Biased Against Accredited Hospitals? Joint Commission Refutes Study

By Steven Porter

A study that found independent hospital accreditation carries no real benefit for patient outcomes has garnered a formal rebuttal from The Joint Commission, which argues the researchers reached faulty conclusions due to a number of methodological flaws.

Authors of the original report, published last month in the BMJ, said their findings show that hospitals accredited by private organizations were no better than those reviewed by a state survey agency, and at least one researcher involved in the project cited it as evidence that the status quo should be upended.

“We need to rethink what private accreditation buys us. Its a huge industry,” Ashish K. Jha, MD, MPH, a professor of global health and health policy at the Harvard T. H. Chan School of Public Health and a practicing internist at the Veterans Affairs Boston Healthcare System, wrote last month in a tweet linking to the report. “We find little evidence that its doing patients good.”

Jha expounded on the report’s conclusions this month in a JAMA Forum article.

“The findings are clear: accredited hospitals do not seem to be providing better care,” he wrote.

“We need to reexamine the standards required for accreditation to ensure that they are promoting what’s actually important: the health, safety, and optimal experience of patients,” Jha added.

The Joint Commission, however, contends that the study drew invalid conclusions by trying to compare “two radically different groups of hospitals” resulting in a bias against accredited hospitals. The organization, which is the predominant independent hospital accrediting organization in the U.S., submitted a formal response that the BMJ published last week, followed by a separate statement.

One of the big complaints raised by The Joint Commission was the difference in size of hospitals in the group accredited by independent organizations versus the group reviewed by state survey agencies. While two-thirds of the hospitals in the former group have more than 100 beds, an overwhelming majority, 93%, of hospitals in the latter group have fewer than 100 beds, the organization said.

Larger hospitals and teaching hospitals, especially, tend to care for more-seriously ill patients, too, but the researchers made their comparisons worse by failing to adjust for differences in patients’ severity of illness, according to The Joint Commission’s healthcare quality evaluation division Executive Vice President David W. Baker, MD, MPH, FACP, and President and CEO Mark R. Chassin, MD, FACP, MPP, MPH, who drafted the organization’s formal response.

What’s more, the study reviewed mortality for six categories of surgical procedures, but a majority of the hospitals in the group reviewed by state survey agencies didn’t perform some of the procedures being studied (because some procedures are uncommon at smaller hospitals), Baker and Chassin wrote.

“[D]espite the small numbers of cases, the authors combined the outcomes of the six types of surgery into a single multivariate model,” they wrote, arguing that this is problematic because more than 80% of all surgical cases for hospitals reviewed by state survey agencies were for hip replacements, while hospitals with independent accreditation covered all six categories.

“For three of the five other surgical procedures, the results favored [accrediting organization] hospitals,” they wrote.

Baker and Chassin complained that the authors minimized the importance of lower readmission rates for independently accredited hospitals.

“Based on the 3 million medical admissions at Joint Commission-accredited hospitals, which represent 88% of all medical admissions to [accrediting organization] hospitals, the findings indicate that patients treated in Joint Commission-accredited hospitals experienced 12,000 fewer deaths and 24,000 fewer readmissions,” they wrote. “These differences matter to patients.”

Jha, who is listed as the point of contact for the authors of the original report, did not respond to HealthLeaders‘ request for a response to The Joint Commission’s concerns.