In response to Harvard’s conclusions, the Joint Commission claimed the study contained “factual errors” and “multiple methodological flaws” in strong rebuttals to findings

Today’s emphasis on value-based healthcare rewards hospitals, physicians, clinical laboratories, and other healthcare service providers for improved patient outcomes. But does hospital accreditation play a role in those improved outcomes? A study published in the British Medical Journal (BMJ) suggests that hospital accreditation may not directly correlate to improved patient care and that one accrediting organization may be just as good as another.

Researchers at Harvard T.H. Chan School of Public Health (Harvard) conducted the study. They looked at healthcare outcomes from 4,400 US hospitals between 2014 and 2017, of which 3,337 were accredited (2,847 by The Joint Commission) and 1,063 received state-based reviews.

The researchers’ objective was “To determine whether patients admitted to US hospitals that are accredited have better outcomes than those admitted to hospitals reviewed through state surveys, and whether accreditation by The Joint Commission (the largest and most well-known accrediting body with an international presence) confers any additional benefits for patients compared with other independent accrediting organizations.”

In their published results, the Harvard researchers concluded:

  • “Patients treated at accredited hospitals had lower 30-day mortality rates (although not statistically significant lower rates, based on the prespecified P value threshold) than those at hospitals that were reviewed by a state survey agency … but nearly identical rates of mortality for the six surgical conditions;
  • “Readmissions for the 15 medical conditions at 30 days were significantly lower at accredited hospitals than at state survey … but did not differ for the surgical conditions;
  • No statistically significant differences were seen in 30-day mortality or readmission rates (for both the medical or surgical conditions) between hospitals accredited by The Joint Commission and those accredited by other independent organizations.”

Why is this finding important? As the largest independent accrediting organization, The Joint Commission holds enormous influence over doctors and other healthcare service providers. The Joint Commission accredits more than 21,000 US healthcare providers, as well as hospitals throughout the world. Most states require Joint Commission accreditation for hospitals to receive Medicare/Medicaid reimbursements.

However, Harvard’s study found hospitals accredited by the Joint Commission had no better patient outcomes than hospitals reviewed by state survey agencies. The conclusions published by this research team casts doubt on the perceived higher value of the Joint Commission’s accreditation over other accrediting bodies, and on the value of accreditation itself.

“There was no evidence in this study to indicate that patients choosing a hospital accredited by the Joint Commission confer any healthcare benefits over choosing a hospital accredited by another independent accrediting organization,” the researchers concluded in their paper.

Ashish Jha, MD, MPH (above) K. T. Li Professor of Global Health and Health Policy at the Harvard T. H. Chan School of Public, co-authored the Harvard study. He maintains that for accreditation to ensure hospital quality, accreditation standards must be refocused. “First, there must be a clear delineation of high-quality care (good outcomes, good experience) and that must be the guiding principle behind accreditation,” he wrote in JAMA Forum. “Hospitals should be held accountable for those outcomes. Accrediting bodies should focus on those processes and structural factors that have been convincingly shown to be associated with good outcomes.” (Photo copyright: Harvard.)

Not So Fast!

The Joint Commission is an independent, not-for-profit organization that has accredited hospitals for nearly 70 years. Approximately 81% of hospitals accredited in the US are accredited by the Joint Commission. So, of course, the Joint Commission took issue with the Harvard researchers’ findings.

In a formal statement and a response published in BMJ, the Joint Commission cited “factual errors” and “multiple methodological flaws that make the [study] results invalid.”

Nonetheless, the Joint Commission also pointed out that Joint Commission-accredited hospitals were found by the researchers to demonstrate lower mortality than state-surveyed hospitals and lower readmission rates for the medical conditions cited.

“While study authors considered the differences ‘modest,’ applying them to the more than three million patients with medical conditions addressed in this study indicates that patients treated in Joint Commission-accredited hospitals experienced 12,000 fewer deaths and 24,000 fewer readmissions,” the formal statement said. “We believe that makes a difference to patients as much as it does to us.” 

Joint Commission Partners with Leapfrog Group

Scrutiny of hospital accrediting bodies is not new. A 2002 article by The Dark Report, Dark Daily’s sister publication, reported on the Joint Commission’s decision to become a “formal partner” in the Leapfrog Group, a non-profit organization founded in 2000 that advocates for improved hospital safety and quality. (See TDR, “Provider Performance Ranking Now Hitting Healthcare System,” January 28, 2002.)

The Joint Commission announced the partnership one day before the Leapfrog Group’s release of data in the journal Quality Management in Healthcare showing “that a hospital’s accreditation status did not correlate to better quality and safety of patient care. The study specifically noted that hospitals with higher-than-average rates of deaths and complications often received favorable scores from the [Joint Commission],” TDR reported.

However, as Robert Michel, TDR’s Editor-in-Chief and Publisher, noted in the article, “The [Joint Commission’s] willingness to partner with the Leapfrog Group is a significant event. The timing of the [Joint Commission’s] announcement, one day before Leapfrog made its hospital data available to the public, demonstrates that it will become more responsive to the quality concerns of employers.

“For laboratory executives and pathologists,” Michel continued, “this is a signal event in determining how the healthcare system will evolve in the next few years. I believe it is the first of what will become a major effort to identify, measure, and report on the quality performance of all categories of healthcare providers.”

Michel made his comments in 2002. Today, hospital and individual health provider reimbursements are increasingly based on those very performance and quality-of-outcome reports.

Healthcare systems now publish data on healthcare providers so patients can make informed decisions. It is consistent with the trend to rank providers by patient outcomes and similar metrics, which TDR predicted nearly two decades ago.

Moreover, the growing availability of the outcomes data from hospitals, physicians, and other types of providers is a signal to both clinical laboratories and individual pathologists that public scorecards on the quality, outcomes, and costs of their labs or their professional pathology services are coming.

However, since major change in the healthcare system takes years to achieve, public scorecards for labs and pathologists are probably still years away as well.

—Andrea Downing Peck

Related Information:

Joint Commission Accreditation Doesn’t Lead to Better Outcomes Study Shows

Association Between Patient Outcomes and Accreditation in U.S. Hospitals: Observational Study

The Joint Commission’s Response to the October 2018 BMJ Article by Lam et. al

Rapid Response: Association between Patient Outcomes and Accreditation in U.S. Hospitals: Observational Study

JAMA Forum: Accreditation, Quality, and Making Hospital Care Better

CMS Seeks Public Comment on Accrediting Organizations and Conflicts of Interest

Structural versus Outcomes Measures in Hospitals: A Comparison of Joint Commission and Medicare Outcomes Scores in Hospitals

Provider Performance Ranking Now Hitting Healthcare System