What is NCQA and JCAHO?The National Committee for Quality Assurance (NCQA) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are two more nonprofit review organizations you should be aware of. Both provide valuable information about PPO's, HMO's, hospitals and other healthcare providers. The National Committee for Quality Assurance www.NCQA.org was founded in 1990 to review PPO plans, and HMO organizations at both the insurance company level and the healthcare provider level. The NCQA provides a grading system of organizations "brave enough" to seek their accreditation. NCQA and URAC accreditations are not required, however providers who wish to be taken seriously as quality care providers seek to be accredited by both organizations. The Joint Commission on Accreditation of Healthcare Organizations www.jointcommission.org (pronounced "Jay-co") was established in 1951 under the name "Joint Commission on Accreditation of Hospitals" (JCAH) for the purpose of setting safety standards within hospitals. By 1981, the organization's reviews included other health care organizations such as home care and hospice agencies. The name was changed to include the other "healthcare organizations". Once again, healthcare organizations do not have to seek JCAHO accreditation. However, if a healthcare organization hopes to be considered a Medicare provider, they must be accredited by JCAHO. Medicare's selection of providers has great influence over other medical insurance providers. If a healthcare organization/provider meets Medicare's standards (which include JCAHO accreditation) then other insurance companies will accept the healthcare organization/provider as one of their preferred providers. In this way, JCAHO is very influential. You may recall a hospital in the Los Angeles area which was in the news. The facility found itself in the headlines because it failed JCAHO's inspection. While there were those who believed the closure of this hospital (which failed not one, but three inspections by JCAHO) would result in a health risk to the community it served, quite the opposite is true! You do not want to use a healthcare organization which did not pass JCAHO inspection with flying colors!!!!! The standards that JCAHO sets are basic safety standards!!!! If the healthcare organization in your area cannot meet these very basic standards, your safety can be at risk! JCAHO surveys occur about every three years. The facility is informed of when the survey will take place. This gives the facility plenty of time to be prepared! If a facility does not pass or passes with low marks, JCAHO will return to insure the areas of non-compliance have been corrected. If the facility continues to "fail" inspection, the facility will lose its accreditation, which translates out to the loss of Medicare funds and the funds of private insurance carriers. With so much advanced notice and the opportunity to correct any errors if a facility fails its initial inspection, you can imagine that it is very hard for an organization/facility to lose its accreditation. If JCAHO does pull an organization's accreditation, we all need to be concerned for the safety of individuals seeking care at this facility! Not being certified by JCAHO, URAC or NCQA does not mean the organization or provider's doors will be closed. It just means that we all must be aware that the quality of the care provided may be seriously compromised. Personally, I would not want my friends or family members to be treated by a provider who could not pass a well-announced safety inspection. Would you?
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