Achieving and Maintaining Accreditation in Managed Care

Credentialing from advanced practice registered nurses (APRNs) perspective is defined as “furnishing the documentation necessary to be authorized by a regulatory body or institution to engage in certain activities and use a certain title” (Hanson, 2014). Credentialing is also define from a local institutional process that consider specific documentations for APRN before they assume the practice role as APRN within their facility. In health care system, credentialing ensures individuals meet required standards of practice and is prepared to perform those duties implied by the credentials. National certification and education are considered as part of credentialing for APRN to acquire basic level of competence to practice. (Hanson, 2014)

Insurers are less likely to reimburse APRN’s in states that mandate physician supervision. Nurses need to push for reform of the regulations governing APRN;s.

The Joint Commission on Accreditation of Healthcare Organizations or JCAHO was founded in 1951 as a private nonprofit organization that established guidelines for the running and management of hospitals and health care facilities in the United States. According to its website (n.d.), JCAHO’s primary mission is, “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest

The Department of Health and Human Services currently are the seven national accreditation organizations that offer accreditation programs that are recognized for purposes of certifying the compliance of almost 7,000 hospitals, critical access hospitals, ambulatory surgical centers, home health agencies, and hospices with Medicare health and safety standards (Lanham, 2013). These accredited health care facilities as having satisfied the health and safety standards

Like mentioned above, JCAHO is a nonprofit organization that accredits institutions consistent with requirements and policies they need to abide by. Their mission is, “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value” (The Joint Commission, 2015) and their vision is “All people always experience the safest, highest quality, best value health care across all settings”. This organization was found in 1951 where they intended to continuously improve health care for the

“While accreditation is technically a voluntary process, through which accrediting bodies like The Joint Commission visit a facility to perform quality and process checks, it is also relied upon by state agencies in all fifty states in lieu of specific state licensure requirements (Hay, n.d.).” All organizations must meet certain standards in order to even open its doors. It is very important for healthcare organizations to be accredited by someone. The Joint Commission is the most popular and well known. Facilities that are accredited by someone other than The Joint Commission many not give the highest care which leads to more readmissions costing more. “In a retrospective analysis at 24 accredited trauma centers in the United States, accreditation was significantly associated with higher survival rates for patients presenting with six types of trauma injuries (Alkhenizan,

The history of the Joint Commission on Accreditation of Hospitals is a story of the health professions’ commitment to patient care of high quality in the 20th century. According to Dr. Ernest Codman, founder of the accreditation system, which would enable hospitals to track every patient it treat long enough to determine whether or not the treatment was effective. If not, the hospital would figure out how to prevent similar failures in the future (Roberts, Coale & Redman, 1987).

The Joint Commission is an accrediting agency that evaluates the services provided by health institutions and recognize that after their assessments meet all requirements. This visit is requested by the institution and after being accredited are visited every three years. “The Joint Commission is working to align and improve how accreditation and certification work together to enhance their value to organizations” (Horn, 2012, p.243). It is a prestige by being accredited by the Joint Commission. The hospital institution is evaluated in all aspects evaluated from the triage is performed in the ER, permits, documentation, security, administration of drugs, surgical procedures, to infection control and other aspects that are related to the safety

Charles HaydenTatia Green, onlineMB208-ICD-1012/3/2015Accreditation Association for Ambulatory Health CareIn 1979, a nonprofit organization was established to assist ambulatory health care organizations in improving the quality care provided to patients. This organization which some may know of is called Accreditation Association for Ambulatory Health Care, Inc. which: "Encourage and assist ambulatory health care organizations to provide the highest achievable level of care for recipients in the most efficient and economically sound manner. The AAAHC accomplishes this by the operation of a peer-based assessment, consultation, education and accreditation program." American College Health Association, Ambulatory Surgery Foundation, The American Group Practice Association, Group Health Association of America, Medical Group Management Association and the National Association of Community Health Centers are the six founding members of AAAHC. A few things that this association does are measure performance, provide consultation and education, review and revise standards. AAAHC accreditation means the organization participates in an ongoing self evaluation, peer review and education to continuously improve its care and services. Not only does this organization live up to its standards, but commits thorough onsite survey by AAAHC surveyors whom are also health care professionals. When surveying an organization, the AAAHC includes the following as listed: Patient RightsAre patients

Under this model, the licensure enables the APRN to legally provide care to the public, with the required education and training, they are allowed to practice within the scope of practice depending of the States where they want to practice. The education

The “Do Not Use” List was created to minimize medical errors. Mistakes were being made in relation to incorrect use of terminology. Before long, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an independent organization that accredits and certifies more than 20,500 health care organizations and programs in the United States, introduced the list as a requirement in accredited organizations in 2004. It includes abbreviations, acronyms, and symbols that should no longer be used.

Length of stays are also evaluated, as length of stays often speak to whether providers are following evidence based medicine and thus providing quality care.Besides looking at volumes the credentialing committee will need to look at performance including morbidities and mortalities. These numbers and other quality indicators should be review to see if providers are performing at with national averages. With the the onset of value based purchasing, there is now much data such as HCAHPS which can and should be evaluated which allows providers to be compared to other local physicians as well as national averages. Patient complaints and disciplinary action which have also be placed in provider's files must be reviewed as part of the credentialing process. This allows institutions to see if there is some type of trend that needs to be corrected or if there's a reason for adjustment to providers privileges. Often completion of the medical records is also considered as well as part of this process. This speaks to providers attention to detail and compliance with other hospital rules and regulations. Continued noncompliance can be cause for disciplinary action, re-education, or may require corrective

Furthermore, licensing and accreditation standards must be heightened to insure the quality of the nurses that enter the workforce. Certifying organizations must therefore mandate the proper demonstration of core competencies and skills prior to endowing students with the nursing title. The nursing profession, according to the IOM report, must undergo fundamental changes within the overall education of nurses. In many respects the basic

With a consistent change in modernizing medicine, along with the continuing advancement in technology, continuing education in nursing is essential for a variety of reasons. The nurse’s main concern is providing safe, efficient, and effective patient care with positive patient outcomes. This paper will examine the differences in competencies between nurses prepared at an associate-degree level versus a baccalaureate-degree level, in order to provide an evidenced-based understanding of the variation in the educational preparation of nurses.

Accreditation seems to be a “process that many nursing programs voluntarily undertake to assure ongoing quality of the program (Adam, 2012).” (Ellis & Halstead, 201, p. 18). The faculty along with administrators who are in new roles may not