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There are 3 certainties in Medicine.
- All bleeding will stop eventually
- And The Joint Commission will come.
I know there are many turtle riders that are nurses, like myself, who will understand this and laugh, but the other 18,000 riders are probably asking themselves what The Joint Commission is and why we are made to jump through hoops to appease these people. It will be my job here to try to boil down the dog and pony show that is survey and why it’s another scam.
The Joint Commission (TJC) is a United States-based nonprofit tax-exempt 501(c) organization that accredits more than 20,000 health care organizations and programs in the United States. A majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement.
Every 3 years, more than 20,000 hospitals have to be accredited by The Joint Commission in order to keep the ability to bill Medicare and Medicaid for services provided to patients who are eligible for these programs. Both of which are Federal Government programs. 90% of peoples on these programs are geriatric, with the rest being on some form of disability. Generally these people are not in the best health and require rather extensive care. So why is a tax exempt organization surveying hospitals for the government?
In 1965 the federal government decided that a hospital that met Joint Commission accreditation met the Medicare Conditions of Participation. The Joint Commission’s hospital accreditation program would be subject to Centers for Medicare and Medicaid Services (CMS) requirements for organizations seeking accrediting authority. To avoid a lapse in accrediting authority, The Joint Commission would have to submit an application for hospital accrediting authority consistent with these requirements and within a time frame that would enable CMS to review and evaluate their submission. CMS would make the decision to grant deeming authority and determine the term.
CMS is a fancy name for the Feds. It’s the branch of the federal government that manages the care for patients on these programs. They dictate re-imbursement rates for hospitalizations and surgical procedures. Usually these re-imbursement rates are significantly less than what the hospitalization usually costs. Therefore these patients are pushed out of the hospital quicker, while tending to be sicker on admission. These low re-imbursement rates and quick discharges lead to a vicious cycle of re admission. Except that CMS will not pay for readmissions for the same issue within 30 days of discharge. Why does the government come up with these standards then allow someone else to enforce them? Especially an entity that was built to police itself.
The Joint Commission on Accreditation of Hospitals was created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association
This is a tax free entity made by the hospitals, to oversee themselves.
The stated mission of The Joint Commission 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”
This is all well and good except that there are numerous claims that the surveyors are too chummy with Hospital Administrators and tend to overlook serious issues. The Joint Commission used to have a nasty habit of letting hospitals know when surveyors are coming for inspections, which take place every three years. That notice allowed hospitals to hire extra workers, staff wards with more doctors and nurses, and spruce up hospital grounds. Only in 2006 did they begin “unannounced” surveys. But those of us that work in hospitals, that staffing ramps up miraculously so we aren’t short staffed, the floors get waxed and polished, and the linen carts are fully stocked. Clearly hospital administration feels that it’s ok for us to work short the other 51 weeks of the year, but that’s none of my business.
The best part if the whole ordeal is that WE, as a hospital pay them to come to our hospital.
The Joint Commission publishes an average fee of US$ 46,000 for a full hospital survey. Reimbursement for surveyors’ travel, living expenses and accommodations is required in addition to the fee .There may be additional costs related to consultancy work etc. directed towards assisting a hospital to be successful in the accreditation process.
That’s right, each hospital that is accredited by The Joint Commission pays them nearly 50K for them to come and see their stocked linen carts, shiny linoleum floors and properly staffed units. You know they aren’t eating at McDonalds and aren’t sleeping at the Worcester City Motel. I guess you pass if you book them nice hotel rooms and feed them 111 Chop House for their entire survey. And for what? Just to keep the feds out of the building? Just so you can bill Medicare for Granny Turtle’s broken hip? And just so that hospital administration can turn around and say “Yay!!! We’re accredited!! But no raises this year because we just paid a bunch of useless suits a shitload of money so we can put more words on the letters no one reads”
This is what happens when there are too many managers and you need to justify their existence. They create fancy terms and mission statements like this “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.” Tell me what any of that means please. Because all I’ve ever seen a surveyor do is flip through a chart and watch me give Cindy Loo Who some medications. There has not been one study that has shown The Joint Commission making any improvement in healthcare.
Maybe I’m just being cantankerous, or maybe I find it insulting that we need a “commission” to tell me that I’m taking good care of my patients. Clearly TurtleNurse isn’t going to re-write federal healthcare laws. But I feel like there needs to be a rehauling of how it goes about. Why are we paying these people who report an annual income of 118 Million dollars to come and say our floors could maybe be shinier or that the hallways could smell more like flowers and cupcakes?
It’s a typical government shitshow and it interferes with care. It’s up to the hospitals to staff the floors correctly year round. To give us the supplies we need year round. How much money could we save? How much stress could be taken off medical staffs shoulders? I don’t know the answers to these questions. But it’s something to think about.
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