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Is Accreditation Really Worth It?
If it's true that a facility can provide excellent care without becoming accredited, why bother? The answers may surprise you.
Robert Kurtz
Publish Date: March 17, 2008   |  Tags:   Accreditation

It adds cost without adding quality. It's inconvenient. It's costly. These are but a few of the ways you can talk yourself out of accreditation. There are others, such as buying the horror stories about those impossible-to-please surveyors, bowing to overrated standards and looking around your facility and wondering how in the world you're going to prepare for a survey.

And there may be some merit to these beliefs. The accreditation process, still largely voluntary, will likely cost you a few thousand dollars each year. The standards are extensive and it'll take many hours to gather the necessary documentation, develop the proper policies and procedures, track the correct data and prepare for the on-site survey.

So why do thousands of surgical facilities choose an accreditor — be it the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC or the Accreditation Association) and the Joint Commission (formerly JCAHO)? Here are 7 reasons why the accreditation process is a worthwhile investment.

1. To participate in Medicare
If you've just opened or are planning to open a surgical facility and want to participate in the Medicare program, you may have little choice but to turn to one of the accreditors to receive Medicare certification. Citing an increase in the number of new providers applying to participate in Medicare as well as limited resources, CMS in November told state surveyors to make new Medicare applicants their lowest priority. Private accreditors have authority to not only accredit your organization but also provide you with "deemed status," meaning you meet Medicare's standards and can receive reimbursement from Medicare for treating Medicare patients.

Some office-based surgical facilities are also finding that accreditation is a requirement. In July 2007, New York passed a law mandating that all doctors performing surgeries requiring moderate sedation, deep sedation or general anesthesia, and certain liposuction procedures, must be performed in an accredited facility. Other states with similar laws include California, Florida, Indiana and South Carolina.

"I think, eventually, if you're going to be doing anything other than oral anesthesia in your office, you're going to have to wind up being accredited," says John D. Newkirk, PhD, MD, FACS, owner of Columbia Plastic Surgery, an AAAASF-accredited facility in Columbia, S.C., and also an AAAASF facility examiner. "The states are clearly moving in that direction."

Accreditation is also mandated by the American Society of Plastic Surgeons and American Society for Aesthetic Plastic Surgery for their members who perform outpatient procedures under sedation or general anesthesia.

In a trend specific to ASCs, some states, such as Colorado and Washington, are increasingly looking to change or adjust their licensure regulations to consider the use of accreditation as an alternative to licensure, says Michael Kulczycki, executive director of the Joint Commission's Ambulatory Care Accreditation Program.

2. Payors require it
Accreditation may become a financial necessity for some facilities.

"Some managed care carriers are requiring accreditation," says Nancy Burden, MS, RN, CPAN, CAPA, administrator of Trinity Surgery Center, a Joint Commission-accredited facility in New Port Richey, Fla. "In Florida, Blue Cross Blue Shield recently put out a directive that they were going to drop any surgery centers that were not accredited."

Could payors requiring accreditation be a growing trend?

"Increasingly, we're seeing that," says Mr. Kulczycki. "Whether it's a surgery center or any other ambulatory health provider, in some markets there are plenty of providers to choose from, so the payers are naturally going to look for ??? a built-in screening device so they don't have to take every one on. Accreditation is a device that they use."

Some facilities are using their accreditation as a negotiating tool with payors.

"Being accredited puts you in a stronger position to negotiate with plans for either a facility fee or in some cases ??? a global or enhanced fee," says Jim Pavletich, senior director and chief operating officer for the Accreditation Association.

3. To appeal to patients
Although many patients still just listen to their doctor's advice when it comes to the location for a procedure, more patients are taking greater interest in their healthcare choices.

"Health care is increasingly becoming a consumer-directed commodity, particularly in the surgery center environment where some procedures are elective," such as plastic surgery and even some orthopedic surgery, says Mr. Kulczycki.

If patients research their options for elective procedures, they're likely to find advice for how to choose a surgeon and a facility.

"There's so much written out there — particularly about plastic surgery — that if you read any of these articles, the authors will always say, make certain that if you are going to have plastic surgery ??? that you're being operated on in a safe place," says Dr. Newkirk. "The best criterion I know of to say that the place is safe is for it to be accredited by one of the three agencies."

As awareness of accreditation grows, facilities that can market themselves as an accredited organization may have an edge over those that cannot.

"There is a loss of some marketing edge by being perceived as a lesser facility than an accredited one," says AAAASF President Alan Gold, MD, FACS. "There may be a public perception that they are not doing everything within their ability to enhance patient safety, or that they are not being open and transparent."

Accreditation can also demonstrate to prospective physicians that your facility considers care of its patients a top priority, says Sandy Berreth, RN, BS, MM, CASC, administrator for Brainerd Lakes Surgery Center, an Accreditation Association-accredited facility in Brainerd, Minn.

"It says to your customer base — not just patients, but also physicians — that you truly care about them as customers," she says. "If you want a physician to use your facility and you can say you're accredited, it's good for marketing. You can say ???we have this, we hold ourselves accountable.'"

4. To recruit staff
As competition for highly qualified nurses remains high, accreditation may serve as a reason why a nurse would choose one facility over another, says Mr. Kulczycki

"ASCs most typically recruit and staff from a hospital environment," he says. "Particularly nursing professionals — they're looking for something different and we've heard anecdotally from customers that often accreditation makes a difference in recruiting and retaining those staff."

Staff members that must work to meet accreditation standards may find it's a valuable, educational experience, says Dr. Gold.

"Accreditation can serve as a terrific learning tool for staff," he says. "New staff members immediately have a guideline for facility expectations. It opens their eyes to practice details that they may not normally consider during a normal work day."

The need to maintain compliance with standards may push staff members to work harder.

"They know that it's a top priority to stay within standards," says Ms. Berreth. "Staff are motivated to work harder when they know they're being held accountable for a higher standard."

It can also serve to bring the staff of a facility closer together, says Mr. Pavletich.

"I think it's a big team-building exercise and it's a significant accomplishment when they earn the accreditation," he says. "Organizations celebrate it, and rightly so."

5. For legal protection
If a facility faces potential litigation as a result of an adverse event, accreditation may help in its defense, says Dr. Newkirk.

"Let's say...I had a non-fatal complication and there was some question about whether the operation was run in a safe fashion," he says. "I can say ???here is my certificate, I am accredited by a national organization. These are the criteria we have. We have everything that we're supposed to have to run (the facility) in a safe fashion.' If you have some bad problem and you're not accredited, you may have a big problem explaining that."

6. To save money
Some facilities have identified savings opportunities by putting in the work necessary to meet and maintain compliance with the standards. For example, when Ms. Berreth conducted a benchmarking project of her ASC's housekeeping services, a project conducted in part to meet accreditation standards, she identified about $12,000 in savings while improving quality.

"We were paying more than we probably should have been in respect to quality of care that we needed (housekeeping) to present," she says. "By benchmarking our housekeeping, we realized that we were spending too much. So we changed our housekeeping staff." In addition to costing less, the new housekeeping staff also made infection control more of a priority.

During a Joint Commission survey, a facility received a tip from a surveyor that saved it from a costly construction project, says Mr. Kulczycki. The facility was struggling to move gurneys around a particular corner of the facility and was considering spending $50,000 to change the hallway.

"Our surveyor knew of a gurney that was designed to navigate tight spaces," he says. "This organization researched it and found that could be their solution instead of a $50,000 capital investment."

7. To provide better quality care
When leaders of first-time Joint Commission ambulatory care accreditation customers were asked why they chose to enter into the accreditation process, the top answer was that they wanted to improve quality care, says Mr. Kulczycki.

"Accreditation gives a facility a shining star," says Ms. Berreth. "It says we don't just say we're doing something; we can prove that we're doing it."

She also believes accreditation helps her and her staff catch issues before they become problems.

"Because we have certain standards in place, we can recognize those near-misses maybe a lot quicker than someone who doesn't," she says. "By being accredited, I think you're more aware of those ???oopses.' I think you're much more careful because of standards ."

Ms. Burden believes accreditation requires her staff to make quality and compliance with standards an ongoing priority

"It's human nature that if you don't have to do something, it slips by the wayside," she says. "Like the stacks on our desks — the ones that we don't have to respond to go to the bottom. Accreditation keeps us focused on certain aspects of our care. That's the biggest key."

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