GAO Report Finds that JCAHO Failed To Identify Many Deficiencies in Inspections

The Joint Commission on Accreditation of Healthcare Organizations over a three-year period failed to identify "serious deficiencies" at hospitals that were later found by state inspectors, "potentially compromising patient safety," according to a Government Accountability Office report released on Tuesday, the AP/Indianapolis Star reports. JCAHO, a private organization in large part comprised of health care professionals, accredits most U.S. hospitals through regular inspections (Sherman, AP/Indianapolis Star, 7/21). Under current law, hospitals accredited by JCAHO are automatically considered eligible for Medicare reimbursements. JCAHO accredited more than 4,200 hospitals in 2002, and those facilities received about 90% of the $109 billion that Medicare spent on hospital care that year, according to the GAO report.

Based on a survey of 500 hospitals inspected by JCAHO between 2000 and 2002, the report found that the organization failed to identify 167 of the 241 deficiencies state inspectors later found at the facilities, or 69% of the total. Deficiencies that JCAHO failed to identify included a serious infection-control problem at a California hospital that had no system to ensure sterilization of medical instruments and a Texas hospital that administered medication without orders from a physician, according to the report. In addition, the report found that 87 of the deficiencies JCAHO failed to identify were related to the physical environment at hospitals, such as fire prevention and safety. "JCAHO did not detect 81% of the serious physical environmental deficiencies identified by state surveyors," the report said (Bell, Baltimore Sun, 7/21). JCAHO denied accreditation to only three of the 500 hospitals surveyed in the report (Heil, CongressDaily, 7/21). The report said that "one serious deficiency in any one of these hospitals could limit its ability to provide adequate care to patients" (Baltimore Sun, 7/21).

JCAHO officials called the GAO report "inflammatory" and "grossly inaccurate" (CongressDaily, 7/21). They added that the report was limited to 500 hospitals and that "it would be unfair to extrapolate the report's findings to the nation's hospitals as a whole," according to the Sun. According to JCAHO officials, the report also did not consider deficiencies identified by the organization that state inspectors failed to find. JCAHO also recently implemented a new inspection process that relies less on paper documentation and more on personal interviews and in 2006 plans to begin to conduct only unannounced inspections, organization officials said (Baltimore Sun, 7/21). JCAHO President Dennis O'Leary said, "In our view, it is irresponsible to alarm the public using statistics that have little meaning" (AP/Indianapolis Star, 7/21). He added that GAO report used "a flawed study methodology and erroneous, alarming statistics that seriously mislead the public" (Carey, CQ Today, 7/20).

In response to the GAO report, a bipartisan group of lawmakers on Tuesday introduced a bill under which CMS could restrict or remove the authority of JCAHO to accredit hospitals. Senate Finance Committee Chair Chuck Grassley (R-Iowa), a main sponsor of the legislation, said, "Congress expects the Joint Commission to be a consumer watchdog on behalf of patients. Instead -- it looks like the Joint Commission is a lap dog" (CongressDaily, 7/21). However, Grassley and Rep. Pete Stark (D-Calif.), a House sponsor of the bill, said that the GAO report should not prompt patients to avoid hospitals (Baltimore Sun, 7/21). Stark added, "There's a lot of institutional experience in JCAHO -- there's no use in throwing that away." Grassley said that the Senate Finance Committee plans to mark up the bill and could reach the Senate floor for a vote this year. Stark added that the legislation could reach the House floor for a vote this year (CongressDaily, 7/21). CMS Administrator Mark McClellan said that the agency agreed with the GAO report (AP/Richmond Times-Dispatch, 7/21). The report is available online. Note: You must have Adobe Acrobat Reader to view the report. NPR's All Things Considered on Tuesday reported on the GAO report. The segment includes comments from Grassley, O'Leary and Stark (Rovner, "All Things Considered," NPR, 7/19). The complete segment is available online in Windows Media and RealPlayer.