Your framed accreditation certificate hangs proudly in your waiting room, but research suggests that the quality of care is the same in accredited and non-accredited surgical centers. All of which begs the question: Are the benefits of being accredited real or perceived? For Cindy Vincent, RN, MSN, director of the Rex Surgery Center of Cary, N.C., the benefits are very real.

Why it matters
In February 2011, the 8-year-old Rex Surgery Center branched off from Rex Hospital to become a freestanding surgery center jointly owned by 25 physicians. "As part of the hospital, we were accredited as one of its departments," says Ms. Vincent. Now operating outside the protection of the hospital's umbrella, Ms. Vincent and the physician-owners decided that earning ambulatory surgery accreditation was vitally important for their new independent center, even though it had to also undergo Medicare and state regulatory surveys to secure its operating license.

New perspectives. Why would a facility already approved by CMS and state regulators seek recognition from a third accrediting body? Ms. Vincent noticed that while many of the same processes are reviewed during the 3 surveys, each surveyor assessed the facility from a different point of view, which gave her new perspectives on improving the center's processes. She says the accrediting organization that visited her facility focused on how the center is run on a day-to-day basis in order to ensure safety and infection control standards are followed to the letter. For example, her staff had to demonstrate proper medication handling, from receipt into the facility to administration at the sterile field.

"The accreditation surveyors traced several patients from the moment they registered to the time they were ready for discharge, and looked through our policies and procedures book with a critical eye to ensure we touched on every point of patient care," says Ms. Vincent. "We also had to demonstrate how we make change happen," she says. "The accreditation survey was much more in-depth," than the CMS and state versions.

Team-building. Working above and beyond their daily duties to prepare the center for the accreditation survey and then enduring the stress of the on-site review helped bring Rex Surgery Center's staff closer. "The process also helped us realize the difference between working in and running a surgery center as opposed to operating as one of the hospital's departments," says Ms. Vincent. "We had to learn a whole new set of rules and regulations, and we learned them together."

To secure accreditation, Rex Surgery Center had to demonstrate how its leadership assessed issues such as infection control and patient safety and show how quality improvement projects are decided upon, initiated and completed. Watching that chain of command in action was a positive for the staff. "They could see exactly how recommendations made in the trenches are acknowledged by leadership and eventually directly impact the center," says Ms. Vincent, who points out that enacting change in the large hospital setting was a more difficult endeavor.

Staying current. Ms. Vincent says running an accredited facility helps her keep up to date with national standard of care requirements, partly because her staff needs to stay well-versed in what accreditors will be looking for during their next visit. For facilities seeking to extend their accredited status, there's nothing like the prospect of a future survey to keep staff in a state of constant compliance and preparedness.

The one-time accreditation fee can be costly, but it's a cost that's "definitely outweighed by the benefits you get," says Ms. Vincent. She became a member of her center's accrediting body, which sends magazines and newsletters containing the latest news and updates on accreditation requirements. She's also able to participate in and learn from comparing her facility's clinical and business benchmarks against those of other member facilities. Ms. Vincent believes her facility easily recoups the annual membership fee in the many value-added services to which she has access. "I wouldn't stay nearly as informed if I wasn't a member," she says.

Marketing the center. "Accreditation shows that you're delivering quality care," says Ms. Vincent, who believes that label speaks volumes to prospective patients shopping for where they want their procedures performed and to third-party payors deciding where they'll send their highest reimbursements. Touting your facility's accreditation "is powerful when negotiating with insurers," says Ms. Vincent.

But is it necessary?
There is no difference in the quality of care delivered in accredited and non-accredited Florida ASCs, according to a study in the September 2008 issue of The Joint Commission Journal on Quality and Patient Safety. Florida ASCs must be accredited by a nationally recognized organization or be subjected to annual licensure surveys conducted by the state regulatory agency, notes the study.

Researchers reviewed hospitalizations following 5 common ambulatory procedures performed in 2004: colonoscopy, cataract removal, upper endoscopy, arthroscopy and prostate biopsy. Hospital admissions following surgery performed in ASCs are easily identifiable quality indicators that reflect perioperative complications, say the study's authors. With the exception of colonoscopy, they discovered no significant difference in admission rates following procedures performed in accredited and non-accredited facilities.

Accreditation status is often used as a marketing tool to communicate that a given center has met established benchmarks associated with excellence in the process of care, say the study's authors. "The ultimate goal of any accrediting body or state regulatory agency is to ensure quality of care among the organizations for which it has oversight," say the authors. However, they point out, each accreditor bases its approval on unique criteria that covers processes and different standards of excellence, but not case outcomes.

Despite differences in review criteria by oversight organizations, accredited and non-accredited facilities offer their patients comparable quality of care, say the authors, who point out that their results differ from research conducted at accredited and non-accredited inpatient facilities. In fact, research published in the October 2011 issue of the Journal of Hospital Medicine showed hospitals accredited by the Joint Commission outperformed non-accredited hospitals on nationally standardized quality measures over a 5-year reporting period.

The authors of the Florida ASC study attributed the difference between accredited outpatient and inpatient facilities to the types of patients cared for and the complexity of the procedures performed in each setting. "Most patients treated in ASCs are relatively healthy, and most undergo elective procedures, making adverse outcomes somewhat rare events.

"Although oversight, including accreditation, may be important, outcomes in the outpatient setting may be more reliant on physician skill," says the study, adding that physician board certification and other physician traits have been linked by research to improved outcomes in both the inpatient and outpatient settings.

?For freshly opened centers, seeking and eventually achieving accreditation and being held to that standard of care could give new staff members the focus and direction they need to achieve sustained success in the eyes of the local surgeons and patients who might look at the new kid on the block with skepticism. That wasn't the case for Ms. Vincent and her team. "We were proud of the care we were delivering as part of the hospital. That hasn't changed since we've become a freestanding center. We're just held to a different body of standards," she says.

The appeal of hanging an accreditor's seal in the waiting room is very much real to Ms. Vincent. "We wanted to be on par with other surgery centers out there," she says, "and wanted to show patients the high standard of care to which we hold ourselves accountable."