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Healthcare Org 1, 1.18 (R) [INFO] Topic 4. Healthcare Organization Accreditation

Topic 4. What are the healthcare organization accreditation associations in the United States? There are many healthcare organization accreditation associations in the United States. As a general rule, accreditation is voluntary. However, accreditation may be necessary or may substitute for some of the healthcare organization's operating requirements. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson One Quiz. For example, Medicare-certified (CMS-certified) healthcare organizations must allow initial and periodic surveys (inspections) from State Survey Agencies working on behalf of CMS to ensure organizational compliance with the Conditions of Participation (CoP) as specified in 42 CFR. However, CMS allows accreditation from CMS-approved accreditation associations to substitute for the surveys of the State Survey Agencies. Healthcare organizations accredited by such an approved accreditation organization, therefore, do not have to participate in the State Survey Agencies surveys. The CMS-approved accreditation associations are said to have “deeming authority” from CMS. Accreditation associations apply for deeming authority and CMS provides information on the process at the CMS Accreditation of Medicare Certified Providers and Suppliers website. The origins of healthcare organization accreditation in the United States lie with Ernest Codman, MD and the American College of Surgeons (ACS) (founded in 1912). Dr. Codman was a founding member of ACS and proposed an “end result system of hospital standardization” which became the ACS Hospital Standardization Program in 1917. This program published a Minimum Standard for Hospitals which ACS used to begin on-site inspections of hospitals. In 1951, the Hospital Standardization Program became the Joint Commission on Accreditation of Hospitals (JCAH). JCAH continued to grow and is now known as The Joint Commission. An excellent timeline and history can be found at The Joint Commission: Over a Century of Quality and Safety . There is an interesting historical note about Dr. Codman' work as a staff surgeon at Massachusetts General Hospital (MGH) and his dedication to "quality improvement and outcomes measurement". Dr. Codman "lost staff privileges in 1914 when he insisted the hospital institute his plan for evaluating the competence of surgeons. " (Website Source of Quote) Note [FUN]: The video for Topic 4 - E.A. Codman, An MGH Legend - is a YouTube video produced by Massachusetts General Hospital (MGH). It is a talk by David F. Torchiana, MD, CEO, Massachusetts General Physicians Organization about Dr. Codman's life and visionary work. Some of the better known healthcare organization accreditation associations in the United States are: The Joint Commission (The JointCommission) Accreditation Commission for Health Care (ACHC) Center for Pharmacy Practice Accreditation (CPPA) Community Health Accreditation Partner (CHAP) Det Norske Veritas – Germanischer Lloyd (DNV GL) Healthcare Healthcare Facilities Accreditation Program (HFAP) National Committee for Quality Assurance (NCQA) URAC (URAC) More information about each of these eight accreditation associations is found below.

1\. The Joint Commission (The JointCommission) “ Joint Commission accreditation can be earned by many types of health care organizations, including hospitals, doctor's offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services.“ (Website Source of Quote) The Joint Commission has deeming authority from CMS for many types of healthcare organizations. Voluntary deemed status is available for: Ambulatory Surgical Centers Clinical Laboratories Critical Access Hospitals Home Health Agencies Hospice Agencies Hospitals Psychiatric Hospitals

2\. Accreditation Commission for Health Care (ACHC) “ACHC offers a full range of nationally recognized accreditation and compliance programs tailored specifically to the home care and alternate site healthcare industry.” (Website Source of Quote) ACHC has deeming authority from CMS for: DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) Home Health Agencies Hospice Agencies ACHC also offers accreditation for Specialty and Infusion Pharmacies and Compounding Pharmacies in cooperation with the Pharmacy Compounding Accreditation Board (PCAB) based on the U.S. Pharmacopeial Convention (USP) guidelines.

3\. Center for Pharmacy Practice Accreditation (CPPA) CPPA “is a partnership established by the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP), and the American Society of Health-System Pharmacists (ASHP) to oversee accreditation of pharmacy practice sites. CPPA develops and implements comprehensive programs of pharmacy practice site accreditation and manages the process leading to the use of consensus-based standards for pharmacy practice accreditation. " (Website Source of Quote)

4\. Community Health Accreditation Partner (CHAP) CHAP provides “home and community-based health care accreditation - and only home and community-based health care accreditation.” CHAP has deeming authority from CMS for: Home Health Agencies Home Medical Equipment (HME) Hospice Agencies

5\. Det Norske Veritas – Germanischer Lloyd (DNV GL) Healthcare DNV GL Healthcare describes itself as "your partner for safer healthcare, providing quality driven accreditation and clinical excellence certifications to America's hospitals. " (Website Source of Quote) DNV GL Healthcare has deeming authority from CMS for: Critical Access Hospitals Hospitals

6\. Healthcare Facilities Accreditation Program (HFAP) "Originally created in 1945 to conduct an objective review of services provided by osteopathic hospitals, HFAP has maintained its deeming authority continuously since the inception of CMS in 1965 and meets or exceeds the standards required by CMS/Medicare to provide accreditation to all hospitals, ambulatory care/surgical facilities, mental health facilities, physical rehabilitation facilities, clinical laboratories and critical access hospitals. " (Website Source of Quote) HFAP accredits and crosswalks to CMS standards (as applicable) for the following programs: Hospitals and their Clinical Laboratories Ambulatory Care/Surgical Facilities Mental Health Facilities Substance Abuse Facilities Physical Rehabilitation Facilities Clinical Laboratories Critical Access Hospitals

7\. National Committee for Quality Assurance (NCQA) NCQA focuses on improving health care quality and states that its "programs and services reflect a straightforward formula for improvement: Measure. Analyze. Improve. Repeat. " NCQA has a special focus on health care plans and states that "NCQA's contribution to the health care system is regularly measured in the form of statistics that track the quality of care delivered by the nation's health plans. " (Website Source of Quote)NCQA accreditation is available for: Health Plans Provider Organizations (e.g., Wellness and Health Promotion) Health Plan Contracting Organizations (e.g., Case Management) Other Organizations (e.g., Utilization Management)

8\. URAC (URAC) URAC "is an ... accreditation entity ... whose mission is to advance healthcare quality through leadership, accreditation, measurement and innovation ... as an independent, third party healthcare quality validator. " (Website Source of Quote)URAC accredits: Health Plans with deeming authority from CMS for Medicare Advantage Plans Healthcare Management Programs Healthcare Operations Programs Pharmacy Quality Management Programs Provider Integration and Coordination Programs



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Topic 4. What are the healthcare organization accreditation associations in the United States? There are many healthcare organization accreditation associations in the United States. As a general rule, accreditation is voluntary. However, accreditation may be necessary or may substitute for some of the healthcare organization's operating requirements. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson One Quiz. For example, Medicare-certified (CMS-certified) healthcare organizations must allow initial and periodic surveys (inspections) from State Survey Agencies working on behalf of CMS to ensure organizational compliance with the Conditions of Participation (CoP) as specified in 42 CFR. However, CMS allows accreditation from CMS-approved accreditation associations to substitute for the surveys of the State Survey Agencies. Healthcare organizations accredited by such an approved accreditation organization, therefore, do not have to participate in the State Survey Agencies surveys. The CMS-approved accreditation associations are said to have “deeming authority” from CMS. Accreditation associations apply for deeming authority and CMS provides information on the process at the CMS Accreditation of Medicare Certified Providers and Suppliers website. The origins of healthcare organization accreditation in the United States lie with Ernest Codman, MD and the American College of Surgeons (ACS) (founded in 1912). Dr. Codman was a founding member of ACS and proposed an “end result system of hospital standardization” which became the ACS Hospital Standardization Program in 1917. This program published a Minimum Standard for Hospitals which ACS used to begin on-site inspections of hospitals. In 1951, the Hospital Standardization Program became the Joint Commission on Accreditation of Hospitals (JCAH). JCAH continued to grow and is now known as The Joint Commission. An excellent timeline and history can be found at The Joint Commission: Over a Century of Quality and Safety . There is an interesting historical note about Dr. Codman' work as a staff surgeon at Massachusetts General Hospital (MGH) and his dedication to "quality improvement and outcomes measurement". Dr. Codman "lost staff privileges in 1914 when he insisted the hospital institute his plan for evaluating the competence of surgeons. " (Website Source of Quote) Note [FUN]: The video for Topic 4 - E.A. Codman, An MGH Legend - is a YouTube video produced by Massachusetts General Hospital (MGH). It is a talk by David F. Torchiana, MD, CEO, Massachusetts General Physicians Organization about Dr. Codman's life and visionary work. Some of the better known healthcare organization accreditation associations in the United States are: The Joint Commission (The JointCommission) Accreditation Commission for Health Care (ACHC) Center for Pharmacy Practice Accreditation (CPPA) Community Health Accreditation Partner (CHAP) Det Norske Veritas – Germanischer Lloyd (DNV GL) Healthcare Healthcare Facilities Accreditation Program (HFAP) National Committee for Quality Assurance (NCQA) URAC (URAC) More information about each of these eight accreditation associations is found below.

1\. The Joint Commission (The JointCommission) “ Joint Commission accreditation can be earned by many types of health care organizations, including hospitals, doctor's offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services.“ (Website Source of Quote) The Joint Commission has deeming authority from CMS for many types of healthcare organizations. Voluntary deemed status is available for: Ambulatory Surgical Centers Clinical Laboratories Critical Access Hospitals Home Health Agencies Hospice Agencies Hospitals Psychiatric Hospitals

2\. Accreditation Commission for Health Care (ACHC) “ACHC offers a full range of nationally recognized accreditation and compliance programs tailored specifically to the home care and alternate site healthcare industry.” (Website Source of Quote) ACHC has deeming authority from CMS for: DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) Home Health Agencies Hospice Agencies ACHC also offers accreditation for Specialty and Infusion Pharmacies and Compounding Pharmacies in cooperation with the Pharmacy Compounding Accreditation Board (PCAB) based on the U.S. Pharmacopeial Convention (USP) guidelines.

3\. Center for Pharmacy Practice Accreditation (CPPA) CPPA “is a partnership established by the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP), and the American Society of Health-System Pharmacists (ASHP) to oversee accreditation of pharmacy practice sites. CPPA develops and implements comprehensive programs of pharmacy practice site accreditation and manages the process leading to the use of consensus-based standards for pharmacy practice accreditation. " (Website Source of Quote)

4\. Community Health Accreditation Partner (CHAP) CHAP provides “home and community-based health care accreditation - and only home and community-based health care accreditation.” CHAP has deeming authority from CMS for: Home Health Agencies Home Medical Equipment (HME) Hospice Agencies

5\. Det Norske Veritas – Germanischer Lloyd (DNV GL) Healthcare DNV GL Healthcare describes itself as "your partner for safer healthcare, providing quality driven accreditation and clinical excellence certifications to America's hospitals. " (Website Source of Quote) DNV GL Healthcare has deeming authority from CMS for: Critical Access Hospitals Hospitals

6\. Healthcare Facilities Accreditation Program (HFAP) "Originally created in 1945 to conduct an objective review of services provided by osteopathic hospitals, HFAP has maintained its deeming authority continuously since the inception of CMS in 1965 and meets or exceeds the standards required by CMS/Medicare to provide accreditation to all hospitals, ambulatory care/surgical facilities, mental health facilities, physical rehabilitation facilities, clinical laboratories and critical access hospitals. " (Website Source of Quote) HFAP accredits and crosswalks to CMS standards (as applicable) for the following programs: Hospitals and their Clinical Laboratories Ambulatory Care/Surgical Facilities Mental Health Facilities Substance Abuse Facilities Physical Rehabilitation Facilities Clinical Laboratories Critical Access Hospitals

7\. National Committee for Quality Assurance (NCQA) NCQA focuses on improving health care quality and states that its "programs and services reflect a straightforward formula for improvement: Measure. Analyze. Improve. Repeat. " NCQA has a special focus on health care plans and states that "NCQA's contribution to the health care system is regularly measured in the form of statistics that track the quality of care delivered by the nation's health plans. " (Website Source of Quote)NCQA accreditation is available for: Health Plans Provider Organizations (e.g., Wellness and Health Promotion) Health Plan Contracting Organizations (e.g., Case Management) Other Organizations (e.g., Utilization Management)

8\. URAC (URAC) URAC "is an ... accreditation entity ... whose mission is to advance healthcare quality through leadership, accreditation, measurement and innovation ... as an independent, third party healthcare quality validator. " (Website Source of Quote)URAC accredits: Health Plans with deeming authority from CMS for Medicare Advantage Plans Healthcare Management Programs Healthcare Operations Programs Pharmacy Quality Management Programs Provider Integration and Coordination Programs


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