[Congressional Record Volume 150, Number 102 (Wednesday, July 21, 2004)]
[Extensions of Remarks]
[Pages E1436-E1437]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    INTRODUCTION OF THE MEDICARE HOSPITAL ACCREDITATION ACT OF 2004

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Tuesday, July 20, 2004

  Mr. STARK. Mr. Speaker, I rise today to introduce the Medicare 
Hospital Accreditation Act of 2004. Forty years ago, the Congress 
abdicated the federal government's regulatory responsibilities to 
ensure that hospitals meet Medicare requirements. Congress empowered 
the Joint Commission on Accreditation of Healthcare Organizations 
(JCAHO) with a unique authority to deem hospitals as eligible for 
Medicare payments with minimal government interference. That was 
clearly a mistake. In the decades that JCAHO has had this unsupervised 
authority, serious inadequacies in hospitals have gone unchecked. Our 
current process is not working and it's time for the federal government 
to reassert its authority. This bill would do just that.
  This bill today responds to a report by the Government Accountability 
Office (GAO-04-850) raising serious concerns about the effectiveness of 
the current system used to accredit and oversee hospitals that serve 
Medicare beneficiaries. The investigation, based on a retrospective 
survey of 500 hospitals, indicates that JCAHO failed to detect a large 
number of serious deficiencies subsequently found later by a team of 
government inspectors. These deficiencies are not superfluous. They are 
important, basic minimum standards needed to ensure both a safe 
environment and quality health care. For example, JCAHO accredited 
hospitals with inadequate procedures for preventing the spread of 
infections, inadequate safeguards to assure competent performance of 
physicians and nurses, and hospitals that outright failed to protect 
patients and staff from fire-related disasters. While this survey 
cannot be generalized to the entire hospital community, it implies a 
troubling lack of compliance with important safety standards and is a 
signal for change.
  This is not the first time that problems in the Medicare hospital 
accreditation and oversight process have come to light. In 1990, we 
held a hearing on this issue in the Ways and Means Committee. Gail 
Wilensky, the Medicare Administrator for President George H.W. Bush, 
expressed concern that JCAHO-accredited hospitals displayed serious 
deficiencies when subsequently surveyed by government surveyors. In 
1999, an investigation by the Health and Human Services Office of the 
Inspector General (OIG) concluded that JCAHO accreditation surveys were 
not likely to identify patterns of deficient care. Finally, for the 
past three consecutive years, CMS has found that JCAHO failed to meet 
the CMS performance standard for the hospital survey process. This is 
one more indication of JCAHO's need to improve its performance, and, 
more importantly, the need to increase CMS' authority to oversee JCAHO.

  Despite this body of evidence, until now, the federal government has 
done little to address the problem. This stems in part from the 
original Medicare law passed by Congress in 1965. In that Act, JCAHO 
was granted the authority to ``deem'' hospitals as meeting the Medicare 
conditions of participation and qualify for Medicare payments. As a 
result, the federal agency administering the Medicare program was not 
granted adequate oversight authority. The agency had no authority to 
regularly review JCAHO's surveying processes, to mandate or approve 
changes to the procedures, or to sanction JCAHO for inadequate 
performance. No other accrediting organization is immune from 
government oversight.
  Thus, Congress delegated oversight to a private entity that is 
essentially under the control of the very industry it attempts to 
regulate. In fact, the American Hospital Association and key physician 
groups appoint approximately 70 percent of the JCAHO Board of 
Directors! This special status is even more alarming when JCAHO's role 
in the market is taken into consideration. In addition to its Medicare 
activities, JCAHO accreditation partially or fully substitutes for 
state regulators in 49 states, it certifies VA facilities, and is often 
used by private insurers and plan sponsors as a requirement for plan 
participation and payments.
  The hospital oversight process is comprised of a three-legged stool--
the private Joint Commission on Accreditation of Healthcare 
Organizations (JCAHO), the Centers for Medicare and Medicaid Services 
(CMS) and their delegates at the state level, and the Congress. This 
report shows that each party needs to act to improve patient safety and 
assure that taxpayer dollars are spent in facilities that meet 
Medicare's minimum requirements.
  Along with Senator Charles Grassley, who is introducing companion 
legislation in the Senate, the bill I'm introducing today is the first 
step toward addressing this problem. This legislation would provide CMS 
with the same oversight authority over JCAHO that it has for all other 
national organizations with deeming authority. We may need to do more, 
but this is an important start.

  In addition, the Administration has also agreed to make significant 
improvements under its current, limited authority. Administrator 
McClelland has worked closely with us on this issue and is committed to 
make the needed changes. Establishing a clear chain of command will 
improve accountability, and that is our goal.
  As far as I am concerned, the GAO report indicates that all three 
legs of the hospital oversight process need to be revamped. JCAHO needs 
to improve its ability to assess the extent a hospital is meeting the 
Medicare quality conditions of participation. CMS needs to make better 
use of the limited authority over JCAHO it currently has and be 
prepared to assume increased authority with the passage of this 
legislation. Finally, Congress needs to correct a decision made nearly 
40 years ago to allow the federal government to abdicate its regulatory 
responsibilities to ensure that hospitals meet Medicare requirements.
  I am are here today to announce our bipartisan, bicameral commitment 
to work with each other, our colleagues, the Administration and the 
community to do just that. I encourage my colleagues in the House and 
Senate to support this legislation. It will provide CMS with the tools 
it needs to ensure that Medicare beneficiaries receive quality hospital 
care in a safe environment. The time to act is now. It is a matter of 
life and death.

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