Health Care:

Criteria Used to Evaluate Hospital Accreditation Process Need Reevaluation

HRD-90-89: Published: Jun 11, 1990. Publicly Released: Jun 11, 1990.

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Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) survey process, focusing on HCFA problems in comparing its survey results with those of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

GAO found that: (1) since HCFA did not have an accurate basis to compare its findings with JCAHO, HCFA could not effectively determine whether a hospital receiving JCAHO accreditation met Medicare health and safety requirements; (2) there were differences in the deficiencies that state survey agencies and JCAHO identified, primarily due to differences in the scope and content of Medicare participation conditions and JCAHO standards; (3) because of differing survey criteria, HCFA could not assess the significance and cause of differences in survey findings; (4) in fiscal year (FY) 1988, 14 of 61 HCFA validation surveys relating to Medicare conditions of participation were different from state agency and JCAHO findings; and (5) the process HCFA used to assess the JCAHO accreditation process was not an effective validation process.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: JCAHO and HCFA have developed a crosswalk between their respective standards and HCFA is using it in its hospital survey activities.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to work with JCAHO to: (1) develop a comprehensive crosswalk between its standards and Medicare's conditions of participation (COP); (2) identify and resolve any significant differences between JCAHO and HCFA survey requirements; and (3) require use of the crosswalk in analyzing and comparing survey results.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: HCFA has written a data-base program to compare differences in survey results and enter results from FY 1989 state surveys. The final JCAHO/HCFA crosswalk has been completed and HCFA used it to produce its FY 1989 reports.

    Recommendation: The Secretary of Health and Human Services, should direct the Administrator, HCFA, to establish a means to measure the significance of differences in state agency and JCAHO survey results and analyze the differences to determine if any trends or systemic problems exist.

    Agency Affected: Department of Health and Human Services


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