patients.

Reed (AAAASF): Patients will — and should — ensure that their physician is board certified in a specialty, fully trained in the procedure he or she is performing, and that he/she makes sure the patient is medically ready for the surgery. I also think it’s important to make sure the physician is a member of his/her medical society and that they work at an accredited facility because the standards are much higher. These standards seem overwhelming to the physician at first, but the truth is, most facilities don’t have to change their physical plant, they just simply have to address a few issues, such as securing the right drugs and crash carts for resuscitation, having the right monitoring equipment, making sure that your staff are ACLS trained, etc. Yes, it costs money but how can you practice without it? Patients realize that in an accredited facility, standards are far more rigorous. At my center, we dot every “i” and cross every “t” because we won’t take chances with patient safety. We also give every patient a brochure that explains what accreditation means — they are reassured that I am not just some guy working in the dark.

With new quality reporting requirements this year, how does accreditation play a role in supporting these efforts toward upholding quality patient outcomes in ASCs?

Kulczycki (TJC): Analysis by TJC suggests that quality reporting requirements may not impact ASCs until 2010, with CMS release of proposed rules probably occurring in mid- to late 2009. ASCs that are accredited have an advantage once these performance reporting requirements in place, because these ASCs typically have systems and processes already in place to evaluate risks, identify data needs, collect and analyze data, and take action and change processes in response to data collected. As the ASC industry edges closer to this important step in improving quality of care through measurement reporting, TJC has also offered to the industry association an opportunity to learn from our 20-plus years of efforts in performance measurement reporting by hospitals and other healthcare providers. TJC president Mark Chassin, MD, reinforced this invitation in a meeting with ASC Association representatives earlier this year.

Kurtz (AAAHC): AAAHC-accredited organizations already understand clinical performance measurement and improvement from the accreditation process. In addition, the AAAHC established the AAAHC Institute in 1999 to provide opportunities for ambulatory healthcare organizations to participate in and learn about clinical performance measurement and improvement. The AAAHC Institute has conducted and reported on 42 performance measurement studies offering both AAAHC-accredited organizations and non-accredited organizations the opportunity to participate. The Institute is involved at the national level in efforts to develop the quality measures for which reporting will be required.

Reed (AAAASF): AAAASF is in the forefront of change because we have a very strong legislative division and we are the go-to group in most states that are considering mandatory accreditation. For example, AAAASF created all of the office-based standards for New York state. Some people think our standards are too rigorous, but I don’t think you can be too rigorous when it comes to patient safety.