[Congressional Record Volume 143, Number 19 (Thursday, February 13, 1997)]
[Extensions of Remarks]
[Pages E250-E251]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              THE ACCREDITATION ACCOUNTABILITY ACT OF 1997

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Thursday, February 13, 1997

  Mr. STARK. Mr. Speaker, today I am introducing a bill that requires 
all Medicare-accrediting organizations to hold public meetings and to 
ensure that at least a third of the governing board consists of members 
of the public.
  Healthcare facilities must comply with certain conditions in order to 
participate in the Medicare Program. Through a process termed ``deemed 
status,'' the Health Care Financing Administration relies on 
accrediting organizations to assure that Healthcare facilities are 
providing quality services to Medicare beneficiaries. The Joint 
Commission on Accreditation of Healthcare Organizations is one such 
organization. If a facility is accredited by the joint commission, for 
example, it is deemed to meet Medicare's conditions of participation.
  When facilities are wrongly accredited, Medicare beneficiaries 
suffer. A 1988 Wall Street Journal investigation found that 
``accreditation masks serious failings in possibly hundreds of the 
5,100 hospitals in America that are inspected and approved by the joint 
commission.'' The Journal also reported that many patients died as a 
result of receiving substandard care in hospitals that were considered 
``marginal'' and that ``many accredited hospitals had actually failed 
inspections but remained accredited for months, even years, as they 
sought to correct their problems.''
  At a 1990 hearing, witnesses agreed on the need to improve the 
hospital accreditation process. Participants reported that accrediting 
organizations' survey standards lacked compatibility with Medicare's 
conditions of participation and that follow-up with noncompliant 
facilities was lacking.
  Today, I am focusing on the importance of an accrediting 
organization's accountability to the public. Accrediting bodies should 
be managed and directed by a balanced combination of healthcare 
professionals and community representatives and consumers. Currently, 
many accrediting bodies are directed solely by leaders of the same 
organizations which they accredit. This is nothing more than the fox 
watching the chicken house.
  The joint commission has attempted to increase its commitment to the 
public. Currently, 6 of its 28 accrediting board members are members of 
the public. Although a good start, it is not enough.
  We should reconsider the dependence of accrediting organizations on 
funding and direction from the same healthcare organizations which they 
survey and accredit. A July 1996 report from the public citizen health 
research group charged that the joint commission is ``a captive of the 
industry whose quality of service it purports to measure.''
  Further, the group concluded that the joint commission ``fails to 
recognize the often conflicting interests of hospitals and the public'' 
and puts the interest of healthcare institutions first when conflicts 
arise. I question the credibility of accrediting bodies, because their 
income currently depends on the facilities they are supposed to be 
monitoring. Until a balance of representation is brought to the boards 
which lead accrediting organizations, we cannot assure the interests of 
the public are truly being considered.
  As the number of accrediting organizations increases, so does the 
need for public accountability. For this reason, I am introducing a 
bill that requires all Medicare-accrediting organizations to hold 
public meetings and to ensure that at least a third of the governing 
board consists of members of the public.
  This bill is a first step in assuring quality of care for our 
Nation's Medicare beneficiaries through the accreditation process. I am 
currently working on a more comprehensive bill that will make 
accrediting organizations more accountable--accountable to the public 
as well as to the health care financing administration. The upcoming 
bill will require the following:
  Accrediting organizations must release the status of all accredited 
facilities to the general public within a reasonable time frame.
  HCFA must scrutinize all advertising claims which use data from 
accrediting organizations, and must deny accreditation to all 
healthcare organizations which falsify accreditation-related 
information.
  Accrediting organizations must allow employees of healthcare 
organizations to meet with survey teams off-premises, must accept 
confidential testimony from healthcare workers during surveys, and must 
provide whistleblower protection for workers who report violations of 
accreditation rules.
  Accrediting organizations must publicly disclose all payments 
received from organizations that are being accredited.

[[Page E251]]

  HCFA must work with accrediting organizations to develop a 
comprehensive crosswalk between the organization's and Medicare's 
standards and must resolve any differences.
  Accrediting organizations must notify HCFA when facilities are found 
to be noncompliant and must work with HCFA to assure that hospitals 
promptly correct identified problems and that HCFA is immediately 
informed of these actions.
  Some accrediting organizations are attempting to increase public 
accountability. For example, the joint commission publicly releases 
information about the performance of specific health care organizations 
so that beneficiaries are able to make educated decisions concerning 
their health care providers. the commission also has a site on the 
World Wide Web through which the public will be able to access status 
information about specific organizations by late this year. However, 
the joint commission is only one of the many organizations that 
accredits Medicare facilities.
  The goal of the bill I am introducing today is to begin the debate . 
. . accrediting organizations must be accountable to the public. We 
must guarantee that the public voice is represented in the 
organizations responsible for safety and quality in Medicare's 
healthcare facilities. When this is achieved, we can begin to assure 
beneficiaries that they will receive high quality treatment in all 
Medicare-approved facilities.

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