Hospital accrediting group misses problems, GAO says

WASHINGTON — WASHINGTON - Although the nation's largest accreditor of hospitals regularly missed serious problems that put patients at risk, the federal government is virtually powerless to discipline the agency, according to a report issued yesterday by Congress' investigative arm.

To deal with the issue, a bipartisan group has introduced legislation to strip the private agency of the special status it has had since Medicare was instituted in 1965.


The measure would bring the Joint Commission on Accreditation of Healthcare Organizations under tighter control, supporters said.

"Congress expects the joint commission to be a watchdog," said Sen. Charles E. Grassley, an Iowa Republican and one of the bill's prime sponsors, at a news conference yesterday announcing the legislation. "It looks like the joint commission is instead a lap dog."


In a formal response, the commission, which is made up mainly of health professionals, said it would not fight the attempt to give the federal government more oversight. But it lambasted a critical report by the Government Accountability Office (GAO), formerly the General Accounting Office, calling its findings "inflammatory" and "grossly inaccurate." It said the report presents a highly misleading and incomplete picture.

Rep. Pete Stark, a California Democrat and leading sponsor of the bill in the House, said later in an interview that the controversy surrounding Maryland General Hospital in Baltimore is an example of how the accreditation system has failed.

The hospital drew top grades last year from an accreditation agency as its laboratories were issuing hundreds of potentially faulty results of HIV and hepatitis tests to patients, state inspectors later found.

The commission was not directly at fault in that instance. The College of American Pathologists inspected the laboratory, and the commission recognizes those inspections as meeting its standards.

But Stark said his bill would give the government more clout with the joint commission, also known as JCAHO (commonly pronounced Jay-Co).

Current federal law says that any hospital the commission accredits is automatically deemed eligible to receive Medicare reimbursements from the government. No other private agency has that authority bestowed on it by law.

The bill would strip that language and give the Centers for Medicare & Medicaid Services, which oversees federal reimbursements to hospitals, the power to revoke JCAHO's authority.

Grassley and Stark said that even if the legislation is enacted, the federal government would probably continue to make Medicare payments to hospitals accredited by JCAHO. But the commission would be subject to probation and the threat of revocation of its contract if it failed to perform.


JCAHO accredited more than 4,200 hospitals in 2002, or more than 80 percent of those participating in Medicare. Those hospitals received about 90 percent of the $109 billion that Medicare spent on hospital care that year, the GAO said.

The report found that JCAHO failed to find 167 of the 241 serious deficiencies that state agencies later discovered in a sample of 500 commission-accredited hospitals. That amounts to missing 69 percent of the problems, the report said.

JCAHO vehemently rejected that interpretation. It said the findings were limited to 500 hospitals that state inspectors visited from 2000 to 2002 as part of a federal program designed to validate the commission's effectiveness.

The commission said it would be unfair to extrapolate the report's findings to the nation's hospitals as a whole.

In its rebuttal, the commission said the GAO did not take into account that JCAHO's surveyors found deficiencies that state inspectors missed.

What's more, JCAHO said, it has instituted a new inspection process this year. It relies less on paper documentation, using personal interviews to trace individual patients through every step of their visit to better identify problems.


The commission also plans to switch entirely to unannounced inspections in 2006. For years, critics have complained that hospitals do well on JCAHO inspections because they generally know when inspectors are coming - something the commission's own statistics back up.

Stark and Grassley said the GAO report shouldn't scare patients away from hospitals. And the report noted that the number of problems commission inspectors missed amounted to just 2 percent of 11,000 possible violations.

Still, the report noted that "one serious deficiency in any one of these hospitals could limit its ability to provide adequate care to patients." For example, it said, state inspectors found these problems that JCAHO surveyors had missed:

A serious infection-control problem at a California hospital that had not developed a system to ensure that medical instruments were sterilized.

A Texas hospital that administered medication without a physician's orders and gave a double dose of narcotics to an emergency room patient who later died.

An Alabama hospital that had no emergency lighting at several exits and failed to inspect its fire extinguishers or sprinkler system annually.


Of the 167 serious deficiencies identified by the validation program but not detected by the joint commission, 87 were related to the hospitals' physical environment, which includes fire prevention and safety.

"For these three years, JCAHO did not detect 81 percent of the serious physical environment deficiencies identified by state surveyors," the GAO report said.