Accreditation, certification, licensure process Flashcards
do institutions know when JC coming to review if they are following guidelines
try to surprise them, so they have exp to always in regulation
accreditation
voluntary process by which perform . of an org is measured against national SOC of perform.
compare plan to perform.
there is financial incentive to be accredited
accreditation plan
HC org explains their method of fulfilling quality management activities
what has happened in past decade?
explosion of quality metrics
DNV required plan
org will outline methodology, prace, for addressing quality and perform. are measured, analyzed and continually improved
does TJC require written plan
no but systemic approach need to be present
payment models
move away from fee for service, towards value based payment
value based purchasing program
take percentage of Medicare payment at risk, depending on comparative Q perform.
all federal plans offer through ACA must
be accreditated
calculated based on clinical perform. and member satisfication
If a healthcare organization
chooses to meet multiple
standards and/or regulations,
which requirements should
they follow?
meet the tougher standard
certification - facility
grant approved for HC org to provide services to specific group of beneficiaries
must meet COP to receive Medicare/Medicaid funding
practitioner certification
show achievement of being skilled, and knowledgeable
ABMS is leader in gold standards for physician specialties
ex: board certified
licensure
act of granting a HC org or individual HC provider permission to provide services of a defined scope in a limited geo area
is illegal when services are provided without
who issues licenses
state gov, evaluate on annual basis- publish report cards
what voluntary?
certification, accreditation
licensure is mandatory
accreditatino/licensure survery
review bodies drop in scheduled and unannounced to review the infrastructure of HC org, puts pressure to maintain at all times,
can’t scramble licensure process before review
survey process
check facility leadership/staff- continuing PI in org, tied to org strategic plan
no standard review process
voluntary process- more flexible
government process- more bureaucratic
JC accreditation standards
270 standards with 2000ish elements under the standards
Assesses the alignment of an institution’s
practices, policies, procedures, and
documentation with its standards of
performance
JC survey process
opening conference - outline schedule of activities, identify individuals to be interviewed, leader provide overview of org mission
preliminary report - noting deficiencies
exit conference - summarize finding, explain deficiencies, will come back to check
who is JC survey team
experts- physicians, nurses, admin, clinicians, state licensure agency rep,
length of survey process depends on
size of org (3-5 days)
tracer methodology
assess standard compliance, follows number of pts through org entire HC delivery process to identify perform. issues in all step of care process
only answer their Qs, don’t expand
high risk process for tracer methodology
medical manage
infection control
data manage
restraints
JC accreditation categories
accredited
Accred with follow up survey (30 to 6 mo)
contingent accred (1 yr)
preliminary denial of accred (sig noncompliant)
denial of accred
CMS COP certified
requires hosp submit more than 60 measures
require measures for long term c are, physician services, dialysis centers
deemed status
if fed gov wants to provide Medicare/MEdicaid reimbursements, will deem authority status to other accred bodies and if you meet their standards, then CMS wont’ check themselves, and will trust the accred body decision
CMS COP unannounced survey
they hear of specific problem/comlpaint, drop in to inspect
certification and licensure of long term care
usually unscheduled reviews
look for three trigger issues: dehydration, ulcers, fecal impaction
rehab care - CARF accred
three surveyors, flexible process, tailored to pt care and community og interest
CARF survey process
opening conf- accessible to all communities of interest
doc review
interviews
exit interview with org leaders
DNV HC accred
alt option, more friendly, more flexible.tailored
have deemed status
