Health Care:

Hospitals With Quality-of-Care Problems Need Closer Monitoring

HRD-91-40: Published: May 9, 1991. Publicly Released: May 9, 1991.

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Pursuant to a congressional request, GAO examined the adequacy of federal oversight of the Joint Commission on Accreditation of Healthcare Organizations' accreditation activities in hospitals serving Medicare patients.

GAO found that: (1) effective June 19, 1990, the Department of Health and Human Services (HHS) had access to data relating to Joint Commission surveys of hospitals serving Medicare patients, regardless of whether the Health Care Financing Administration (HCFA) conducted a survey; (2) once every 3 years, the Joint Commission surveyed hospitals that seek its accreditation; (3) HCFA considered hospitals that did not comply with one or more Medicare participation conditions to be susceptible to providing poor-quality care, and subject to termination from the Medicare program if compliance is not achieved within a specific period; (4) in nonaccredited hospitals, HCFA regional office review teams found that state agency surveys did not consistently identify Medicare conditions with which hospitals did not comply; and (5) to effectively assess the Commission's ability to identify hospitals that are not complying with Medicare requirements, HCFA must be able to establish a direct relationship between its conditions of participation and the Commission's standards.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: According to HCFA officials, JCAHO has begun to annotate its survey reports to identify, using the crosswalk, the HCFA COP that are not being complied with.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to continue to work with the Joint Commission to develop a crosswalk between Medicare conditions and Commission standards. Once the crosswalk is completed to the satisfaction of HCFA and the Commission, HCFA should request the Commission to annotate its survey reports to identify standards, required characteristics, and elements that are not being complied with that relate to specific Medicare requirements.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: According to HCFA officials, HCFA is monitoring JCAHO follow-up activities and, when necessary, will intercede to ensure that proper action is taken by hospitals.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to closely monitor the Joint Commission's follow-up of hospital efforts to correct deficiencies that it has found to relate to Medicare conditions of participation and, where necessary, intercede to assure that the hospital takes timely corrective action. This includes conditionally accredited hospitals and those receiving an accreditation with Type I recommendations.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Implemented

    Comments: The percentage used by HCFA is 1 percent. HCFA regional offices followup on the causes of any differences that are identified between federal and state findings.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to establish a minimum number or percentage of monitoring surveys that must be conducted by federal personnel in nonaccredited hospitals and follow up on the causes of any differences that are identified between federal and state agency survey findings.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed - Implemented

    Comments: HCFA regions were given some flexibility for followup because problems vary by region. However, a history of noncompliance is a major reason for doing a survey.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to develop survey guidance that requires priority attention be given to hospitals with a history of noncompliance with Medicare requirements when determining which nonaccredited hospitals to survey.

    Agency Affected: Department of Health and Human Services

 

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