What is Accreditation and Why Should Your Agency be Accredited?
Accreditation means that a medical facility has volunteered to undergo a challenging, comprehensive evaluation. It has made a significant extra effort to review and improve the key factors that can affect the quality and safety of the care it provides
Accreditation by JCAHO (Joint Commission on Accreditation of Hospital Organizations), CHAP (Community Health Accreditation Program), or others are considered the Gold Standard in health care. Hospitals and healthcare agencies have been evaluated by JCAHO or other accrediting organizations for more than 50 years.
Of special interest, having the accreditation deems your agency certified to take Medicaid and Medicare insurance money. (see below)
Reasons to be accredited:
Helps organize and strengthen patient safety efforts – Patient safety and quality of care issues are at the forefront of Joint Commission standards and initiatives.
Strengthens community confidence in the quality and safety of care, treatment and services – Achieving accreditation makes a strong statement to the community about an organization’s efforts to provide the highest quality services.
Provides a competitive edge in the marketplace – Accreditation may provide a marketing advantage in a competitive health care environment and improve the ability to secure new business.
Improves risk management and risk reduction – Accreditation standards focus on state-of-the-art performance improvement strategies that help health care organizations continuously improve the safety and quality of care, which can reduce the risk of error or low quality care.
May reduce liability insurance costs – By enhancing risk management efforts, accreditation may improve access to and reduce the cost of liability insurance coverage.
Provides education to improve business operations – Accreditation bodies like JCAHO provides continuing support and education services to accredited organizations in a variety of settings.
Provides professional advice and counsel, enhancing staff education – Accreditation surveyors are experienced health care professionals trained to provide expert advice and education services during the on-site survey.
Provides a customized, intensive review – Accreditation surveyors come from a variety of health care industries and are assigned to organizations that match their background. The standards are also specific to each accreditation program so each survey is relevant to your industry.
Enhances staff recruitment and development – Accreditation can attract qualified personnel who prefer to serve in an accredited organization. Accredited organizations also provide additional opportunities for staff to develop their skills and knowledge.
Provides deeming authority for Medicare certification – Some accredited health care organizations qualify for Medicare and Medicaid certification without undergoing a separate government quality inspection, which eases the burdens of duplicative federal and state regulatory agency surveys.
Recognized by insurers and other third parties – In some markets, accreditation is becoming a prerequisite to eligibility for insurance reimbursement and for participation in managed care plans or contract bidding.
Provides a framework for organizational structure and management – Accreditation involves not only preparing for a survey, but maintaining a high level of quality and compliance with the latest standards. Accreditation provides guidance to an organization’s quality improvement efforts.
May fulfill regulatory requirements in select states – Laws may require certain health care providers to acquire accreditation for their organization. Those organizations already accredited may be compliant and need not undergo any additional surveys or inspections.
Aligns health care organizations with one of the most respected names in health care – Being accredited helps organizations position for the future of integrated care.
In 2011, Medicare spent a total of $549.1 billion on health care coverage for 48.7 million beneficiaries. This accounted for roughly 15 percent of the national budget and 21 percent of overall U.S. health care spending, according to the Congressional Budget Office.
First, what is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage Plans)
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
In 2011, Medicare spent a total of $549.1 billion on health care coverage for 48.7 million beneficiaries. This accounted for roughly 15 percent of the national budget and 21 percent of overall U.S. health care spending, according to the Congressional Budget Office. (http://www.newrepublic.com/article/politics/86449/medicare-medicaid-welfare-budget)
More than 60% of people living in nursing homes are covered by Medicaid
What is Medicaid?
Medicaid is the nation’s main public health insurance program for low-income people. Most Medicaid beneficiaries lack access to private insurance and many have extensive needs for care.
Medicaid is also the dominant source of long-term care coverage in the U.S. As a major insurer of low-income people, Medicaid provides key financing for the safety-net institutions and providers that serve the low-income and uninsured population, as well as the larger public. Medicaid is financed through a federal-state partnership, and each state designs and operates its own program within broad federal guidelines. Medicaid’s structure has enabled the program to evolve and facilitated state innovation.
WHO DOES MEDICAID COVER?
By design, Medicaid covers low‐income people. Currently, the program covers more than 62 million Americans, or 1 in every 5, including many with complex health care needs. Medicaid plays an especially large role in covering children and pregnant women; it also covers millions of individuals with severe disabilities and provides extra assistance for millions of poor Medicare beneficiaries. Medicaid historically has excluded most non‐elderly adults, but the Affordable Care Act (ACA) expands Medicaid to people under age 65 with income at or below 138% of the Federal Poverty Level, which was roughly $14,000 for a single person and $30,000 for a family of four, effective January 1, 2014. The expanded Medicaid program is integral to the broader framework the ACA creates to cover the uninsured. Following the Supreme Court’s ruling on the ACA, each state will decide whether or not to adopt the Medicaid expansion. However, all states must comply with ACA requirements to simplify and streamline Medicaid eligibility and enrollment to ensure seamless coordination between Medicaid and the health insurance exchanges, the other new major coverage pathway for the uninsured.