Once you decide to take the accreditation plunge, the next step is determining which accrediting body to use. Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Accreditation Association for Ambulatory Health Care (AAAHC), and American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF) all aim to maximize patient safety by enforcing similar general standards, each comes to the table with a different history and unique business philosophy. To help you determine which accreditor will work best for you, we asked readers for a list of top questions and posed them to JCAHO, AAAASF, and AAAHC. Here are their responses.

Q: How many ASCs, office-based surgical facilities, and hospital outpatient departments have you accredited? What proportion of each failed to obtain accreditation?

AAASF: Of the 800 AAAASF-accredited facilities, 93 percent (744) are office-based surgery suites and 7 percent (56) are ASCs. AAAASF does not accredit hospitals. Approximately 3 percent do not complete the accreditation process.

AAAHC: Of the 1,500 AAAHC-accredited organizations, approximately 850 are ASCs and 200 are office-based surgical facilities. AAAHC does not accredit hospitals. Because applicants are committed to succeeding, only approximately 1 percent or fewer applicants fail.

JCAHO: Approximately 1,200 hospital-based ambulatory facilities, 275 ASCs, and 60 office-based surgical facilities. JCAHO reports that it does not track the number of failures but notes: "Organizations that seek accreditation are committed to patient safety and quality care, so the number of failures is very low."

Q: Why should an outpatient facility choose your organization?

AAAASF:

• AAAASF emphasizes the office-based surgical practice and notes that a primary goal is to show the public that office-based surgery has at least the same level of safety as an ASC or hospital.
• AAAASF says it works to educate organizations to ensure they complete the process.
• AAAASF does not require a separate credentialing process. Rather, this accreditor requires each surgeon to hold unrestricted hospital privileges in the community and specialty, and to participate in the hospital's peer-review program. All surgeons must also be certified by a surgical board recognized by the American Board of Medical Specialties, or be board eligible and working toward certification.

AAAHC:

• AAAHC says its primary focus has been on ambulatory health care for 22 years, noting: "We understand the ambulatory environment, and our standards are developed to serve this environment."
• AAAHC says it has taken a "consultative approach" since 1979: "We strive to be sure our facilities learn from the process and can comply with our standards, which are written so they can achieve compliance in a way that is most compatible with their organization."

JCAHO:

• JCAHO reports that its accreditation is "nationally recognized," and that the hospital accreditation program is also "internationally recognized."
• In many cases, JCAHO accreditation satisfies the quality assurance needs of contractors, third-party payors, and regulatory bodies.
• JCAHO describes its ambulatory care standards as "nonprescriptive," in that it "encourages organizations to apply their own methods to the process rather than dictate exactly how to achieve the standards."
• JCAHO assigns a "dedicated" account representative to each facility to manage administrative functions and field any issues that may arise, and says the fact that it does not "delegate out" components of the accreditation process is a benefit.

Q: What are your criteria for passing or failing a facility?

AAAASF: Facilities either pass or fail and do not receive accreditation until they comply with every standard. AAAASF emphasizes that it requires "100 percent compliance" and notes that its standards are "very straightforward and not open to much interpretation." Typically, when a surveyor finds deficiencies, facilities correct the deficiencies and document this in writing for AAAASF. Occasionally, when a surveyor identifies numerous and/or serious problems, AAAASF will reinspect a facility. Accreditation lasts for three years, and the facility director and staff must perform annual self-evaluations during the second and third years.

AAAHC: There are six potential outcomes for the first-time applicant:

• Three-year accreditation, awarded to facilities in "substantial compliance" (80 percent of applicants receive three-year accreditation).
• One-year accreditation, awarded to facilities in "partial compliance." Before the year is up, the facility must correct the deficiencies and document this in writing. AAAHC conducts a re-survey within 10 months to verify corrective actions (8 percent).
• Six-month deferral, awarded to facilities that do not meet the bulk of the standards yet demonstrate a commitment and ability to correct the deficiencies within six months. AAAHC conducts a re-survey within five months to verify corrective actions (3 percent).
• No accreditation (