OP-ED

Hospital Quality Group Obscures Hospital Quality Reports, Journalists Charge

The Joint Commission, which accredits four-fifths of the nation’s hospitals, is being accused of misleading consumers about the quality of care at those hospitals and then ignoring suggestions on how to correct the problem.

“The organization that accredits hospitals around the country, and voices support for transparency about hospital quality, has a Web site that obscures the reality of many hospitals’ performance,” said Charles Ornstein, president of the Association for Health Care Journalists (AHCJ) and a reporter for the public-interest journalism group ProPublica . In a March 1 letter sent to Dr. Mark R. Chassin, the Joint Commission’s president and CEO, Ornstein noted that not only has the group not addressed the “navigational issues” raised by AHCJ more than two years ago, but problems that make the commission’s QualityCheck site even less useful have cropped up.

For instance, that “Gold Seal of Approval” for your local hospital? Perhaps it should be called a Gold Seal of Possible Approval. Says the AHCJ: “[It] is misleading because hospitals with conditional accreditation or preliminary denial of accreditation still receive the same gold seal as fully accredited facilities.”Meanwhile, if you want to find only those hospitals with less-than-full accreditation, you’re out of luck. Says the AHCJ: “To check on a hospital’s accreditation status, one has to open each individual profile. The Joint Commission once had a mechanism to sort hospitals by accreditation status, but that is no longer available.”

Also, “no longer available” is any past record that a hospital flunked its survey. Says the AHCJ: “After a hospital loses accreditation, its past Accreditation Quality Reports are eventually removed from the site, leaving only the facility’s name with no historical record.” The journalists are too polite in their letter to mention that the Joint Commission surveys are paid for by the hospitals, themselves.

The accusations of purged information are particularly troubling given the Joint Commission’s embarrassing history. Its predecessor began life by taking the results of the very first national survey ever of hospital quality and burning them in a hotel furnace at midnight specifically to avoid the poor performance scores falling into the hands of the press. That seminal 1919 event is missing from the official Joint Commission history on its Web site – like other bad news? — although it is publicly acknowledged elsewhere.

As a consultant who has been frustrated by the Joint Commission Web site for years, the general navigational problems came as no surprise. I have had great difficulty using it; I can only imagine what the average consumer experiences. Nor is the lack of responsiveness to complaints surprising. Chassin is a brilliant quality improvement pioneer, but, like many physicians, he believes the best way to help patients is to help make providers better at what they do. When I spoke to Chassin privately about the consumer-unfriendly QualityCheck site last year, he was about as interested in fixing it as a wholesale plumbing supplies dealer would be helping you find the right guy to clear a clogged sink. I think Chassin sees his job as making all plumbers great plumbers so you won’t have to worry about which one to call.

Of course, while the Joint Commission is working on the Exciting Future (see my previous blog on its Center for Health Transformation), you, the patient, are left on your own to cope with the mundane present. OK, not exactly on your own. The Joint Commission does publish a series of pamphlets called Speak Up, as in Help Avoid Mistakes in Your Surgery and (if that doesn’t work) Information for Living Organ Donors. In fact, as part of this year’s celebration of Patient Safety Awareness Week (March 7-13), you can complete an online quiz to test your Patient Safety IQ and be entered in a drawing to win the Joint Commission’s book, You: The Smart Patient.

See? The Joint Commission believes in smart patients. Just not, “too smart.”

One member of the Joint Commission’s Board of Commissioners is a consumer representative, Ilene Corina of PULSE of New York. It’s unclear whether the journalists reached out to her or any other commissioner. Meanwhile, in mid-2008 the Joint Commission received an 18-month grant, partly funded by the Robert Wood Johnson Foundation, “to find new ways to help consumers better understand healthcare quality data and use the information to make informed healthcare decisions.”

I can’t decide whether the answer is going to be “better pamphlets” or “don’t ask, don’t tell.”

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age”.

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16 replies »

  1. A hospital, in the modern sense of the word, is an institution for health care providing patient treatment by specialized staff and equipment, and often, but not always providing for longer-term patient stays. Its historical meaning, until relatively recent times, was “a place of hospitality”.Hospital helpful to recover from any disease.Good hospital atmosphere helpful to recover from disease.Hospital management also play an important role for patient to recover from diseases.
    thanks for post this article..its very interesting to read this article…Its provides me a lots of information related to hospital quality.

  2. As a nurse for 25 years and having worked mainly in hospitals, I can honestly say that it would behoove everyone to have a nurse advocate at their side monitoring all aspects of care. The System is for the bottom line….the dollar. Unethical practices are a daily event. I see more money spent on the esthetics of the hospitals than on patient care. Nurses are the modern day slave and must act subservient to their superiors. I have complained to the Agency for Healthcare and also to Joint Commission on unethical practices of the hospital administration. I have received letters that basically say, ‘too bad, so sad’. It seems as though the practice of caring for patients is without the word “care”. Patients are now liabilities to insurance companies and are being raped daily by hospitals and cheated out of good medical care. What will it really mean when all people are insured and have access to medical care? I agree with you, Dr.Joe Silverman. Thanks for speaking up.

  3. The best thing that we can do for consumers is to warn them that The Joint Commission is NOT a patient safety or hospital rating organization that acts on behalf of patients. We need to be clear that their allegiance is to hospitals; at the expense of patients.
    Investigations of serious patient harm by The Joint Commission are handled in a manner that allow hospitals to escape accountability, answer to the complaint in writing alone (no on-site visit) and worst of all: the patient is banned from knowing anything at all about how the hospital responded to the complaint.
    Anyone who has been seriously harmed or had a family member die from medical errors knows that hospital administrators lie, mislead, remove crucial evidence from the medical record, and silence their employees, so you can be sure that when they are asked to respond to a Joint Commission complaint in writing, it’s more of the same.
    The reality is that there is no system in existence that offers any accountability to patients except the courts.
    Until we as a country want to face these facts, preventable medical errors and hospital acquired infections that kill more people than auto accidents, pneumonia, AIDS or breast cancer will continue unabated.
    We need to start focusing on hospital CEO’s at the helm of these facilities. The hospitals that are seeing great improvement are the ones who have leaders who put patient safety first by investing in it. The others continue to perform poorly year after year (just check the Healthgrades reports). It’s not an issue of lacking the resources or the know-how, it’s about who’s in charge.
    Which is why these CEO’s are fighting so hard against transparency; they don’t want to be held accountable for high infection, complication and mortality rates. Why is that we can call Toyota’s CEO to Washington within just a few months of 30 people dying, but hospital CEO’s are allowed to be at the helm of facilities with high moratlity rates for for years with no accountabiltiy?
    Healthcare consumers can’t be engaged consumers until we can gain access to hospital outcome data (infection, complication and mortality rates)so that we can make informed decisions.
    The problem is that we can’t seem to shake this data loose from the tight grip of the agencies that own it. (The Joint Commission, AHRQ, Hospital Associations, IHI, etc).
    As a patient safety advocate, I am so disturbed whenever I get a call from another family who is in crisis over a loved one suffering from serious complications or has died from a hospital acquired infection or botched surgery. Knowing that it tends to be the same hospitals over and over, and that if they had only been able to look up this facility’s infection or mortality rates for high risk surgery, then they might still be alive.
    When will our government do the right thing and mandate that this information be put in the hands of the people whose lives depend on it: patients?

  4. My take is different from the others. My hospital is scared to death of violating TJC requirements. And the requirements are mainly matters of form, not content. They deal with process, not outcome. Physicians spend most of their time treating the chart, not the patient. Aiming to hit TJC targets, hospitals are diverted from making changes that would improve the quality of care.
    I would prefer that TJC maintain contact with institutions year round, bringing ideas that have been proved elsewhere and helping hospitals try out these changes.

  5. Just to clarify a misleading point made above. The Joint Commission is not a trade association of hospitals. The name is derived from the fact that is a collaborative formed by the American College of Physicians, the American Hospital Association, the American Medical Association, the American College of Surgeons and the Canadian Medical Association. Their Board reflects shared governance by all these organizations.
    Physicians who rail against the entity should recall the Joint Commission is an organization in which they had a hand in creating and govern to this day.

  6. We, as a nation, are as close as we have ever been to providing health care for most of the people in these United States. I, for one am hoping that congress will pass the senate’s version of the bill and then the senate passes a modified version of that bill to provide the competition in the marketplace so badly needed. As it stands right now, we the people are handcuffed by the enormous insurance lobby in Washington, which allows the few insurance company to hold us hostage to higher and higher insurance rates. Pretty soon, health care for the average working man and woman will be unaffordable. Only the rich will be able to see a doctor or dentist and afford to pay the bill. I urge eveyyone to let their voice be heard in this matter. Write or call someone, anyone who will listen and tell that you deserve the right to seek affordable medical attention when you or your loved ones require it.

  7. The Joint Commission should be a deep concern for all patients who expect a reasonably Safe Hospital Visit. This organization operates as cheer leaders of Hospital Misconduct and Unsafe enviroments. Their sounding Board of patient complaints ends in a deafening thud of filtered pleasantries and meaningness closed investigations.
    The Protection Money paid by Hospitals to Fund Them; are the primary cause for the Disparities of this fundamentally inept and,Overrated Organization.
    Certainly, JACHO rates High on my list of a needless entitlement Program that severly fails to progressively promote Comprehensive Patient safety programs.

  8. Just to be clear about one comment posted: the Joint Commission’s deeming authority has NOT been repealed. What happened is it was opened up to others who previously were shut out.
    And, yes, in theory, Republicans and Democrats agree about this issue, as Tom Coburn’s bill and John McCain’s presidential platform would indicate.
    Alas, the Republicans have decided that this is an area of agreement with the Democrats that they’d rather keep silent about for now. What a shame.

  9. Actually, this is one area where Democrats and Republicans should be able to find some agreement. Sen. Tom Coburn’s 2009 Patents’ Choice Act (which Coburn doesn’t seem to talk about any more) would establish a five-person Health Care Services Commission, appointed by the President and modeled on the Securities and Exchange Commission, to publish and enforce standardized health care quality and price information. It would be assisted by a 15-person Forum for Quality and Effectiveness. The commission’s job would be to improve the quality of care by disseminating information on effective care and on the costs of care.
    The Commission would have authority to require health care providers to comply with the guidelines and standards, wielding the threat of civil monetary penalties and exclusion from federal health programs for non-compliance. The Republican competition model is premised on the foundation that medical consumers have ready access to solid quality and cost information. So it seems that Republicans should be as concerned about the Joint Commission issue as Democrats, and should be willing to require the dissemination of standardized, meaningful data.

  10. As we have seen time and time again from either a federal regulatory authority (e.g., SEC, OCC) or a quasi-authority like JHACO, having ‘oversight’ over an area where the regulators have potentially somewhat conflicting interests is extremely problematic. It basically presents the illusion of a legit 3rd party monitoring certain activities when that reality isn’t quite the case.
    Funny thing is that the anti-regulation zealots usually use these cases as a political opportunity to do two things:
    1. Argue that no new regulations are needed because the existing regulations don’t even work. Doesn’t matter if the ‘new regulations’ would potentially be more streamlined, smaller, and more efficient.
    2. See this as a chance to roll back existing regulations. Chicago School zealots will jump in with “free market would take care of this” and largely use a bunch of empty rhetoric and highlighting the failures of the current regulatory approach. Reform of existing regulations simply isn’t an option.
    Frankly I am kind of surprised that more people (on the left and right) have pressured Congress about JHACO’s roll. From what I saw firsthand, it was really more of an expensive & cumbersome ‘dog and pony’ show that really didn’t bring much value add to the hospital & its employees, purchasers, or patients.
    For the left – you would think they would a quasi-authority like JHACO to actually do something and uncover areas of abuse that are occurring especially in the nursing home industry.
    For the right – you would think they would be miffed that Congress is spending a small fortune on this quasi-authority and that the types of information that are needed to make a consumer-directed health system work aren’t being generated.

  11. I will say it again: Accrediation by the JC is like saying your hospital is listed in the phone book. Big deal. The JC has been committing fraud, for years. There is a lot of blood on their hands and the FBI should raid their offices and start criminally prosecuting. Ilene Corina called me at home once, years ago (in response to my constant JCAHO complaining) and told me that a hospital has to be “caught in the act” at least 3 times (violating JCAHO standards) before they can “do anything” about any wrongdoing. She did not say what they would do about it, and if you know how infrequently JCAHO makes onsite visits then you know the odds of them “witnessing” violations even once, much less three times, are slim to none. JCAHO accrediation is meaningless and they are not a regulatory agency.

  12. The JC is a trade association by the hospitals, of the hospitals, and for the hospitals.
    It provides an illusion that the hospitals that pay the JC fees get reports that enable its executives to rape the patients and keep the patients as grist for hospitals’ cash registers.
    The JC additionally has alliances with manufacturers of healthcare information technology products and promotes them as a solution to the death traps that many hospitals have become.

  13. Michael
    I got a real chuckle out of reading this and then seeing your comment at the end. Do you think these people are really serious, or are they just seeing how much they can get away with before someone puts a stop to the nonsense? But I suspect as long as there is money to spread around, we will see even more creative ways to waste it.
    Congress gave the Joint Commison (JCAHO) authority to inspect hospitals and nursing homes to determine whether they meet the patient health and safety standards required to treat Medicare patients. The services provided by JCAHO are paid for, by the tune of $113 million, by the health institutions being inspected.
    By “deeming” authority by Congress means that if JCAHO gives its seal of approval to a hospital or nursing home, CMS is satisfied that the institution is following federal regulations. In other words, they only have to please one master, who accredits 99% of all institutions it surveys.
    During its existence, JCAHO has weathered years of criticism. A July, 1999 report from HHS Office of Inspector General concluded that Joint Commission surveys are unlikely to detect substandard patterns of care.
    In July 2004, a GAO report went further, concluding that 78% of the time the Joint Commission survey process did not identify serious deficiencies that were found by State Survey Agencies.
    In 1998, an independent evaluation found that JCAHO surveyors repeatedly miss instances where nursing home residents suffered actual harm because of inadequate care. In more than half of 179 cases, where both Health Care Financing Administration (HCFA) and JCAHO conducted inspections of the same nursing homes, JCAHO failed to detect serious problems identified by HCFA.
    JCAHO surveys focuses on structure and process measures, not on whether residents actually get appropriate care. Also, the public does not have access to JCAHO survey findings. According to Abt Associates, granting “deeming authority” to JCAHO would place nursing home residents at serious risk. It had been concluded in the report that JCAHO’s approach to the survey process is unacceptable. The “foxes have been guarding the chicken coop.”
    The bottom line is, it has been proven, over and over again, what the problems are. JCAHO is hopelessly in an incestuous/unholy alliance with much of what’s wrong with American Medicine. But no one who has the power to hold them accountable also has the mettle to draw that line in the sand.

  14. Last week, e-Patient Dave wrote about this story.
    Just one more example why contemporary patients must doubt everything they read and assess the potential bias of any information coming from a professional organization. It makes our life much more complicated , but sometimes our survival depends on having this highly developed critical mind.
    Thankfully, if you interview college students about how they assess medical information, you can see that we may be the last generation that will ever accept medical diagnosis or prescription without checking its validity online.

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