The Role of Accreditation in Mitigating Risk Compliance Issues
Accreditation is the external peer review process that determines whether a healthcare organization complies with the pre-defined performance standards that improve the quality of care. The accreditation process is overseen by various non-governmental and governmental entities using various approaches.
Accreditation mitigates risk compliance issues by ensuring that healthcare organizations maintain a high level of quality in care provision and have a framework for continuous improvement (Hussein et al., 2021). Through accreditation, healthcare organizations are able to comply with various local, state, and federal regulations. Additionally, the accreditation process enhances the public trust in healthcare organizations as this assures them of safe and effective care.
Cottage Hospital: A Case Study in Lost Accreditation
Cottage Hospital was placed on probation by the Centers for Medicare and Medicaid Services (CMS), causing it to lose Medicaid and Medicare insurance. Many private insurers do not compensate healthcare organizations unless they are certified. Cottage Hospital's loss of Medicaid and Medicare patients meant the organization lost 72% of its revenue from outpatient and inpatient services (Martin, 2021).
The major reason for the probation was failure to ensure the safety, health, and well-being of the patients. CMS is responsible for ensuring healthcare organizations meet health and safety standards for accreditation as Medicaid and Medicare providers. Revocation of a hospital's Medicare reimbursement is typically the last resort after all attempts to remedy deficiencies fail (Martin, 2021).
How It Could Have Been Prevented
The loss of accreditation could have been prevented through consistent internal compliance audits, proactive corrective action plans when deficiencies were identified, and a robust quality improvement program. Regular training of staff on safety protocols and maintaining transparent communication with accrediting bodies are essential preventive measures.
References
- Hussein, M., Pavlova, M., Ghalwash, M., & Groot, W. (2021). The impact of hospital accreditation on the quality of healthcare: a systematic literature review. BMC Health Services Research, 21, 1-12.
- Martin, T. (2021). What's next for Cottage Hospital? Galesburg Register-Mail.
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