Is It Time to Abandon Hospital Accreditation?

Hospitals contracting with the Centers for Medicare & Medicaid Services (CMS) must comply with Conditions of Participation (CoP), enforced by 4 certified independent accrediting organizations (AOs) or individual state survey. Recent work documents that the system fails to achieve consistent clinical outcomes, allowing several-fold variation in mortality and patient safety. Other publicly reported evidence shows weaker clinical performance by state-surveyed hospitals, inexplicable variation in individual state surveys, and recurring disagreement between initial and audit surveyors. Although the leading AOs and CMS are committed to continuous improvement, a proven management system that is extensively documented in hospitals, accreditation has not achieved it. Requiring an auditable public annual report by each hospital, including improvement targets and analogous to the 10K reports required of publicly listed corporations, might create a more effective system. Updating the CoP and refocusing the on-site inspection also would help.