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According to JC AHO, a dozen hospitals have lost accreditation nationwide since 1998. “When you lose accreditation, you can lose third-party patients and payments. The problems were severe enough that JC AHO issued a preliminary denial of accreditation.
If a hospital loses its Joint Commission accreditation, which happens only a few times each year across the country, a hospital could lose its ability to treat commercially insured patients, said Jim Lott, executive vice president of the Hospital Assn.
Medicare termination would be tantamount to closing down a hospital in most cases. In 2012, the Cleveland Clinic received 29% of all its net patient revenue from Medicare, according to audited financial statements. Although hospitals must be accredited to get paid, they don't have to do it through the Joint Commission.
Quite simply, hospitals pursue accreditation because it is required in order for their organizations to receive payment from federally funded Medicare and Medicaid programs. The Joint Commission accredits more than 4,000 facilities throughout the United States, which accounts for approximately 78 percent of hospitals.
Today, it accredits approximately 4,500 general, children's, long term acute, psychiatric, rehabilitation and surgical specialty hospitals. Approximately 82 percent of the nation's hospitals (including critical access hospitals) are currently accredited by The Joint Commission.
The WSJ investigation found that the Joint Commission, which accredits about 80% of U.S. hospitals, rarely pulls its accreditation. In 2014, the Joint Commission revoked accreditation for just 1% of facilities in 2014.
The Joint Commission is one of several organizations approved by CMS to certify hospitals. If a hospital is certified by The Joint Commission, they are deemed eligible to receive Medicare and/or Medicaid reimbursement. However, a hospital that is compliant with CMS is not necessarily accredited by The Joint Commission.
The Joint Commission accredits and certifies more than 22,000 health care organizations and programs in the United States, including hospitals and health care organizations that provide ambulatory and office-based surgery, behavioral health, home health care, laboratory and nursing care center services.
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