Andrea L. Devoti, RN, MSN, MBA, is executive vice president of the National Association for Home Care & Hospice. For more information, visit nahc.org.
Accreditation is defined in the Oxford Living Dictionary as “the action or process of officially recognizing someone as having a particular status or being qualified to perform a particular activity. For example,‘the accreditation of professionals.’”
Accreditation in health care is the process of demonstrating that an organization meets an elevated standard of performance. This performance is confirmed by an open and honest examination in all aspects of business, from board relations to finance, hiring, orientation of new personnel, and the actual provision of quality care while maintaining a safe environment for patients or clients.
The arduous and time-consuming process of accreditation requires an organization to be introspective and thorough, and complete a self-assessment that audits policies, procedures and operations.
As part of the accreditation process, outside experts perform an objective on-site assessment, comparing the organization’s results to the quality standards for care developed by the accrediting body for each part of the business. Once this review and on-site survey are completed, the results will be submitted to a review board for a final determination of the organization’s status in relation to the aforementioned standards. If the organization meets those standards, some form of accreditation is earned.
However, there are different levels of accreditation. An organization may earn:
- Full accreditation—with or without required actions to correct some identified areas of weakness, or
- Accreditation with commendation —performance is above the stated quality standards, or have a best practice exceeding similar organizations.
The other possible result of an accreditation assessment is a finding that the organization does not yet meet the required standards, and further work, followed by another focused visit, will be necessary to achieve accreditation.
Once an organization has been deemed to be in compliance with the elevated standards required by accreditation, that organization may display the seal of the accrediting body and dates of accreditation. These notices indicate that the organization is committed to the provision of high-quality patient care with continuous process improvement and adherence to the highest patient safety standards.
The accreditation process forces a business to focus on a continual internal auditing process, and sharpen its business focus to maintain current best practices. The organization may use this accredited status in marketing to their community and to other companies who may be current or future business partners.
What to do
Budgeting is necessary before the accreditation process. The costs can be both tangible and intangible. The survey itself will cost a varying amount of money, depending on the size of the company, number of surveyors, hours spent in achieving compliance, and travel costs. The price of accreditation will be several thousand dollars, at least, as well as the internal costs in human resources to complete the internal assessment and develop, update or revise the policies and procedures, human resource files, patient records, education and staff as required.
Accreditation costs will need to be built into the future budget; accrediting bodies require reassessment and survey on a cyclical basis—about every three years. A planning process should be established to conduct a self-assessment before the application to determine the costs.
Organizations interested in accreditation should ask themselves some questions, including:
- Do we have policy and procedure manuals for all departments including administration?
- Do we have organized minutes of meetings of our board of directors and committees?
- Do we have job descriptions, individual personnel files with the medical portion separated from the employment portion, and all of the documents needed to put someone on payroll?
- Do we have a clear on-boarding program for staff and evaluations of all staff?
- Do we have clear charts with documentation for patients, with appropriate consent forms and other mandated documentation?
More questions should be reviewed before accreditation begins. The amount of work that is needed before starting the process will help determine when to officially start. Knowing the process will help organizations set a realistic timeline for completion. A clock begins when the deposit or application fee is paid.
Choice of accrediting organization matters. If there is no clear choice in mind, call all three accrediting organizations (see sidebar at right) to discuss the options and costs before a decision is made.
Why do it?
Why would anyone put their organization through this process, particularly when accreditation is not necessarily required either to provide care, or to obtain a license to provide care? The best reason is to demonstrate that your organization strives to provide the highest quality of care for your patients and clients.
Patients, post-acute care providers such as assisted living and skilled nursing facilities, and hospitals and health systems are more likely to consider a relationship with an organization that is accredited than one that is not. Accreditation is a measure of quality care and consideration of high standards for the organization.
Other benefits of accreditation include its value as a marketing tool. Achieving accreditation should be noted in communication such as the accredited organization’s website, its printed materials and electronic media, as well as in its community outreach. Agencies with accreditation will often receive a higher rating from groups that refer consumers to health care providers.
Finally, it should be noted that accreditation is required for some services, and those regulations are determined by both the state and federal governments. Some state laws require accreditation for some services, and other jurisdictions are considering making some accreditation mandatory, but there is no universally-mandated standard.
There are commercial insurance products, including Medicare Advantage and Medicaid products that require accreditation in order to be considered as a contract provider. Furthermore, some Accountable Care Organizations (ACOs) will only contract with accredited organizations.
The focus of accreditation differs in the provision of “non-skilled” homecare services. The accreditation guidelines were developed in the 1970s and 1980s to provide standards for those providing paraprofessional care. The basis of accreditation for paraprofessional care is to ensure for the patient, family, community and the insurer, that safe, responsible and appropriate care is provided to the patient.
The accreditation process focuses on training standards for direct care providers in order to prove competency. This ensures that managers are documenting training, education and hiring of labor following the wage and hour laws, while scheduling and providing quality care for the benefit of the consumer.
The business side of the provision of homecare is reflected in the standards around finance, risk management and quality improvement.
Accreditation can serve as an owner’s road map to setting up a compliant organization, which lends credibility to the consumers and positively affects marketing efforts. All of these efforts surrounding the provision of competent care instills confidence in the consumer that he or she can stay in their place of choice to recover or live their life.