The Medicare Hospital Certification System Needs Reform

HRD-79-37: Published: May 14, 1979. Publicly Released: May 14, 1979.

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The Department of Health, Education and Welfare (HEW) is required by law to certify that all hospitals participating in the Medicare program are providing quality care to patients. Hospitals accredited by the Joint Commission on Accreditation of Hospitals (JCAH) are automatically certified except for two requirements.

The certification system has problems caused by a limited capacity to measure the quality of hospital care, differences in standards used by HEW and JCAH, differences in how states and JCAH conduct surveys and apply standards, and ineffective monitoring of states' activities. HEW must improve its policy guidance and monitoring activities at all levels, including controls for discovering and correcting weaknesses in JCAH, the regional offices, and the states.

Matter for Congressional Consideration

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Matter: Congress should revitalize the Medicare certification system for hospitals by requiring HEW to contract with JCAH to conduct all certification surveys, use federal surveyors to survey nonaccredited hospitals and validate accredited hospitals, or significantly improve the existing system.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary, HEW, should: (1) regularly review and update the conditions of participation, making sure they are specific enough to enable surveyors to establish compliance or noncompliance; (2) define the relationship between Medicare conditions and JCAH standards, establishing equivalencies or waivers where requirements differ; (3) determine what constitutes compliance with the conditions; and (4) improve the accuracy of the computer system so it can be used to monitor certified and accredited hospitals.

    Agency Affected:

 

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