A hospital accrediting agency considered the industry’s gold standard is backing away from a controversial plan to sell hospital and patient data to insurance companies.
The Joint Commission on Accreditation for Healthcare Organizations, or JCAHO, announced last week it will not seek to sell further hospital data or its analyses to private third-party payors. The announcement came on the heels of a quick and forceful e-mail campaign led by the American Hospital Association this month, in which several California industry members participated.
Still left unanswered is if JCAHO violated patient privacy laws such as the landmark Health Insurance Portability and Accountability Act, which allows patients the option to be in a hospital, for example, without the staff disclosing their presence.
JCAHO began selling the data to Blue Cross Blue Shield several months ago and said it will honor its contract, which ends in February, said JCAHO spokeswoman Cathy Berry.
The performance data includes such information as the number of patients who had heart attacks at a given hospital or what medication or procedures staff administered.
Regional and national hospital trade organizations said they bombarded the commission with outraged messages saying that the organization was about to “shatter” its credibility as one of two private organizations that the government allows to accredit hospitals for Medicare reimbursement.
Nancy Pratt, senior vice president of clinical effectiveness for Sharp HealthCare, one of San Diego’s largest health care networks that includes four hospitals, said JCAHO’s selling of hospital and patient data confuses their role as an “agent to the public trust.”
“My concern as an administrator responsible for performance improvement is that it is not reasonable for the organization that is there to ensure safety of patients and that holds the public trust to then turn around and profit from our information,” Pratt said shortly before JCAHO announced it would not sell the data. “They’re either there to make a profit or as a quasi-governmental organization. They shouldn’t get confused as to what their mission is.”
Hospitals pay tens of thousands of dollars every three years to the Illinois-based commission for surprise as well as scheduled inspections.
In 2003, Sharp Grossmont paid $54,000 for a three-year accreditation from the organization. The hospital will pay $72,862 for the next inspection, according to Sharp.
The Office of Civil Rights, which oversees HIPAA, met with the commission and the Chicago-based American Hospital Association separately in the last couple months to discuss the hospital association’s concerns that data JCAHO was selling would violate HIPAA, according to both organizations.
Amy Lee, a spokeswoman from the American Hospital Association, said her organization expects a ruling from the Office of Civil Rights, but that it gave no clear timeline. The Office of Civil Rights did not return phone and e-mail messages.
While much of the data JCAHO is selling to Blue Cross Blue Shield is available through an interactive research feature on JCAHO’s Web site, much of it is not available to the public, Berry said, adding that the analyses sold to Blue Cross Blue Shield does not include an opinion from JCAHO. She also said it does not include names of patients. However, HIPAA law could still be violated if enough information is available to identify a patient through process of elimination.
“We’re not trying to violate anything,” said Berry, adding that the organization’s mission is to improve the quality of health care. “Performance measurement really drives improvement. We’re asking organizations to help measures drive their improvement.”
Some hospital administrators and leaders of hospital trade organizations say they are concerned JCAHO’s selling of data could give health plans an advantage in negotiating contracts and that poor ratings on inspections might eventually mean being eliminated from a health plan network.
They caution that if JCAHO is able to profit by selling data to health plans, the body could lose its objectivity as an accreditor. In addition, some administrators worry that JCAHO might require more in-depth reporting year after year to gain accreditation.
When the Sacramento-based California Hospital Association’s Dorel Harms found out about JCAHO’s sale of hospital data, the vice president of quality professional services organized comments from several state hospital associations, urging them to contact the commission.
“JCAHO is supposed to be an unbiased, third-party accreditor,” Harms said prior to JCAHO’s decision. “That’s a different role than a marketer of information, and that’s what they are doing. How do you trust someone who has motives other than accrediting? It doesn’t seem to pass the smell test.”
Harms and the American Hospital Association say JCAHO officials said in recent weeks that they wanted to turn the organization into a data analysis company, an allegation JCAHO denies.
Steve Escoboza, chief executive officer of the Hospital Association of San Diego and Imperial Counties, agrees JCAHO should not be selling hospital performance data to third parties.
“The fear (among hospitals) is that if you report it that it will be misused,” Escoboza said.
JCAHO has been accrediting hospitals and thousands of other health-care organizations for a fee since 1951.
JCAHO’s stamp, said a California Hospital Association spokeswoman, has become the equivalent of the “Good Housekeeping Seal of Approval.”
JCAHO has said it wants to work with hospital industry leaders to examine ways to protect patient privacy.