Accreditation standards offer stability amid storm of change

“Scary” times prompt closer scrutiny

“There is tremendous pressure on organizations due to cutbacks in reimbursement rates, significant delays in making reimbursements even when they're not reduced, and a great deal of uncertainty about how healthcare reform is going to impact the field, says Richard Klarberg, President and CEO of the Council on Accreditation (COA, New York, N.Y., www.coastandards.org).

“The implications of these things are having a ripple effect in organizations. Governing bodies of not-for-profits are looking more carefully about how money is being utilized, seeking to maximize their endowments, maximize staff effectiveness, and basically wrap their arms much more closely around the organizations.”

The result, he says, is that “the leadership of many organizations feels subject to more scrutiny, and we've seen a higher level of turnover at the executive level.” But the stress is also felt by service delivery staff “concerned about job security, handling expanded caseloads, and continued delivery of excellent services.”

“What's scary about these times is the underpinnings of many organizations are threatened and many high-quality, long-time organizations find they're struggling financially,” says Klarberg. “The level of uncertainty at the federal, state, and local levels has coalesced to form a ‘perfect storm’ for many organizations. And, how they will weather the storm is yet to be determined.”

Because the tough financial outlook is forecast to linger into 2013, Klarberg says that COA has placed “greater emphasis on our risk-prevention and management standards-to encourage organizations to plan not only for what's immediately ahead, for what could come down the road.”

“The level of uncertainty at the federal, state, and local levels has coalesced to form a ‘perfect storm’ for many organizations. And, how they will weather the storm is yet to be determined.”

Accreditation is important, he concludes, because it gives boards, leadership, and management a common way to look at the organization's progress. It forces a shared look back as a means of quality improvement, but also drives proactive consideration of the risks, opportunities, and strategic changes that lie ahead.

Cash-strapped payers demand accredited providers

“We're definitely seeing a trend toward integration as more and more larger providers-both primary care and behavioral health-are working to bring in the other,” says Nikki Migas, Managing Director, Behavioral Health and Child and Youth Services at CARF International (Tucson, Ariz., www.carf.org/programs/bh). To meet the need, CARF has “developed standards for integrated programs that help organizations to focus on the collaboration, communication, and co-location aspects of integration.”

She adds that “as bad as the economy is, we're starting to see some recovery at the federal level, but more and more cuts at the state and local levels that have trickled down to providers.” And, as payers-states, insurance companies, and managed care companies-feel the financial pressure, “we've seen more and more mandates from them for accreditation of service providers.”

She continues: “We've seen growth as states are looking at third-party accreditation to ensure quality that they no longer have the staff to assure on their own. The states have absorbed some of the budget cuts through attrition of their own workforces, but are requiring that providers get accredited to demonstrate that they are worthy of the public trust.”

Developing new standards, new ‘leading practices’ database

Recently, the Joint Commission introduced “an entirely rewritten chapter in our behavioral healthcare standards for 2011,” says Mary Cesare-Murphy, PhD, Executive Director of the Behavioral Health Care program at the Joint Commission (Oakbrook Terrace, Ill., www.jointcommission.org/accreditation/behavioral_health_care.aspx). The rewritten Care, Treatment, and Services standard integrates recovery concepts, includes new standards for eating disorder programs, enhances standards for outdoor programs, and offers a number of newly created standards for programs serving youth and young people.

Cesare-Murphy notes that there's been noticeable recent growth in these “transition age” programs as more individuals struggle with the passage from adolescence to adulthood, often by “staying in school longer and experiencing more difficulties in launching a career.” Such programs ease the transition by teaching young people how to function independently, by helping them develop key skills such as finding a job, finding housing, and budgeting. “It's an interesting phenomenon,” she observes. “You see it in the child welfare world as well.”

To support behavioral health organizations that are planning to incorporate primary healthcare services, Cesare-Murphy says that the Joint Commission is working on “some new standards that will apply in 2011 to behavioral health organizations that provide primary physical healthcare to those they serve.”

“The other thing we're doing-and this applies to current Joint Commission accredited organizations-is that we're assembling a new ‘leading practices’ database,” she adds. “We want to encourage our accredited organizations, particularly in the behavioral health field, to contribute to this database, which will provide a way of sharing good ideas or learning from the practices shared by other accredited organizations.” She notes that there are no requirements or limitations on what organizations may share.

Building on roots in home-health industry

With long-time roots in the home-health industry and, more recently, in related businesses including hospice, pharmacy, home medical equipment and durable medical equipment and prosthetics, the Accreditation Commission for Health Care, Inc. (ACHC, Raleigh, N.C., www.achc.org) decided to launch a behavioral health accreditation program in 2010

“ACHC's decision to offer its Behavioral Health Accreditation Program was in response to the requests of our accredited home health providers who are also providing behavioral health services,” explains Britt Welch, MS, LPA, ACHC's Behavioral Health Clinical Manager. “Several of these providers have been in the position of having to be accredited by more than one national accrediting body, based on the services they provide and local/state requirements. They wanted to have all their services accredited by one accrediting body, ACHC.”

Welch adds, “Currently we've completed 19 behavioral health standards.” Each, he says, “goes through a rigorous review process with behavioral health experts around the country, followed by another review by ACHC's Standards and Review committee, and then beta testing, which involves evaluating the reliability and validity of the standards with actual organizations.

“At present-we're seeking companies, large or small, who would like to participate in the beta test process with a range of standards from integrated care to residential treatment,” he says, noting that the beta test process is provided at no cost to the participating organization (for details, contact bwelch@achc.org). Given the company's history in the community-based home-health industry, Welch says that ACHC's accreditation standards are “focused on the service recipient, realistic, relevant, and easily understood.” Behavioral Healthcare 2011 March;31(2):44-45