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Published: Saturday, 7/13/2002

Agency is good ally in disputes on health care

Did that hospital, nursing home, health maintenance organization, or other health care organization brush off your complaint about the quality of care? Then consider taking it to the agency they really dread to offend:

The Joint Commission on Accreditation of Health Care Organizations (JCAHO).

JCAHO is the independent, non-profit agency that since 1951 has set nationally recognized rules for patient safety and quality care. Organizations that do a good job of applying those “standards” get JCAHO's coveted seal of approval, termed “accreditation.”

About 18,000 currently are accredited.

They include general, children's, psychiatric, and rehabilitation hospitals; health maintenance organizations, preferred provider organizations, and other health care networks; home health care organizations; nursing homes and other long-term care facilities; assisted living facilities that provide health-related services; outpatient surgery and other ambulatory care facilities, and clinical laboratories.

JCAHO accreditation is a badge of honor in the health care industry. It means that the organization has made the grade, and is recognized for complying with stiff national performance standards that help to assure high-quality care for patients.

Accreditation also bears on an organization's ability to do business.

Many states, for instance, require that a health care organization be accredited before issuing it a license to operate. Accreditation may automatically qualify a health care organization to receive Medicare, Medicaid, and commercial health insurance reimbursement. Health care organizations must be accredited to have the internship and residency programs which supply key staff.

JCAHO, based near Chicago, has a staff of 1,000 inspectors who make regular visits to health care organizations - every three years for hospitals, for example, and every two years for clinical laboratories. They check to make sure that staff and administrators are following JCAHO's standards.

Depending on the survey team's findings, a hospital or other organization may be fully accredited, accredited with contingencies, or not accredited.

When a health care organization's accreditation is in jeopardy, it shifts into a crisis mode. Staff responsible for the situation may be disciplined or fired.

As part of efforts to improve patient safety, JCAHO encourages patients and families to report certain problems covered by commission standards.

Those include quality of care given patients, patient rights, safety, medication use, infections, and security.

JCAHO does not get involved in billing and payment disputes, labor relations problems, or other issues. It suggests that patients first report a problem to the health care organization management. If the results are unsatisfactory, contact JCAHO.

Complaints can be sent by mail, fax, or e-mail. Summarize the situation in one or two pages. Include the name and address of the health care organization, and your own contact information.

E-mail: www.complaint@jcaho.org. Fax: Office of Quality Monitoring. 630-792-5636. Mail: Office of Quality Monitoring, JCAHO, One Renaissance Boulevard, Oakbrook Terrace, IL 60181.

Individuals with Internet access can print a fill-in-the-banks “Quality Incident Report Form “ at JCAHO's Web site (www.jcaho.org). Click on the General Public link, and in the new screen on Report a Complaint. Fax or mail the form.

If you have questions about filing a complaint, call JCAHO's toll-free number: 1-800-994-6610. JCAHO promises to investigate every complaint and inform the complainant of actions taken.

In very serious situations, JCAHO may dispatch a team of inspectors for an unannounced visit to the health care organization. An unannounced inspection may occur, for instance, if JCAHO has gotten several similar complaints about a situation that the organization promised to correct after JCAHO's last regular inspection.

In others, it may ask the organization for a written response to the complaint or bring up the topic during its next scheduled onsite evaluation of the organization.

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