[Congressional Record (Bound Edition), Volume 145 (1999), Part 9]
[Extensions of Remarks]
[Page 12557]
[From the U.S. Government Publishing Office, www.gpo.gov]



                         HOSPITAL ACCREDITATION

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, June 10, 1999

  Mr. STARK. Mr. Speaker, Healthcare facilities must comply with 
certain conditions in order to participate in the Medicare program. The 
Health Care Financing Administration relies on accrediting 
organizations to certify that healthcare facilities provide quality 
services to Medicare beneficiaries. The Joint Commission on 
Accreditation of Healthcare Organizations (JCAHO) is one such 
organization. A facility that receives JCAHO accreditation 
automatically meets the Medicare Conditions of Participation.
  I believe that there is a serious conflict of interest between the 
mission of accrediting agencies and their internal governance. 
Currently, the majority of members of these governing boards are 
representatives of the very industries that the agency accredits. While 
the accrediting agencies are likely to object and claim that the 
members of their governing boards are beyond reproach, I remain 
skeptical and wish to establish several basic checks and balances.
  Because accrediting agencies have a prominent role in certifying 
Medicare facilities, I believe that we have a vested interest to ensure 
that the accrediting process is as rigorous and quality-oriented as 
possible. Doing so will help ensure that all citizens may expect high-
quality, safe, and effective medical treatment at any medical facility 
they use.
  Others share my skepticism. A July 1996 report from the Public 
Citizen Health Research Group charged that the JCAHO is ``a captive of 
the industry whose quality of service it purports to measure'' and 
``fails to recognize the often conflicting interests of hospitals and 
the public''.
  In my home state of California, 29 JCAHO-approved hospitals had 
higher-than-expected death rates for heart attack patients. In some 
cases the rate was as high as 30-40% compared to a state-wide average 
of approximately 14%. What is particularly troubling is the fact that 
two of these hospitals received JCAHO's highest rating.
  In an analysis of New York hospitals, the non-profit Public Advocate 
presents strong evidence that hospitals circumvent JCAHO's annual 
announced survey visits--simply by hiring extra staff to make 
operations look smoother than they really are. In too many cases, the 
report finds that JCAHO's accreditation scores mask the truth--some 
accredited hospitals do not meet basic standards of care. For example, 
15 accredited hospitals showed problems ranging from substantial delays 
in treatment of emergency room patients to outdated and broken 
equipment to overcrowded, understaffed clinics and unsanitary 
conditions.
  Given the critical role of health care facilities to our society, we 
must ensure that these facilities and the agencies that certify them 
are held publicly accountable. For this reason, I am introducing a bill 
that requires all Medicare-accrediting organizations to hold public 
meetings and to ensure that half of the governing board consists of 
members of the public.
  The intent of the bill I am introducing today is to ensure the 
accountability of accrediting boards--to guarantee that the public 
voice is represented in the organizations responsible for the safety 
and quality in Medicare's healthcare facilities. With these checks and 
balances we can assure all patients that they will receive high quality 
treatment in all Medicare-approved facilities.
  This bill has two simple provisions. First it requires that half of 
the members of an accrediting agency be members of the public who have 
been approved by the Secretary of Health and Human Services. These 
individuals are specifically prohibited from having a direct financial 
interest in the health care organizations that the agency certifies. 
Second, the legislation would require all meetings of the governing 
board be open to the public.
  Medicare and health care organizations operate in the public trust. 
Our tax dollars fund all Medicare benefits delivered by health care 
organizations as well as countless other medical benefits and programs. 
Therefore, the accreditation and certification of hospitals and other 
health care organizations must represent the interests of the public.




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