WHAT IS ACCREDITATION?

Accreditation, often used synonymously with certification, is broadly defined as the process in which confirmation of competency, authority, or credibility is achieved. In healthcare, the main goal of accreditation and/or certification programs is to demonstrate a strong commitment to quality and patient safety standards. Here we'll look at some prominent accrediting bodies in the United States that consumers can utilize to evaluate the quality of healthcare organizations, physicians, and health insurance plans.

The most well known accrediting body in the United States is The Joint Commission (formerly JCAHO). The Joint Commission is probably best known for its accreditation of hospitals, although it offers accreditation to many types of healthcare providers including doctor's offices, skilled nursing facilities, and ambulatory surgery centers among others. Since 1965, The Joint Commission has held CMS deeming authority for hospitals in the United States. Deeming authority means that The Joint Commission can officially determine if hospitals meet Medicare and Medicaid certification standards. Thus, for many hospitals, their Joint Commission accreditation is a condition of reimbursement by Medicare and Medicaid, and as such is critical to their viability. The Joint Commission is not the only organization with hospital deeming authority, but it is the most commonly used. The Joint Commission imposes fairly rigorous quality and safety standards by which accredited facilities must abide and has developed a tool known as Quality Check that allows consumers to search for accredited organizations.

In addition to the Joint Commission, a variety of other accreditation bodies exist in healthcare and many specialize in a certain type of provider or type of care. Some of the non-profit professional medical associations that service particular specialties offer accreditation, such as the American College of Radiology and the American College of Surgeons. The Accreditation Commission for Health Care (ACHC) and the Healthcare Facilities Accreditation Program (HFAP) provide accreditation options for certain types of providers. Everything from urgent care centers to advanced medical imaging providers have organizations that offer them accreditation, and it would be exhausting to attempt to list and explain them all here. However, from a provider's perspective, the accreditation program chosen will most likely be one that is recognized by CMS and other insurance carriers. CMS and other carriers sometimes require accreditation in order to be reimbursed for certain services, so providers will usually make sure that their accreditation status is acknowledged and will not prevent them from getting paid.

Board certification is perhaps the most well known method that individual physicians use to demonstrate their expertise, and easy to access resources are available to check the board certification status of physicians. Board certification for MD's is most commonly achieved through a Member Board of the American Board of Medical Specialties (ABMS), such as the American Board of Internal Medicine (ABIM). Osteopathic physicians (DO's) are commonly certified by the American Osteopathic Association (AOA) via one of their certifying boards, such as the American Osteopathic Board of Internal Medicine (AOBIM). Both the ABMS and the AOA offer resources to check board certification status and search for board certified providers.

In addition to organizations that accredit and certify provider organizations and individual physicians, there are also organizations that accredit health insurance plans. The National Committee for Quality Assurance (NCQA) is the most well known organization that offers accreditation to health plans. NCQA utilizes what are known as Healthcare Effectiveness Data and Information Set (HEDIS) measures to assess the quality of care that health plans provide to their members. Insurance carriers track and report HEDIS measures to the NCQA as one component of the accreditation process, although some carriers submit HEDIS data even if they do not seek accreditation because CMS requires them to report Medicare HEDIS data in order to offer Medicare Advantage plans. NCQA offers an excellent tool to compare accredited health plans on customer satisfaction and quality called the Health Plan Report Card. Consumers can enter their state and the type of plan they're looking for and search accredited plans. Individual insurers can then be chosen to compare on a report card.

Essential QSA Knowledge

Accreditation and certification are used in healthcare to demonstrate a strong commitment to quality and patient safety standards. The Joint Commission is the most well known accrediting body in the United States, although many exist. Board certfication is used by individual physicians to demonstrate expertise in a medical specialty. The NCQA is the most well known organization that accredits health insurance plans, and they offer useful resources for consumers to compare accredited plans.

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