Ch. 16 Accreditation, Certification, and Licensure Process Flashcards
Exam 4
What is accreditation?
Process by which the performance of an organization is measured against nationally accepted standards of performance
Is accreditation voluntary?
Yes
Standards and requirements of QM plan …
varies and can be written or not.
- Must have a policy in place to implement
Payment models are changing from ______ to a _____
Fee for service –> value based payment model
What is a value-based payment model??
Payments based on the achievement of measure-based quality goals
If a healthcare organization chooses to meet multiple standards and/or regulations, which requirements should they follow?
The one with the most stringent
Overall accreditation status is calculated based on… (2)
- Clinical performance
- Member satisfaction (via survey)
Facility Certification
Grants approval for healthcare organization to provide services to specific group of beneficiaries
Practitioner Certification
show significant achievement of being skilled and knowledgeable in specific area
Are licensure voluntary?
NO; REQUIRED
What is licensure?
Granting a HC org/provider permission to provide services of a defined scope in a limited geographical area
When are licensure facilities evaluated?
On an annual basis by state health department
Is there a standard review survey process?
No, depends on the individual accreditor agency
What is a solid accreditation and licensure infrastructure?
Having a big window of when JC comes so that quality metrics are maintained so org is ready for an inspection at any time
What are the JC accreditation standards?
Assesses the alignment of an institution’s practices, policies, procedures, and documentation with its standards of performance
~270 standards
Is JC accreditation announced or unannounced?
unannounced every 3 yrs
JC surveyors will come with knowledge of the….. (4)
- Midpoint assessment action plan
- Any consumer complaints
- Previous accreditation data
- Core measure data
JC Survey Process (3 steps)
- Opening Conference (outline, interviews, meeting with leaders)
- Onsite survey
- Exit Conference (summarize findings and deficiencies)
JC survey team composition
Composed of many types of ppl (MD, RN, Admin, state licensing agency rep, etc)
JC accreditation process length
Depends on site or org but between 3-5 days
What is tracer methodology?
Evaluates standards compliance and tracks several patients throughout an organization’s complete healthcare delivery process to pinpoint performance issues in one or more steps of the care process.
Tracer Methodology High-Risk Process/Areas (4)
- Medical management
- Infection control
- Data management
- Restraints
CMS CoP certification
Requires hospitals to submit >60 measures in addition to HCAPHS survey results
(long-term care, phys care, dialysis centers, etc)
JC Accreditation Categories: Best to worst (5)
- Accredited
- Accreditation with FU survey
- Contingent Accreditation
- Preliminary denial of accreditation
- Denial of accreditation
