Accreditation Services: Finding the Right Fit

Accreditation

By: Irene Tsikitas

Published: 7/5/2010

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6 things to look for when evaluating which of the 4 accrediting bodies is best for your facility.


How do you know which accrediting body is best for your facility? Is it the prestige associated with the organization, a sense that you can meet the standards, or other factors such as cost and survey methodology? Whatever the criteria, few relationships are more intimate, important and potentially delicate as that of you and your accreditation surveyor. Whether you're in the estimated 30% of unaccredited ASCs or are thinking about changing agencies, here's what to look for in an accreditor.

1. Standards. Before you apply, assess your facility to ensure you're able to comply with the standards of the organization you're considering, says Debra Stinchcomb, RN, BSN, CASC, of Progressive Surgical Solutions in Poway, Calif. Consider how they're structured: Do the standards spell out exactly what your facility must do to be in compliance, or do they leave implementation largely up to your own interpretation? Do they reflect your practice setting? How often are they updated?

The Healthcare Facilities Accreditation Program (HFAP) standards, which closely mirror CMS requirements, were a big selling point when Evansville (Ind.) Surgery Center Associates switched its accreditation provider about 3 years ago. "We found it mimicked the Medicare rules and regulations nicely," says Administrator Cathy Head, RN, MHA, CASC, of HFAP, making it "a nice fit" for her hospital-affiliated center. David Watts, MD, of Watts Plastic Surgery Association in Vineland, N.J., says he chose the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) because he found its standards to be particularly rigorous. "I felt their standards were a higher degree of quality," recalls Dr. Watts, now an AAAASF inspector himself. "It may require a little more work on our end, but the thing we're most concerned about is patient safety."

2. Survey methodology. Once you've examined the standards by which your facility will be judged, consider how the accreditor will determine whether you're meeting those standards. Surveyors for the Joint Commission and the Accreditation Association for Ambulatory Health Care (AAAHC) are employees of those organizations, while surveyors for AAAASF and HFAP are more like contractors. All 4 organizations hire surveyors with hands-on experience in the field as physicians, nurses or administrators in ambulatory surgery settings. They also all employ a survey methodology that combines a review of documented policies and procedures with observation of patient care and interviews with staff.

Ultimately, your experience with a particular body may rest with "the surveyor that walks through your doors," says Sandy Berreth, RN, MS, CASC, administrator of the Brainerd Lakes Surgery Center in Baxter, Minn. "The biggest reason why I went with one vs. another vs. another is that I looked at the relationship that the surveyors have with the organization that they're going to be surveying," says Ms. Berreth, who chose AAAHC for her facility and is now a surveyor herself. "I want it to be a learning and growing type of relationship, not a punitive type. I want to learn from the surveyors."

Assessing the Accreditors

Here's a brief look at 4 organizations that offer accreditation services for ambulatory surgery facilities and have deeming authority from the Centers for Medicare and Medicaid Services. Each comes with its own set of standards, including all the Medicare rules and regulations, plus any additional standards set by the accrediting body. The fifth organization, the Institute for Medical Quality, originated as a state-specific accreditor for California but is now recognized in states across the country. IMQ does not have Medicare deeming authority but says it's actively pursuing it.

— Irene Tsikitas

The Joint Commission
www.jointcommission.org
Established: Ambulatory Care Accreditation Program established in 1975.
No. of accredited facilities: More than 1,850 freestanding ambulatory care facilities, 45% to 50% of which are ASCs.
Surveyor profiles: Surveyors are employees of the Joint Commission, conduct 40 to 125 surveys per year and have at least 5 years of leadership experience in an ambulatory care organization.
Surveyor method: All deemed status surveys are unannounced; accreditation surveys are announced and scheduled ahead of time.

  • Using the "tracer method," surveyors spend about two-thirds of the site visit following patients along the continuum of care and interacting with staff.
  • Facilities presented with a summary of findings at the conclusion of survey; notified of final accreditation decision within 5 days of successful completion of post-survey steps.
  • From application to receipt of accreditation, the entire process (except on-site survey) is conducted electronically.

Accreditation terms: 3 years for all initial customers.
Pricing: Survey fee plus annual fees spread over 3 years:

  • $9,635 for facilities with up to 5,000 annual patient visits;
  • $14,515 for facilities with 5,001 to 10,000 annual visits; and
  • $17,245 for facilities with more than 10,000 annual visits.

Accreditation Association for Ambulatory Health Care
www.aaahc.org
Established: 1979
No. of accredited facilities: Nearly 5,000 ambulatory healthcare facilities, almost 50% of which are ASCs and office-based surgery centers.
Surveyor profiles: Highly skilled healthcare professionals with knowledge of the ambulatory field, including physicians, nurses and administrators. As of 2010, all surveyors are employees of AAAHC.
Surveyor method: All deemed status surveys are unannounced; accreditation surveys are announced and scheduled ahead of time.

  • During on-site visits, the survey team holds an opening conference with the organization, tours the facility, interviews staff, looks at policies and medical records and ends with a summation conference during which the team reports findings to the organization.
  • Survey reports are reviewed by an accreditation committee, which conducts an official peer review and renders an accreditation decision.

Accreditation terms: Vary from 6 months or 1 year for facilities in "partial compliance" to 3 years for facilities in "substantial compliance."
Pricing: Accreditation survey costs about $3,800 for a small office-based surgery setting; a median of $10,000 for a smaller ASC. (AAAHC doesn't post exact pricing information)

American Association for Accreditation of Ambulatory Surgery Facilities
www.aaaasf.org
Established: 1980
No. of accredited facilities: More than 1,400 U.S. ambulatory surgery facilities.
Surveyor profiles: Physicians and nurses trained by AAAASF.
Surveyor method: All inspections are announced, except emergency inspections conducted in response to untoward events or incident reports.

  • During on-site reviews, inspectors go through the entire standards manual, review charts and other records, and interview physicians, nurses and staff independently.
  • Findings are reported to a committee; facilities have 30 days to make any necessary corrections; committee awards accreditation.

Accreditation terms: 3 years, contingent upon facilities conducting and submitting twice-annual peer reviews and annual self-inspections.
Pricing: Regular annual accreditation annual fees range from $750 to $6,885 based on facility size and classification.

  • Medicare accreditation annual fees range from $1,655 to $7,410 based on the number of specialists and specialties.

Healthcare Facilities Accreditation Program
www.hfap.org
Established: Maintained deeming authority from CMS since 1965; began accrediting ASCs in 2000.
No. of accredited facilities: Between 400 and 500 ambulatory surgery facilities, including hospital-based and office-based facilities, and 16 freestanding ASCs.
Surveyor profiles: Survey teams are led by a physician and also include nurses and/or administrators. Surveyors are independent contractors of HFAP.
Surveyor method: All surveys are unannounced.

  • Typical 2-day survey involves direct observation of facility staff and leadership, review of documentation (medical records, meeting minutes, bylaws), completion of 16-page CMS infection control worksheet and observation of a patient from pre-op through surgery and recovery.
  • Survey reports are reviewed by HFAP staff, which send any deficiencies back to the facility for corrective action.

Accreditation terms: 3 years.

  • Interim accreditation lasting no longer than 12 months may be issued to facilities that generally meet the standards but need more work to be fully compliant.

Pricing: Triennial fee for ASCs and office-based surgery centers is $4,000, paid upfront when they apply. 3-year accreditation costs approximately $10,600.

Institute for Medical Quality
www.imq.org
Established: Ambulatory Care Review program established in 1996.
No. of accredited facilities: More than 300 facilities in California, 90% of which are office-based surgery centers and ambulatory surgery centers.
Surveyor profiles: Physician surveyors, matched to the specialty of the organization being reviewed, have extensive ambulatory care experience and are familiar with government regulations and patient needs.
Surveyor method: All surveys are announced and scheduled ahead of time. Facilities undergoing for-cause surveys are informed 24 hours in advance.

  • During on-site visits, the survey team holds an opening conference with the key members of the organization, tours the facility, interviews staff, and reviews credentialing files, personnel files, medical records, policies and procedures. At the end of the day the team reports its findings to the organization in a summation conference.
  • The Ambulatory Care Review Committee reviews the survey team's report and renders an accreditation decision. The facility is notified the day after the committee meeting.

Accreditation terms: Vary from 6 months for new facilities to 1 to 3 years for established facilities.
Pricing: Surveys are as priced low as $2,850 for small, office-based surgical facilities. Contact IMQ for exact pricing.

3. Convenience. All 4 bodies have made changes to their services in the name of convenience in recent years:

  • The Joint Commission's entire process, from application to receipt of accreditation, is conducted electronically. The commission also employs 5 account executives to work exclusively with its ambulatory customers.
  • AAAHC, as of this year, brought its formerly 89-page paper application online, letting applicants complete it more quickly and send all their materials electronically.
  • AAAASF conducts all of its business electronically and makes frequent updates to its online standards and resource guides using data gathered from inspections and peer reviews.
  • HFAP is striving to commit to a 30-day turnaround time from application to survey for ASCs that meet all Medicare requirements for deemed status eligibility.

Particularly for new facilities, the time it will take for the organization to send a survey team can be a critical factor, as you'll need to complete your Medicare survey before you can begin billing for services, says Ms. Stinchcomb, a Joint Commission surveyor.

4. Expense. Consider the cost of the application process, standards manual, survey and any annual fees, plus the cost of any other services the organization may offer, such as workshops and benchmarking.

5. Payor preferences. Some third-party payors may look more favorably upon your facility if you're accredited with one organization vs. another, says Jack Egnatinsky, MD, an anesthesiologist and AAAHC surveyor. "Ask what accreditation is going to do for you. Know what third-party payors are going to accept."

6. Community clout. If most of the hospitals and surgical facilities in your area are accredited by the same organization, you may want to consider following suit, since the local physicians, nurses and patients are likely to be familiar with it, says Jan Kleinhesselink, RN, CPHQ, chief quality officer for Lincoln (Neb.) Surgical Hospital. "You want to make sure you're being considered at the same level. And if you're using your accreditation for marketing, you want to be on par with everyone else." That's one reason why The Surgery Center in Middleburg Heights, Ohio, sought Joint Commission accreditation: in order to better compete with prestigious nearby hospitals like the Cleveland Clinic. "We can say we're accredited just like the hospitals are. That's a really good marketing tool," says Administrator Barb Draves, LPN, CASC.

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