Healthcare accreditation and certification programs can help organizations foster compliance with regulations and requirements, and to further quality improvement, risk management, and safety initiatives. Participation in some accreditation programs may serve as proof of compliance with regulatory requirements. For example, several accreditation programs are deemed by Medicare to evidence compliance with Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoP) required for reimbursement. Additionally, accreditation may be a condition for reimbursement by some health plans and government payer programs. Accreditation may also help provide consistency and standardization across organizational processes, as requirements for accreditation require application of a regimented set of standards for participation.
Many organizations in the healthcare industry offer accreditation and certification programs, and specialize in certain sectors of the healthcare industry. Here is a selection of reputable and widely recognized accreditation programs that cover a variety of healthcare sectors.
The Joint Commission
Formed in 1951, the Joint Commission is the largest and oldest accrediting body for healthcare organizations in the United States, with more than 22,000 organizations and programs currently accredited. The Joint Commission offers accreditation to organizations, including, but not limited to, general, psychiatric, children’s, and rehabilitation hospitals; critical access hospitals; home care organizations; hospice organizations; nursing homes; rehabilitation centers; long-term facilities, behavioral health organizations; addiction treatment organizations; ambulatory care providers; and independent or freestanding clinical laboratories. The Joint Commission’s mission is “to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.”
To earn The Gold Seal of Approval, the title The Joint Commission has branded for its accredited organizations, a Joint Commission survey team conducts an on-site survey of the organization at least every three years (every two years for laboratories). Accreditation status from The Joint Commission is also assurance that a facility that is deemed meets CMS Conditions of Participation.
Find the standards here: https://www.jointcommission.org/standards/.
National Committee for Quality Assurance
The National Committee for Quality Assurance (NCQA) accredits health plans for participation in Medicare Advantage and state Medicaid managed care programs, managed behavioral healthcare organizations, credentials-verification organizations, and physician organizations. NCQA also offers a Long-Term Services and Supports (LTSS) Distinction for organizations providing managed health services and coordinating social services for LTSS. CMS has approved NCQA for deeming of Medicare Advantage Special Needs Plans (SNPs) Model of Care (MOC) requirements, meaning that organizations that meet NCQA SNP deeming module requirements are deemed to meet Medicare requirements for SNP MOC.
NCQA uses two quality measure frameworks to assess its accredited organizations, the Healthcare Effectiveness Data and Information Set (HEDIS) measures and Consumer Assessment of Healthcare Providers and Systems (CAHPS) consumer experience surveys. The HEDIS is widely used as a healthcare performance measurement tool. The HEDIS tool includes more than 90 measures across six domains of care, including:
Effectiveness of care
Access/availability of care
Experience of care
Utilization and risk-adjusted utilization
Health plan descriptive information
Measures collected using electronic clinical data systems
CAHPS surveys are designed to capture patient experiences, and the results offer an indication of how well healthcare organizations meet patient expectations. The CAHPS program was designed by the Agency for Healthcare Research and Quality to better understand patient healthcare experience and to develop scientifically valid strategies and tools to help organizations improve their quality of care.
The NCQA’s full accreditation standards and guidelines can be found here: http://store.ncqa.org/index.php/accreditation.html?___SID=U.