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Accreditors Blamed for Overlooking Problems

The $98 Banner

The joint commission, which is based outside Chicago, boasts that its imprimatur represents a "Gold Seal of Approval." And to advertise that, it suggests that the 15,000 groups it oversees purchase banners, decals, coffee mugs and enamel pins to tout their accomplishments.

" 'We Are Accredited' products are available exclusively to Joint Commission accredited organizations," the group's Internet site proclaims. The cost of a 5-by-2-foot blue and burgundy banner: only $98. "No one who walks into your reception areas or waiting rooms can miss the message," the Web site says.

The money from these vanity sales is pocket change for the group, which takes in millions from its accreditation surveys, consulting services and educational materials. Still, it helps to drive home a message that the joint commission has been selling in one way or another for more than half a century: If you have our stamp of approval, you are the best.

The "best," it turns out, includes almost every institution that pays the joint commission's fees, which for a large hospital average $26,000 per survey. The nonprofit inspects hospitals once every three years.

Some critics point to the approval rate as evidence that the joint commission is captive to hospitals. The joint commission notes in its literature that the group wants to work together with the facilities it accredits, referring to them as "customers" and "clients." The commission still tells hospitals in advance when its survey teams are coming but says it will switch to surprise reviews next year.

The board of directors of the joint commission is dominated by representatives of the American Hospital Association and the American Medical Association.

"I agree that on the surface if you look at our board, you'd have those concerns and you would probably wonder how in the hell it even works," O'Leary said. "But I would say you have to look at what we have done and not how we look. I think our record speaks for itself."

The joint commission serves as more than just a gatekeeper for Medicare, O'Leary said. It collects and analyzes data on medical mistakes, works to improve patient safety and has won praise for lifting the overall performance of hospitals.

One initiative of the joint commission is relatively new. Its subsidiary, Joint Commission Resources, was established in the 1990s to consult with hospitals on how to gain accreditation and improve their performance. It also operates the nonprofit's busy publishing and conference business.

JCR solicits hospitals so that they can "achieve peak performance on their next survey," one brochure notes, and also sells its services to state hospital associations.

The average bill for one of its 300 annual consultations runs about $10,000, said Karen H. Timmons, JCR's president and chief executive. Directly or indirectly, most of JCR's nearly $33 million in revenue comes from helping hospitals win the joint commission's seal of approval.

Timmons said that there is a firewall between the subsidiary and the joint commission, and no inspection information is exchanged. "The joint commission would have no knowledge who we're dealing with," she said. "We're in a separate building several miles away" from the commission's Oakbrook Terrace, Ill., headquarters.

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