[Congressional Record Volume 150, Number 101 (Tuesday, July 20, 2004)]
[Senate]
[Pages S8482-S8483]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRASSLEY (for himself and Mr. Baucus):
  S. 2698. A bill to amend title XVIII of the Social Security Act to 
revoke the unique ability of the Joint Commission for the Accreditation 
of Healthcare Organizations to deem hospitals to meet certain 
requirements under the medicare program and to provide for greater 
accountability of the Joint Commission to the Secretary of Health and 
Human Services; to the Committee on Finance.
  Mr. GRASSLEY. Mr. President, I rise today to speak to an issue that 
is vitally important--hospital safety. For too long, the Federal 
Government has not had the appropriate oversight authority to assure 
safety in our Nation's hospitals.
  I am proud to introduce the Medicare Hospital Accreditation Act, 
bipartisan legislation that will give the Centers for Medicare and 
Medicaid Services (CMS) the same oversight capacity over hospital 
accreditation that it has over all other health care accrediting 
bodies.
  The Joint Commission for Accreditation of Health Organizations 
(JCAHO) is a private, not-for-profit organization. In 1965 Congress 
granted JCAHO ``deeming authority'' for Medicare certification under 
Section 1865 of the Social Security Act. This sweeping authority gave 
hospitals accredited by JCAHO the ability to participate in Medicare 
with minimal CMS oversight. Since then, JCAHO has accredited most of 
our Nation's hospitals--over 80 percent in 2002. No other health care 
accreditation program has had this same statutory exception.
  Congress gave JCAHO an important role to detect and correct problems 
that directly affect the lives of patients in hospitals. Congress, CMS 
and in turn the American people, rely upon JCAHO's work to ensure the 
quality and safety in our Nation's hospitals.
  JCAHO's own mission claims to continuously improve the safety and 
quality of care provided to the public through the provision of health 
care accreditation.
  Unfortunately, JCAHO was entrusted with this responsibility without 
the necessary checks and balances so crucial to a government responsive 
to the needs of the people it serves.
  This GAO report is only the most recent evidence showing problems 
with the Joint Commission. In June of 1990, the GAO found that CMS, 
which was then called the Health Care Financing Administration (HCFA), 
needed to reevaluate the criteria used to evaluate the JCAHO's survey 
process and recommended that HCFA establish a means to detect 
significant differences between state agency and Joint Commission 
surveys.
  In May of 1991, the GAO published a report titled ``Hospitals with 
Quality-of-Care Problems Need Closer Monitoring'' and recommended that 
HCFA closely monitor the Joint Commission's follow-up of hospital 
efforts to correct deficiencies it found related to Medicare conditions 
of participation.
  Then in 1999, the Inspector General for the Department of Health & 
Human Services also raised serious concerns. The IG looked at how well 
the Joint Commission identified deficiencies in hospitals and found 
that the Joint Commission's surveys were not likely to identify 
patterns of deficient care.
  Today's GAO findings are likewise significant. Over the course of 3 
years--

[[Page S8483]]

between 2000 and 2002--500 hospitals were surveyed by both JCAHO and by 
a state survey agency on behalf of CMS. According to the GAO, a 
comparison of these surveys revealed that the state surveys often found 
serious deficiencies--serious deficiencies that went overlooked or 
unnoticed by JCAHO.
  In fact, the GAO found that out of the 157 hospitals found with 
serious deficiencies, JCAHO identified only 34. In other words, 
compared to state surveyors, JCAHO missed hospitals with deficiencies 
78 percent of the time.
  A hospital that prepared and administered drugs in violation of 
federal and state laws is just one example of a serious deficiency 
found by a state agency, but missed by JCAHO in its 2000 survey.
  Serious deficiencies found by state agencies but missed by JCAHO 
represent a pattern of deficient care--not merely isolated incidents. 
Unlike isolated incidents, a pattern of deficient care raises grave 
concerns because of the potential to place dozens of lives in danger, 
involving for example a floor or entire wing where many hospital 
patients are receiving their care.
  Because JCAHO's hospital ``deeming authority'' is statutorily 
mandated, CMS cannot terminate this authority. Today, we are taking the 
first step to give CMS the same oversight capability over JCAHO that it 
has over all other health care accrediting organizations.
  This legislation will give CMS the authority and responsibility to 
hold JCAHO accountable and, if necessary, restrict or remove its 
hospital accreditation authority. It will bring uniformity to the 
health care accreditation process and will provide a more effective 
chain-of-command. JCAHO will have to answer to CMS--as it does in other 
sectors of health care accreditation.
  The GAO recommends that Congress grant CMS greater oversight over 
JCAHO's hospital accreditation process. CMS agrees. JCAHO agrees. My 
colleague from across the aisle and across the Capitol, Congressman 
Stark--who as we speak is introducing the companion bill in the House 
of Representatives--agrees with this finding.
  I urge your support for this much-needed legislation.
  Mr. BAUCUS. Mr. President, I rise to call my colleagues' attention to 
a very important matter--the safety of America's hospitals. This is an 
issue that affects every State and people of all political beliefs. In 
an effort to keep American hospitals safe and ensure they provide 
quality health care, Chairman Grassley and I are introducing the 
Medicare Hospital Accreditation Act of 2004, which is simultaneously 
being introduced by our colleagues in the House of Representatives.
  As I can attest through personal experience, America's hospitals 
provide outstanding health care. Every day, thousands of people receive 
the treatment they need from dedicated and highly competent hospital 
staffs working in well-run hospitals across the country.
  But confidence in our hospitals should not be confused with 
complacency. Every so often, someone from outside a hospital must come 
in to each facility and look under the hood, so to speak, to read 
through patient charts, check clinical practices and to make sure that 
sprinklers are working and stairways are sound. We have put our trust 
in accrediting organizations to identify problems in hospitals so that 
they may be corrected and quality and safety improved.
  Most hospitals are accredited by the Joint Commission on 
Accreditation of Healthcare Organizations (JCAHO), which has been 
accrediting hospitals for over 50 years. When JCAHO accredits a 
hospital, that hospital is deemed to be in compliance with the 
conditions of participation for Medicare. As today's report by the 
Government Accountability Office (GAO) shows us, JCAHO's record of 
identifying problems in hospitals is far from perfect. Furthermore, the 
GAO points out that government has little oversight authority over 
JCAHO's hospital accreditation process. Less oversight authority, in 
fact, compared to accrediting organizations for other kinds of 
healthcare facilities.
  While the GAO's findings are a reason for concern, the report does 
not mean that American hospitals are unsafe. But it does send a clear 
message--one that the Congress and the Administration should heed--that 
there is room for improvement in identifying problems at hospitals. 
Given my commitment to keep hospitals as safe as possible, I view the 
GAO's recommendations as a call to action.
  Therefore, I am pleased to join Chairman Grassley in introducing 
legislation to remove JCAHO's unique status as an accreditation body 
and to give the Centers for Medicare & Medicaid Services (CMS) the same 
authority over JCAHO's hospital accreditation that it already has with 
respect to the accreditation of other healthcare facilities. Putting 
all accrediting organizations on equal footing will result in better 
accreditation and better healthcare facilities for everyone. Expanding 
oversight by CMS of JCAHO's hospital accreditation will help improve 
the process, keep patients safe and ensure that hospitals continue to 
perform to our expectations.
  The legislation we're introducing today is bipartisan and bicameral. 
I urge my colleagues to join us in co-sponsoring this bill and working 
together to get it passed.
                                 ______