Health Care: Hospitals With Quality-of-Care Problems Need Closer Monitoring | U.S. GAO

Highlights

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.

Recommendations

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Health and Human Services	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.	Closed – Implemented 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.
Department of Health and Human Services	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.	Closed – Implemented 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.
Department of Health and Human Services	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.	Closed – Implemented 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.
Department of Health and Human Services	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.	Closed – Implemented 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.

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Topics

Health surveysHospital administrationInstitution accreditationInternal controlsMedicareMonitoringQuality controlSafety standardsState programsQuality of care