Anyone familiar with the healthcare industry knows that managed care, mergers, restructuring and cost-containment are the buzzwords of the last decade. Healthcare has evolved into a money-making venture, often resulting in cutthroat competition between healthcare providers for lucrative managed care contracts.

Who is watching out for patients? The only organization that has the authority in most states to oversee hospital quality is the Joint Commission on the Accreditation of Healthcare Organizations (JCHAO).

JCAHO is a private organization created in 1951 to provide voluntary accreditation to hospitals. In 1964, it began charging hospitals for the surveys it performed. In 1965, Congress passed amendments to the Social Security Act stating that hospitals accredited by JCAHO are "deemed" to be in compliance with most of Medicare's "Conditions of Participation for Hospitals" and therefore are able to participate in Medicare and Medicaid. This means that by passing a JCAHO inspection, a hospital is eligible for millions of federal healthcare dollars. Many states, too, rely on JCAHO accreditation as a substitute for their own inspection programs.

Today, JCAHO accredits more than 80 percent of the nation's hospitals. It also accredits home health agencies, clinical laboratories, ambulatory surgical centers and hospices.

But JCAHO is run by the very entities it is supposed to oversee. Hospitals pay for JCAHO surveys, and more than 70 percent of JCAHO's revenue comes directly from the organizations it is supposed to inspect.

There are also other problems with JCAHO's regulatory accreditation process. Hospitals and other healthcare providers are notified weeks or months in advance that a JCAHO survey team will be arriving--giving the provider plenty of time to make cosmetic changes, prepare staff to answer questions, update patient and personnel records and increase staff levels. Although JCAHO encourages workers to speak with survey-takers, most workers do not have legal protection from retaliation if they do so.

AFT Healthcare is leading a coalition of AFL-CIO unions to improve the JCAHO survey process. JCAHO has responded positively, at least in part. At our urging, JCAHO recently announced a new, unannounced survey process and is revising its nurse staffing plan guidelines.

If you would like to know if your hospital is part of the current round of surveys, or if you know your hospital is going to be surveyed soon and you wish assistance in how your union can make an impact on the JCAHO survey process, please contact us.

On the right are some resources which help explain what JCAHO is, how the accreditation process works, and how the new accreditation procedure will be implemented.