HOSPITAL OVERSIGHT: HHS Report Cites Major Deficiencies
A two-year study by the HHS Office of the Inspector General released yesterday found "major deficiencies" in hospital oversight and recommends the federal government take a more active role in improving quality and accountability. "Our study shows the current system of hospital oversight has important strengths that help protect patients, but the system -- a combination of private accreditation and state certification -- also has significant weaknesses that must be addressed," said Inspector General June Gibbs Brown. The report notes that the nation's 6,200 hospitals rely on two types of review to meet the requirements for participating in Medicare: accreditation by the Joint Commission on the Accreditation of Healthcare Organizations (80%) and certification by state government agencies (20%). The study found that the JCAHO surveys "help reduce risk and foster improvement in hospital care but are unlikely to detect substandard patterns of care or individual practitioners with questionable skills." Specifically, the report criticizes the JCAHO's "collegial" approach to oversight, rather than a more regulatory approach (HHS release, 7/20). The JCAHO's board is "dominated by representatives of hospitals and other health care groups," the Boston Globe reports. "The emerging dominance of the collegial mode may undermine the existing system of patient protection," Gibbs Brown concluded (Knox, 7/21). George Grob, the deputy inspector general who oversaw the report, said, "They could not detect a flaw that the hospitals did not want them to detect" ( AP/Baltimore Sun, 7/21). The report also revealed that state oversight agencies "rarely conduct routine, not-for-cause surveys of nonaccredited hospitals." Gibbs Brown recommends that HCFA take a more active role in steering external reviews of quality to ensure a balance between the collegial and regulatory modes of oversight.
Back and Forth
In a written response, the American Hospital Association disagreed that the "oversight pendulum must swing back towards the punitive mode." Chief Legal Counsel Mary Grealey said, "I think the question is: What is the value of the collegial approach versus the 'gotcha,' policeman approach? It's a fine balance, and we need to collaborate on improving things" (Globe, 7/21). Calling the report's findings "unfounded and not substantiated," JCAHO President Dennis O'Leary said, "The educational thrust embodied in a collegial orientation is the most critical election in achieving lasting improvement" (AP/Sun, 7/21). But Dr. Sidney Wolfe of the Public Citizen Health Research Group said, "If you announce well in advance that you are going to do a survey, allow the hospital to hand-pick most of the medical records which are going to be reviewed ... and view the hospital as a 'customer' rather than an institution which must be regulated, it is not likely you will discover the serious, often life-threatening problems which exist in many hospitals. After reading all these reports, we are all the more convinced that the external review of hospitals should be conducted by a publicly accountable body" (Fox, Reuters/Nando Times, 7/21).