Does your local hospital or doctor’s office tout a seal of approval from a health-care accreditation organization? It can be one of many criteria to use when deciding where you go for care. But not all seals of approval are created the same—or can be equally trusted.
In general, accreditation organizations evaluate how well a health-care facility, medical practice or service program follows nationally established protocols and procedures when providing care.
Getting accredited is voluntary for many health-services providers. (One exception: Health plans on state Affordable Care Act (ACA) Marketplaces must be accredited by a government-approved agency such as NCQA or URAC, both of which are discussed below.) Because the review process involves providing a lot of detail on its operations over many months—and sometimes up to a year—seeking accreditation is a way of demonstrating interest in high levels of safety and quality.
There is some overlap among the major health-care accreditation organizations, but each has some unique areas of focus. Depending on the type of service or provider you’re researching, you may want to visit the website of one or more accreditation organizations. While you’re there you can also learn about the criteria and methodology each organization uses for each type of medical entity it accredits.
Here are the accreditation organizations that provide “seals of approval” you’re likely to see touted by your doctors and other health-service providers—and what those seals really mean…
The Joint Commission
Dating back to 1951, The Joint Commission is the best known of all medical accreditation organizations. It accredits more than 21,000 health-care facilities and programs in the US, primarily hospitals, ambulatory surgery centers, urgent care centers, sleep centers, independent laboratories, imaging centers, nursing homes and rehabilitation and behavioral health centers.
When Joint Commission reviewers go to organizations seeking its accreditation, they’re not there to assess specific clinical methods or treatments. Rather, they review records and equipment, and check that staff members have the proper education and training credentials to do their jobs and that the facility is complying with pertinent state and federal laws. How well procedures are performed is not directly assessed by The Joint Commission.
Important: Joint Commission accreditation of a hospital will include all of the facilities it owns including stand-alone satellite offices for procedures such as colonoscopy or knee replacement.
At The Joint Commission’s Quality Check page, you’ll get the most current information on a facility’s accreditation such as the date it was given. If you have a safety concern about a Joint Commission–accredited facility, you can file a complaint on The Joint Commission website. The Joint Commission will check to see whether any other patients have lodged the same complaint and might contact or visit the facility to see whether one of its certification standards isn’t being upheld.
The Joint Commission awards a “Gold Seal of Approval” to successful applicants for accreditation. Applicants must show how they corrected any concerns the survey found. Accreditation is good for two or three years, depending on the type of facility, and a reinspection is needed for renewal.
Commission on Accreditation of Rehabilitation Facilities (CARF)
Programs that carry CARF accreditation specialize in health and human services, an umbrella term that includes addiction treatment, behavioral health, aging services, child and youth services and medical rehab centers. Home and community services and retirement living (including independent and continuing-care communities) are also among the 50,000 programs and services accredited by CARF, which was founded in 1966.
In addition to assessing a facility’s business and service delivery practices, CARF looks at the systems needed for outcomes measurement, management and improvements and to what extent a facility upgrades services in the interest of providing the highest level of care. You can search for providers that meet CARF standards on its website. Consumers can report a complaint about CARF-accredited providers.
Providers who satisfy CARF standards receive a three-year accreditation. If CARF surveyors find substantial areas needing improvement when visiting a program seeking accreditation, the provider may be given a one-year accreditation and must submit a plan describing how it will fix any problems within the year. Each accredited provider must submit an “Annual Conformance to Quality Report” for CARF review demonstrating that it continues to improve its services. Maintaining accreditation from CARF is an ongoing process that includes an on-site survey every three years and annual reporting to CARF.
National Committee for Quality Assurance (NCQA)
Established in 1990, NCQA recognizes medical practices and health-care providers—more than 67,000 clinicians have this recognition. It also accredits Patient-Centered Medical Homes (the term used to describe a high standard of patient care)—more than 13,000 sites have earned this recognition. These providers must show that they deliver high-quality, coordinated care to patients not only in the primary care office but also in other places patients might get care within their local health-care system, such as specialty practices and urgent care clinics. There are also specific NCQA recognition programs for practices that specialize in diabetes, back pain and heart/stroke as well as special-needs care.
NCQA also accredits health insurance plans, including private insurers, Medicare, Medicaid and the ACA’s Marketplace health plans, and managed behavioral health-care organizations.
The organization developed the Healthcare Effectiveness Data and Information Set (HEDIS), an assessment tool to measure quality—many of its measures are used throughout the health-care industry. It also uses feedback directly from patients through its Consumer Assessment of Health Plans Survey. Practices submit paperwork that reviewers examine to determine whether “best practices” for patient care—including preventive care—are being followed.
NCQA gives consumers more detailed information than other accreditation organizations, including online report cards on doctors, medical practices and health plans. Practices are renewed for recognition every year.
Utilization Review Accreditation Commission (URAC)
Also founded in 1990, URAC focuses on patient outcomes and satisfaction. It accredits some of the same types of health-care practices as NCQA, such as disease-management programs and health insurance providers, but also accredits dental plans, prescription-by-mail services and specialty pharmacies. It’s also the first organization to offer a telehealth accreditation, designed for organizations providing health-care–related services, education and information delivered via telecommunications technology, such as videoconferencing, remote monitoring, electronic consults and wireless communications.
The URAC accreditation review includes examining policies and procedures, staff qualifications and information-management systems. Most URAC accreditations last three years.
Health-service providers given the “URAC Accredited” seal must collect and submit quality measures annually to maintain accreditation, and then the review process must be repeated for every renewal.
THE DECIDING FACTOR?
In the quest to demonstrate high levels of care, some practices and health-care facilities might apply for accreditation from more than one of these organizations. While having one or more accreditations shouldn’t be the only measure for choosing a care provider, it can be an important one—even the deciding one—because it tells you that the provider devoted a lot of time and effort to satisfying a long list of requirements.