Thinking About Health: Hospitals may get accredited event with poor, unsafe care

Earlier this year an Illinois woman sent an email telling me of the poor care her husband received at a large Chicago hospital. After six weeks of fighting for his life, he died.

“I wish you could see his records and all the infections and surgeries he had,” she told me. “I’ve been wanting to do something about the care he got and just didn’t know who to go to.”

I return to this topic from time to time because everyone is vulnerable to hospital mistakes. Most people think of hospitals as safe, loving places that advertise their miracle cures on TV and build new wings to house the latest technology. How can things go wrong? But they do, and readers of this column have been eager to share their experiences.

Increasingly, it’s becoming clear there are few places patients and their families can turn for help in avoiding bad care and equally important there’s almost no guidance from state or the federal regulators. When news outlets try to write about unsafe hospitals, they run into a “veil of secrecy that protects the industry” as one reporter in Michigan put it.

The Wall Street Journal has just published a fine story that begins to lift that veil.

Not many Americans know that the federal government has turned over the task of accrediting most of the nation’s hospitals to a private organization called the Joint Commission, which is funded by hospitals and governed by a board of directors some of whom are executives in the health systems it accredits.

Medicare requires hospitals to comply with safety standards, and they can use state inspections or hire a government-approved accrediting body to show they are in compliance. Most have chosen the latter.

Hospitals have a lot of skin in this game paying the Commission an annual fee between $1,500 and $37,000 depending on how big they are, the Journal reported. They also pay for the inspections, which in 2015 cost on average $18,000.

The Joint Commission awards a “Gold Seal of Approval” to those facilities that meet its standards. Maybe you’ve seen them when you’ve visited a hospital. It encourages hospitals to use those accreditations in their marketing activities, even providing them with a publicity kit. The Commission has also created a patient brochure with this reassuring message, “Whenever and wherever you receive health care, look for The Joint Commission Gold Seal of Approval.”

However, the Journal found that those seals of approval can be misleading. Using information from inspection records, reporters found that in 2014 some 350 hospitals had Joint Commission accreditation even though they were in violation of Medicare safety requirements, and 60 percent of them had safety violations in the preceding three years.

It seems that most patients facing an operation or a hospital stay would want to know that. Dr. Mark Chassin, president and chief executive of the Joint Commission, told the Journal that his organization doesn’t routinely withdraw accreditation of hospitals with safety problems because its focus is less on regulating or penalizing and more on preventing problems.

And this brings us back to that age-old problem: Should a government regulate business, including hospitals which have become very big businesses - or should it provide information so buyers, or in this case patients, can compare the offerings and make decent choices? Opponents of regulation argue that providing information is best.

In the case of hospitals, though, patients have neither regulation nor information. The Journal’s reporting shows that the Joint Commission’s inspection process often lets hospitals keep their accreditation even as they deliver poor care. At the same time, the Joint Commission has continually refused to make its hospital inspection reports public. So if patients are supposed to do their homework before undergoing health procedures, it’s a fair question to ask: How should they do that?

Earlier this year the Centers for Medicare & Medicaid Services proposed a rule that would have required the Joint Commission to make its inspection records public. The agency cited serious concerns about the Commission’s ability to identify safety problems. The Commission opposed the regulation, arguing it would make its work harder. Hospitals opposed it, too.

CMS heard their pleas and withdrew the proposal leaving patients in the same information vacuum they were in before.

Earlier this year Ashish Jha, a professor of health policy at the T. H. Chan School of Public Health at Harvard, told me he had no idea which hospital in New York City had the lowest risk of safety problems. At best he could only make a rough guess. He told the Journal its findings show “accreditation is basically meaningless – it doesn’t mean a hospital is safe.”

What kind of information would you like to see about safety and quality of care at your local hospital? Write to Trudy at trudy.lieberman@gmail.com.