International Hospital Accreditation
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International Hospital Accreditation
Learn what international hospital accreditation is all about and what it isn't
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International Hospital Accreditation: What it is... and What it Isn't

International Hospital Accreditation: What it is... and What it Isn't | International Hospital Accreditation |

For medical assistance companies and international private medical insurers, international hospital accreditation is but one item in a long list of credentialing and vetting elements when contracting with hospitals. Read on to learn what it is... and what it isn't.


About the author:

Maria Todd (pictured above) is the CEO of the Mercury Healthcare Companies, which includes a globally integrated health delivery system® spanning across the USA and more than 92 countries, with more than 6000 contracted and inspected hospitals and more than 750,000 physicians, together with over 650,000 ancillary clinics and facilities.


Mercury Healthcare Advisory Group, Inc., a wholly-owned subsidiary is a consultancy of 40 advisors based located throughout the world with special expertise in healthcare and clinical administration, and health travel program development. Mercury Cost Containment and Mercury Travel Assistance are additional wholly-owned subsidiaries of the Mercury Healthcare Companies.


In my role, I establish the organizational standards for provider qualifications, train our inspectors and provider relations staff how to vet hospitals and healthcare organizations and their professional medical staff, and share sign-off on completed files ready for finalization and contracting. It is from this point of view that this article is written.


Many international private and teaching hospital administrators I chat with tell me that they have been told that in order to be eligible to contract with insurance plans and employer-sponsored health plans, that JCI accreditation as a specific brand of accreditation is “required” as threshold criteria for network entry.


When I ask who told them that and ask to see any contracts that those advisors produced as evidence to back up their assertion, I get blank stares. As a former hospital administrator, I have had to address hospital boards to commit to an expenditure and project and consulting costs of over USD250,000 to seek out an "additional" initial accreditation and repeating costs over the three years after the final successful survey for re-accreditation. I would have been laughed out of a job had I not been able to substantiate nonsensical hearsay without copies of such alleged requirements by insurers and referral sources with whom we sought contractual relationships. And so have many former hospital administrators for whom the ROI for JCI accreditation was never realized.


I have a copy of thousands of managed care agreements from U.S. health plans. I have them because I have negotiated them on behalf of hospitals and physicians nationwide over the last 25 years. I haven’t found one that requires JCI or even Joint Commission, per se. I challenge you to prove me wrong with examples of at least 50 contracts. That will equate to perhaps .0005% of the contracts on the street.


Fundamentally hospital accreditation is about improving how care is delivered to patients and the quality of the care they receive. It has been defined in general terms, as "a self-assessment and external peer assessment process used by health care organizations to accurately benchmark and assess their level of performance in relation to established standards and to implement continuous improvement." In addition to many well-established national accreditation schemes such as those in the United Kingdom, the USA, Australia, New Zealand, Malaysia, Brazil, Colombia, Thailand, South Africa, and Canada, sophisticated accreditation groups have grown up to survey hospitals and become accredited by the International Society of Quality ( which accredits the accreditors, some hospitals use international healthcare accreditation as a de facto form of advertising in addition to their national accreditation scheme.


All ISQua-accredited programs are essentially structured so as to provide objective measures for the external evaluation of quality and quality management. They each focus primarily on the patient and their encounters with, safety and quality measures encountered through the healthcare system – this includes how they access care, documentation, how they are cared for after discharge from hospital, and the measurement of the quality of the services provided for them. There is a core list of competencies and standards which, attempt to review and measure in some systematic and comprehensive way the standards of professional performance in a hospital. What it does not address is the challenge of inter-rater reliability, inter-rater agreement, or concordance which is the degree of agreement among surveyors. It gives a score of how much homogeneity, or consensus, there is in the ratings given by surveyors.


It is here where I take a stand personally, against reliance upon scores which in essence, are only a snapshot into the ongoing activities of a hospital.


Of the more than 6000 hospitals in our network, I have personally walked more than half of them, all of which were accredited by some ISQua-accredited organization, and all of which on the day I made my observation would not have achieved a 100% score on one element or another.


As a former accreditation preparation consultant for several programs in the USA and abroad, I consider myself a trained observer that vigilantly maintains currency in the changes to the standards. This includes not only understanding direct patient care as a former surgical nurse, but also understanding the credentialing process, training and education of staff, privileging, clinical governance and audit, research activity, ethical standards etc. medical records management, patient communications, and other elements involved in the survey process.


Having reviewed a majority of those standards of ISQua accredited programs, I can atest that they are all essentially alike. Yes, there may more emphasis on customer service and other KPIs, but none requires any particular language for patient care, or medical records entries. None requires any specific cultural standard, and none requires any particular standard of care beyond the standard of care of the community in which the services are rendered.


For this reason, I am a proponent of direct inspection by the referral source, and strongly opposed to reliance upon branded accreditation of any kind as a substitution for that inspection. I hold the strong opinion that referral sources are often guilty of negligent referral by such blind faith in labels associated with accreditation. The snapshot in time as seen by an unaffiliated observer has no particular application to the relevance and appropriateness for clients and patients of those referrers.


When we inspect hospitals for network participation in our networks, there are times we approve hospitals and healthcare facilities for health travelers and medical tourists, and others who are approved specifically for medical assistance, and still others that are better qualified to receive steered referrals for IPMI clients who are local resident expats. In some cases, hospitals qualify to be in all three. As a matter of practicality, our contracts are actually divided into a base document and three attachments, one for each of the above programs. We could not discern the subtleties for case management, cost containment, and care coordination as effectively as we do otherwise.


Maria Todd, MHA PhD is the President and Chief Executive Officer of The Mercury Healthcare Companies. Her personal blog, AskMariaTodd™ has been ranked 9th worldwide on OrganizedWisdom® for Top Health Executive Contributors and 22nd worldwide in Healthcare Insurance industry thought leadership. She has been active at the forefront of managed care, healthcare business administration and medical tourism for more than 30 years. The author of 9 books, she has clinical, administrative, health plan provider relations and health law paralegal professional experience, and frequently lectures on hospital business operations, quality, marketing and medical tourism program development. Dr. Todd believes in the value of all hospital accreditation surveys for the purpose in which they were intended, and has no particular brand favorite.


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