[Congressional Record Volume 144, Number 150 (Tuesday, October 20, 1998)]
[Extensions of Remarks]
[Page E2239]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

[[Page E2239]]



         THE NEED FOR A BETTER HEALTH CARE ACCREDITATION SYSTEM

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Tuesday, October 20, 1998

  Mr. STARK. Mr. Speaker, human rights violations are occurring every 
day in the United States--worse yet, the victims and the Federal 
Government are funding these atrocities. While many nursing homes do an 
excellent job, all too many nursing homes throughout the country are 
not providing adequate care for elderly patients. As the proportion of 
older Americans in the population continues to grow and the number of 
those requiring long term care also rises, we must find a better way to 
improve quality in nursing homes.
  A Special Report on Nursing homes in the October 12, 1998 edition of 
USA Today profiles the devastating conditions in some Florida nursing 
homes. According to the article, the Brian Center in Tampa exemplifies 
the neglect which is all too frequent in the nursing home industry. 
More than a dozen ``residents' rights'' lawsuits, including a class-
action claim, are pending against Brian Center of Tampa. These lawsuits 
accuse Brian Center and its succession of owners and management 
companies of systematic fraud, abuse and neglect orchestrated to 
inflate profits at the expense of vulnerable patients.
  As the USA Today article describes, enforcement lawsuits against 
nursing home owners take up to four months to be heard in court, and an 
additional month to be decided. Fines are limited to $5,000 per 
violation. Nursing homes only need to prove that they have improved the 
conditions of the home by the time of the hearing to defeat the 
enforcement lawsuit.
  There is no substantial punishment for nursing homes which fail to 
adequately care for their patients. Further increasing the likelihood 
of poor care, government and private authorities like the Joint 
Commission on Accrediting Health Care Organizations do not effectively 
inspect facilities to identify existing problems. The date of annual 
inspections are rarely varied by more than a week, allowing nursing 
homes to present a positive example for the inspectors and then return 
to a poor standard once the inspection was finished.
  The Brian Center and similar examples point out the problems with the 
Joint Commission on Accrediting Health Care Organizations, the national 
organization responsible for approving hospitals and nursing homes for 
medicare coverage. The October 19, 1998 edition of The Wall Street 
Journal contains a succinct description of the problems with the 
current accreditation and ranking process for HMO's, ``Who's on 
First?'' by Nancy Ann Jeffery. Both JCAHO and National Committee for 
Quality Assurance accredit HMO's, but each uses a different standard. 
JCAHO itself provides multiple accreditation plans which allows each 
plan to measure their most positive indicators.
  Using different standards for different accreditation renders the 
results of such accreditations useless. The rankings by JCAHO and NCQA 
are not standardized so comparing accreditation reports among provider 
groups is difficult and/or meaningless.
  The Wall Street Journal article also identifies the key flaw in the 
JCAHO type of accreditation: conflict of interest.

       When it comes to policing health-care quality, some groups 
     are afraid to bite the hand that feeds them. In 1994 the 
     Joint Commission rolled out a set of standardized performance 
     measures off hospitals, at a cost of more than $5 million, 
     creating a much sought-after single yardstick for comparing 
     one hospital with another.
       There was just one problem: Some hospitals would look bad. 
     The hospitals balked. So the Joint Commission, with a board 
     dominated by the hospital industry and medical associations, 
     backed off the plan.\1\
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     \1\ Jeffery Nancy Ann, The Ratings Game: Who's on First? The 
     Wall Street Journal. October 19, 1998 pg. R16.

  The Federal Government needs to improve the oversight of accrediting 
organizations to ensure that they are protecting the consumer, and 
providing useful material.

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