WHO’S WHO
THE ORGANIZATIONS

By John Roark & Tina Brooks

While there are many organizations that serve the ambulatory surgery industry, in this issue we spotlight two agencies that have been pushing hard to raise the standards of healthcare delivery in ASCs and surgical hospitals through a critical credentialing process — accreditation. Whether it is a means to benchmark, market to new patient populations, or demonstrate superior healthcare delivery, accreditation is essential to the success of every outpatient facility.

For almost four decades, accreditation has been the highest form of public recognition a healthcare organization could receive for the quality of care it provides. The concept started with hospitals. Now, thanks to the Accreditation Association for Ambulatory Health Care (AAAHC), nearly all types of ambulatory healthcare providers can achieve this distinction. Accreditation offers many quantitative as well as intangible benefits than public recognition alone. But most importantly, accreditation helps ASCs deliver their ultimate bottom line — high-quality patient care.

One of the most important issues facing the AAAHC right now is education. Education of the public regarding the meaning of accreditation as they seek high quality healthcare in the outpatient setting, education of states on how accreditation can help them ensure higher quality of care and education of organizations on what accreditation is really about.

“Frequently, we hear that organizations are afraid to go through accreditation, worried that it might be a punitive experience and that they will not ‘pass,’” says executive director John Burke, PhD. “It is one of our goals to help organizations understand that our accreditation program is educational rather than punitive in nature and is designed to help them improve the care they give.”

Each year, as increasing numbers of procedures move into the ambulatory setting, AAAHC reviews and refines its standards to ensure they remain relevant to a changing environment. “We have recently revised standards on credentialing and privileging, as well as anesthesia services,” says Burke. “These are two areas that are critical to advancing high quality patient care and safety. By constantly revising our standards, we continue to promote higher standards for the ambulatory arena.”

The association’s approach to accreditation is to provide an educational and consultative experience as each organization moves toward the highest possible quality of care. “We want to promote the standards and advance quality, safety and efficiency,” says Burke. “Many accredited organizations have told me that they were impressed by how much they learned by going through the process of accreditation. They have told me that when they started out towards accreditation, they felt their organization was well-run and effective, but by the time they completed the survey process, they realized that there were still many ways to improve and advance the quality of care. Whenever I meet someone from an organization who feels this way, I realize that we are making a difference, one organization at a time.”

Over the last few years, the association has seen a sharp increase in the demand for accreditation, with surveys up 33 percent in the last year alone. “We now accredit over 1700 organizations, including ambulatory surgery centers, office-based surgery centers, student and Indian health centers and HMOs,” says Burke. With a renewed interest in assuring the quality of care in the ambulatory environment, the AAAHC has been recognized at both the state and national levels, as one way to promote higher quality care.

2004 will mark the 25th anniversary of AAAHC. Says Burke, “The AAAHC will continue to educate and provide opportunities for ambulatory care organizations to participate in quality improvement activities to advance quality of care and increase patient safety.”

For more than 52 years, The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has developed standards and evaluated compliance to those standards. JCAHO currently evaluates and accredits more than 16,000 healthcare organizations and programs in the United States, including more than 1,400 organizations under its ambulatory accreditation program.

JCAHO had several major accomplishments in 2003, and next year will be even more momentous with the implementation of a new initiative. JCAHO’s “Shared Visions — New Pathways” aims to shift the accreditation process from a focus on survey preparation to one of continuous improvement.

“The emphasis is to try and have accredited organizations use the standards as a daily operational tool,” says Michael Kulczycki, executive director of the ambulatory care accreditation program at JCAHO. “Instead of the focus on a once every three year event, we have established a number of touch points over the three year accreditation cycle.”

The new accreditation process will begin after January 2004, with certain components being phased in later for some accreditation programs. One significant aspect of the new process includes spending 50 to 60 percent of a survey with direct care givers. Kulczycki says this involves “observing their work with patients and talking to them about their care for the patients. It’s not talking to them about their knowledge of Joint Commission standards, but essentially how they do things as a demonstration that their organization is in compliance with those standards.”

As we head into the new year, Kulczycki notes that the Joint Commission Board of Commissioners has also added a strategic issues work group, focusing on “Health Care Quality and Safety Alignment.”

Dennis O’Leary, MD, president of JCAHO says, “There are no payment disincentives for experiencing preventable adverse outcomes, nor are there payment incentives for successfully providing safe care. There is now a growing imperative to determine how payment incentives can be aligned among payors, purchasers, provider organizations and practitioners toward the goal of improving the quality and safety of care.”

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