What is Meant By Healthcare Accreditation, Recognition, and Certification?

Posted on January 30, 2013 by Linda Ringquist

Summary: What is the value of healthcare accreditation? Who are the major players? What are the differences? What is the difference between Accreditation, Recognition, and Certification? Are they the same? Are they synonymous?

There are 5 major healthcare accreditation organizations in the United States:

URAC
NCQA
TJC
CARF
COA

Accreditation

URAC uses this term accreditation for their programs. URAC accreditation is defined by the URAC website as “a process by which an impartial organization (URAC) will review a company’s operations to ensure that the company is conducting business in a manner consistent with national standards. URAC has more than 25 types of accreditation including PCHCH Accreditation, Independent Review Organizations (sometimes referred to as Physician Advisor Services), Health Plan, Health Web Site, PCHCH Auditor Certification, and Drug Therapy Management (just to name a few, as they have an extensive list).
NCQA Accreditation refers to “support continuous improvement in plans’ quality and value”. Some of their accreditations include: Accountable Care Organizations, Health Plan Accreditation, Wellness and Health Promotion, Case Management Accreditation, Managed Behavioral Healthcare Organizations, New Health Plans, Disease Management, and Accreditation Users Group
TJC Accreditation is used to indicate a particular program and is characterized by the type of organization. Accreditation may be achieved for: Ambulatory Health Care, Behavioral Health Care, Critical Access Hospitals, Home Care, Hospitals, International Accreditation, Laboratory Services, Nursing and Rehabilitation Center, and Office-Based Surgery.
CARF Accreditation is used to denote different types of programs. The CARF accreditations include: Aging Services, Behavioral Health, Business and Services Management Network, CARF-CCAC, Child and Youth Services, DMEPOS, Employment and Community Services, Medical Rehabilitation, One-Stop Career Center, Opioid Treatment Program, and Vision Rehabilitation Services.
COA accredits organizations surrounding child welfare, behavioral healthcare, and community based social service programs to children, youth, adults, and families. COA Accreditation programs include: Private Organization Accreditation, Public Agency Accreditation, Canadian Organization Accreditation, After School Program Accreditation, Military and Family Readiness Program Accreditation, Hague Accreditation and Approval, and Quality Childcare Expansion Accreditation.

Certification

NCQA represent a subset of accreditation products as listed above. They pertain to services as opposed to programs. The current certification programs consist of: Credentials Verification Organization, Disease Management, Health Information Products, Multicultural Health Care, Physician and Hospital Quality, PCMH Content Expert Certification, Utilization Management and Credentialing, and Accreditation Users Group.
TJC uses this term to denote chronic diseases and conditions. The certification programs consist of: Advanced Certification, Disease-Specific Care, Health care Staffing Services, and International Certification.

Recognition

NCQA uses the term recognition to “empower employers, health plans, patients and consumers to make informed health care decisions based on quality. The recognition programs consist of: Patient-Centered Specialty Practice Recognition Programs, Patient Centered Medical Home (PCMH-2011), Government Recognition Initiative, Diabetes Recognition Program, Heart/Stroke Recognition Program, Physician Practice Connections, and Back Pain Recognition Program.
COA uses the term recognition to denote how they are recognized as opposed to how they recognize a program. Recognitions include such things as: deemed status, mandate, quality rating systems, tiered reimbursement systems, and training and/or financial support.

As you can see, the terms are not necessarily synonymous. Each organization uses these terms differently.

Are you in the process of seeking accreditation or re-accreditation? Are you in need of URAC consultants? Are you in need of an NCQA Consultant? Are you in need of TJC Accreditation Consulting? Are you in need of CARF Accreditation Consultants? Are you in need of COA consulting? If you answered yes to any of these questions, please call BHM Healthcare Solutions at 1-888-831-1171 or email us at newideas@bhmpc.com. We look forward to hearing from you.

TJC Accreditation – How to Become Accredited

Posted on December 18, 2012 by Linda Ringquist

Summary: What is the process required to achieve TJC accreditation? What does TJC accreditation mean?

TJC accreditation is a national recognition for a healthcare organization who has complied with all of the standards set forth by TJC. TJC stands for The Joint Commission. They used to be referred to as JCAHO which was the Joint Commission on Accreditation of Healthcare Organizations. TJC is one of the few national organizations to be recognized by CMS for accreditation services. TJC accreditation is difficult to obtain and carries a prestige which sets apart those organization who are accredited from those who aren’t. It also provides a competitive advantage as consumers are becoming more and more astute and ,generally speaking, if they have a choice between and accredited organization and a non-accredited organization, accreditation will be chose. Accreditation gives a level of confidence to consumers that the organization strives for and has attained a high level of both quality and patient satisfaction.

What do the standards accomplish?

An objective evaluation process to assist health care organizations measure, assess, and improve performance
Focus on patient and organizational functions required to provide safe high quality care
Set expectations that are reliable and measurable

What is involved in the survey process?

The TJC evaluates an organization’s performance with the intent of providing continuous improvement in terms of patient outcomes. The survey process is based upon:

Patient tracer methodology in which a patient is traced through the continuum of care as he progresses through the health care system.
Helpful information provided by TJC both written and verbal
Observations by surveyors first hand and on site
Documentation review

All TJC surveys are unannounced meaning the organization must be in a constant state of readiness. The unannounced visit no longer exists. For these unannounced visits, the organization had a tendency to “cram” for the survey just prior to the TJC arrival rather than eating, sleeping, and breathing the accreditation way of life. If you practice something enough, it becomes a habit and that is the intent of these surveys. Surveys occur generally between 18 and 36 months apart.

The decision as to whether or not to grant accreditation is based upon how well the organization provides excellent patient care in a safe environment.

There are 6 decisions which can be reached at the close of a survey:

Preliminary accreditation
Accreditation
Accreditation with Follow-Up survey
Contingent Accreditation
Preliminary Denial of Accreditation
Denial of Accreditation

TJC accreditation is not only difficult to achieve but provides an immense feeling of satisfaction upon being granted “Accreditation”. The TJC website has a listing of all organizations who have achieved accreditation. If you require a TJC consultant to assist you with all of your TJC accreditation consulting needs, please contact us.

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BHM Healthcare Solutions Assists MIRA with TJC Accreditation

Posted on December 10, 2012 by Linda Ringquist

Summary: Menzies Institute for Recovery from Addiction (MIRA) partnered with senior TJC consultants at BHM Healthcare Solutions to prepare for accreditation. Consequently, a TJC Accreditation for the Medication Assisted Inpatient Detoxification and Rehabilitation Services was awarded to them, demonstrating a commitment to quality and safety in the provision of healthcare service and management.

Menzies Institute for Recovery from Addiction (MIRA) – part of the Assisted Recovery Centers of America (ARCA) in St. Louis, Missouri, was awarded TJC Behavioral Health Accreditation for the Medication Assisted Inpatient Detoxification and Rehabilitation Services. BHM Healthcare Solutions, a comprehensive healthcare management consulting firm, guided MIRA to accreditation success. The Joint Commission (TJC), an independent, not-for-profit agency, strives to continuously improve health care for the public by evaluating healthcare organizations and leading them to excel in the delivery of safe, effective and quality care.

Assisted Recovery Centers of America (ARCA) was founded in 2001 by Percy Menzies, M.Pharm. ARCA is a mental health facility that specializes in the outpatient treatment of alcoholism and drug addiction through a combination of FDA-approved specialized medications, counseling, and treatment of co-occurring disorders and dual-diagnoses. Based in St. Louis, this evidence-based treatment approach can allow patients to return to work within days.

BHM’s TJC Accreditation Consulting Team, led by Anthony Grimaldi, conducted a thorough review of Menzies’ existing documentation such as policies, procedures, program descriptions and reports. This information was examined and evaluated against TJC standards. In order to help prepare for accreditation in the most cost-efficient manner possible, BHM consultants detailed a project plan and collaborated with Menzies’ staff to implement changes, where necessary. “We are thrilled that this organization attained accreditation,” states Anthony Grimaldi, Senior Vice President with BHM. “ARCA offers the most scientific treatment that integrates proven non-addicting, anti-craving medications with relapse prevention counseling, thus enabling patients to experience long-term recovery in their own natural home environment. TJC Accreditation is a perfect fit for the Institute, and we were proud to have assisted them in achieving their goal.”

Company Info

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including accreditation, financial risk management, clinical operations, quality improvement, and denial management.

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TJC Accreditation – the Value of “Deemed” Status

Posted on December 3, 2012 by Linda Ringquist

What does “deemed” status mean? What areas does The Joint Commission (TJC) have deemed status?

Deemed status is given by Centers for Medicare and Medicaid Services (CMS and affirms that a national healthcare accreditation organization not only meets but exceeds expectations for a particular area of expertise in the accreditation realm. Deemed status for an accreditation organization is similar to a healthcare organization receiving national accreditation. There is a large amount of prestige associated with the designation. It is one of the goals of accreditation organizations.

TJC has achieved such a level as voluntary “deeming” status for many of their accreditation areas. Those areas include:

Ambulatory Surgical Centers – deemed as of 1996
Clinical Laboratories
Critical Access Hospitals – deemed status as of 2002
Home Health- deemed status since 1993
Hospice Agencies – deemed status since 1999
Hospitals – deemed status since 1965
Psychiatric hospitals – deemed status since 2011

TJC has achieved not voluntary “deeming” status for the following areas:

Advanced Diagnostic Imaging
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
Opioid Treatment Programs

What is the relationship between CMS and TJC?

CMS provides oversight authority for accreditation organizations. CMS conducts random audits of Joint Commission accredited and deemed organizations. In return, TJC provides CMS with a list of deemed organizations receiving decisions of accreditation with follow-up survey, contingent accreditation, preliminary denial of accreditation as well as denial of accreditation.

Deemed status as it relates to state licensure and certification

Generally the fact that an organization has achieved accreditation in and of itself doesn’t guarantee the requirements of individual states have been met, the TJC accreditation and certification programs are recognized and relied upon by many states in regard to state quality initiatives.

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BHM Healthcare Solutions is a healthcare management consulting firm offering a wide variety including by not limited to TJC accreditation. TJC accreditation consulting can be invaluable. Our TJC consultants are experts in their field and have already helped many clients who are in your shoes. Why reinvent the wheel when we have already created a successful path for you to follow to help you achieve your accreditation goals?

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Which TJC Accreditation Program is Right for Your Organization?

Posted on October 4, 2012 by Linda Ringquist

The Joint Commission (TJC) was founded in 1951 and evaluates and accredits more than 19,000 health care organizations in the US. TJC’s main emphasis is to provide safe and effective care of the highest quality and value. TJC accreditation programs are specific to the type of organization.

All TJC accreditation programs are valid for 3 years with the exception of Laboratory which is valid for 2 years. Following is a summary of each type of accreditation and the benefits associated with each:

Ambulatory Care:

Established in 1975
Approximately 1,900 accredited organizations
CMS provides deemed status to TJC for Ambulatory Care accreditation
Some of the benefits include: strong commitment to patient safety and patient care, easier access to managed care contracts, nationally known benchmark of quality, increased competitive edge, and surveyors offer insights and compliance hints

Behavioral Health:

Established in 1969, began accrediting in 1972
Approximately 2,000 accredited organizations
Benefits include: recognized by many state authorities, condition of reimbursement, provides customized review, and increased ability to attract and retain quality staff

Critical Access Hospitals:

Established in 2001
Approximately 1,327 accredited organizations
Some of the benefits include: organizes and strengthens patient safety efforts, provides competitive edge, improves risk management, improves staff recruitment, provides deeming authority for Medicare certification, recognized by insurance companies, and may fulfill state regulatory requirements

Home Care:

Established in 1988
Approximately 5,600 accredited organizations
Some of the benefits include: commitment to high level of patient safety and patient care, easier access to managed care contracts, nationally recognized benchmark, constructive educational possibilities, surveyors offer insights and tips, and dedicated account executive
Deemed status relationships with hospices and home health

Hospital:

Established approximately 60 years ago
Approximately 4,168 accredited organizations
Some of the benefits include: strengthens patient safety, improves community confidence, increases competitive advantage,improves staff recruitment, provides deeming authority for Medicare certification, recognized by insurers, and may fulfill state regulatory requirements.

Laboratory:

Established in 1979
Approximately 1,700 accredited organizations
Deemed status by CMS

Long-Term Care

Established in 1966
Approximately 1,000 accredited organizations
3. Some of the benefits include: improving organizational performance, demonstrating a commitment to quality and safety, reducing risk, and improving recruitment of staff

Office-Based Surgery

Established in 2001
Approximately 500 accredited organizations
Some of the benefits include: commitment to high quality patient safety and care, easier access to managed care contracts, increased competitive edge, and nationally recognized benchmark,

Additionally, TJC just added in 2011 the Primary Care Medical Home Certification. This certification is available to organizations which have already achieved Ambulatory Care Accreditation.

About Us

BHM Healthcare Solutions is a healthcare management consulting firm, with one of our specialties being accreditation. Our TJC consultants are on the top of their game. They are current with all of the new healthcare regulations including the Affordable Care Act. They are current with all of Joint Commission’s standards and areas of accreditation. TJC accreditation consulting can provide peace of mind to our clients. Let us worry about all of the processes, standards, and survey preparation. We have achieved a 100% success rate with our clients who were seeking accreditation or re-accreditation. Please visit our accreditation webpage and call us today at 1-888-831-1171 for a free consultation. We are looking forward to working with you.

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The Joint Commission Releases its New Transition of Care Portal

Posted on July 10, 2012 by Linda Ringquist

The Joint Commission (TJC) had determined there is an ineffective transitions of care. According to TJC website, transitions of care are defined as “the movement of patients between health care practitioners, settings, and home as their condition and care needs change.” The ineffective transitions between these health care settings can cause adverse events as well as drive up hospital readmission rates and costs. One study indicated that 80% of serious medical errors involve miscommunication when a patient is transitioning. The federal government has taken interest in this issue and will impose financial penalties for hospitals with unacceptably high readmission rates for Medicare and Medicaid patients.

TJC believes the root causes of ineffective transitions of care include:

Communications breakdown
Patient education breakdown
Accountability breakdowns

The following elements are currently being researched by TJC to improve transitions of care:

Multidisciplinary communication, collaboration, and coordination
Clinician involvement and shared accountability during all points of transition
Comprehensive planning and risk assessment throughout hospital stay
Standardized transition plans, procedures, and forms
Standardized training
Timely follow-up, support and coordination after the patient leaves a care setting
If a patient is readmitted within 30 days, gain an understanding of why.
Evaluation of transitions care measures

This article is the first of many to be released in the Transitions Portal. For the full article please go to the Joint Commission Website.

The Healthcare industry as we know it is constantly changing. Just look at Healthcare Reform a.k.a. Obamacare. Who knows the full intensity of the effects this will eventually produce? With all of these changes/reforms, it is important to rely on consultants who keep current with all of the regulatory changes. BHM Healthcare Solutions is one of the top healthcare consulting firms in the country. Our TJC consultants are experts in their field. To find out more information on our TJC accreditation consulting, please contact one of our experts and setup a free consultation, please call 1-888-831-1171.