Is It Time to Abandon Hospital Accreditation?

Area of Science:

• Healthcare quality and safety
• Hospital accreditation and regulation
• Public health policy

Background:

• Hospitals must meet Conditions of Participation (CoP) set by the Centers for Medicare & Medicaid Services (CMS).
• Compliance is verified through accredited organizations (AOs) or state surveys, but current systems show inconsistent clinical outcomes and patient safety.
• Evidence indicates weaker performance in state-surveyed hospitals and significant surveyor disagreement.

Purpose of the Study:

• To evaluate the effectiveness of current hospital accreditation and survey systems in ensuring consistent clinical outcomes and patient safety.
• To propose a new system for improved hospital accountability and performance.

Main Methods:

• Analysis of publicly reported evidence on hospital clinical performance and survey variations.
• Review of existing accreditation and CMS Conditions of Participation (CoP) enforcement mechanisms.
• Proposal for a new auditable public annual reporting system for hospitals.

Main Results:

• Current accreditation and state survey systems fail to achieve consistent clinical outcomes, with significant variations in mortality and patient safety.
• State-surveyed hospitals demonstrate weaker clinical performance compared to those surveyed by AOs.
• Recurring disagreements between initial and audit surveyors highlight systemic weaknesses.

Conclusions:

• The existing accreditation and survey system has not achieved its goal of consistent quality improvement.
• A mandatory, auditable public annual report for hospitals, detailing improvement targets, could enhance accountability.
• Updating CoP and refining on-site inspection focus are also recommended for a more effective system.