(Re)accreditation is often an important component of an organization’s strategic planning. For congregate living facilities (residential or group home settings) seeking reimbursement under Title IV-E as a qualified residential treatment program (QRTP), achieving or maintaining accreditation by an approved accrediting body is a required component of strategic planning.
Likewise, (re)accreditation may also be required to obtain/maintain a license/certificationfor an organization to operate/deliver services or for reimbursement through commercial or public health insurance.
Fortunately, all three accrediting bodies have found efficient and meaningful ways to continue their work so organizations can continue in their accreditation efforts.
CARF International:
CARF’s Digitally Enhanced Site Surveyshave been occurring since mid-May and CARF advises Accreditation Guru (AG) that this process has been met with very positive responses from its programs.
Council on Accreditation (COA):
Effective July 1, COA is providing virtual options for site visitsand will work with each organization to determine most appropriate option.Having an onsite presence is part of some of the COA options.
The Joint Commission:
The virtual survey option offered since June by The Joint Commission for behavioral health care accreditation of Opioid Treatment Programs (OTPs) will be expanded to include a virtual survey option for organizations meeting Joint Commission eligibility requirements (including certain technology capabilities). On-site survey is also an option for some organizations in geographic areas identified as low risk by Joint Commission leadership – details here.
All three accrediting bodies are asking organizations to confirm with applicable federal/state/local regulators that virtual site visits/surveys are acceptable. (AG has been advised by The Joint Commission that the US Administration of Children and Families has approved virtual surveying for Qualified Residential Treatment Programs (QRTPs) if accepted by any related state regulatory authority).
Accreditation Guru assists organizations in creating a customized (re)accreditation timeline based on its strategic planning and provides support along the way to successfully meet each milestone. A re(accreditation) calendar provides a visual tool to keep leadership and staff focused for an efficient process.
If you have questions on (re)accreditation please contact us – 212.209.0240 or email info@accreditationguru.com
Accredited by The Joint Commission since 1986, the Tamarack Center provides top-tier residential psychiatric treatment to adolescents in Spokane, Washington. In addition to a web page devoted to “Accreditation and Licensing” on their site, they also display the Gold Seal of Approval logo from The Joint Commission. Recently, Tim Davis, CEO at Tamarack Center expanded on the importance of accreditation and its significance to his organization.
Tamarack achieved accreditation because their contract with the state required it. Though the process and its aftermath helped turn Executive Director Tim Davis into a strong advocate for the benefits of being accredited.
In this interview with Accreditation Guru, Tim contends that accreditation limits liability, attracts top talent and convinces parents to trust their children’s care to Tamarack. You may even be able to negotiate a discount with your insurance carrier.
What are some of the prime benefits of accreditation?
With the world being so litigious, you want to limit liability. You don’t want to be out there without some form of accreditation, which is a statement about how you do things. Plus, you’re regularly reviewed by outside parties on a continuous improvement plan.
Over the last 35 years I’ve seen a lot of people who never thought about these things. Now realizing it’s not only smart to do, but it also offers huge protection in any disagreement or litigation.
The legal protection is so important, especially in [the behavioral health] world. Something bad can happen at any time, be it a successful suicide, a sexual assault, running away, being harmed or harming someone.
Typically, the basis of any lawsuit is that the institution had no idea what they were doing. From the parental perspective, it’s “I left my child in their care and they have no idea how to handle my kid.”
When it gets to that point, attorneys say that it’s helpful to show that you’re adhering to accreditation standards over a period of time. That you’ve thoroughly covered your processes and you’re dedicated to running the place with that in mind. You can even show surveys where they found deficiencies and you took steps to correct that issue as an ongoing daily process.
It ensures that you’re paying attention to the environment of care and ethical standards. Then, you have a much stronger defense. Otherwise, it’s he-said-she-said, back and forth. I value this kind of protection.
To what do you attribute a rise in knowledge about accreditation?
There’s a little more awareness each year. People go on the web and begin to understand. Now, insurance companies are spreading the word and getting more involved.
Really? That’s interesting. Do insurance companies offer discounts to organizations that are accredited?
[Laughs.] I’ve never heard of that, but they should.
[Accreditation Guru note: Some liability insurance companies will take into account accreditation when determining the cost of liability insurance for a residential program because they view accreditation as an acceptable risk reduction strategy. The cost saving may be the result of a direct discount on premiums or due to having accreditation status gives the program a better rating that results in a reduced rate.]
You mentioned that you operate in a distinct environment.
Over the years, there have been a lot of conversations about residential care for kids. There are a lot of unlicensed, rogue programs that certainly aren’t accredited who think they know how to heal problem kids.
A lot of boot camp style centers got a lot of publicity on Dr. Phil and NBC News, but the residential treatment centers that are accredited can’t do things that people consider to be rogue. They made a commitment to do just the opposite, with a set of agreed upon standards.
We talk about assessment and such a key part of anything you do is to try and understand what the conditions are and what your organization can do for them. I tell parents that we’re going to do a mountain of assessments and you can have access to all of this and decide on the course of treatment.
The rogue operators say “just let Johnny stay with us two months and you’ll get a different kid back.” Are they going to do legitimate service to families? One way to do that is to adhere to an agreed upon set of standards.
Why don’t more residential treatment centers become accredited?
It’s not an easy thing to do and it represents an expense. But our organization considers it money well spent.
When I talk with non-accredited places, I realize how fortunate I am. I’ve got a high bed rate, top-flight staff and a high level of safety. Other places may have a lower bed rate and take kids because they need to fill the beds, but they may not be equipped to deal with suicidal or psychotic kids and if they have three people with a high school equivalence working the floor and a psychiatrist who comes in two hours a month, that’s a nightmare.
Sometimes, nonprofits can be naive about the mission, thinking that all you need to take care of disturbed kids is “if you hug ‘em and feed ‘em, they’ll get better,” but that’s where accreditation comes in. It adds a level of seriousness and professionalism that you can’t get anywhere else.
My biggest battle with the state is that our accreditation defines the scope of care – we have 16 beds and we’ve decided that there are certain types of kids we can’t serve and the state goes crazy when we declare that a placement might be out of our scope of care, which is the foundation of our contract.
Nonprofits that don’t define their scope of care get into a tremendous mess when they take people for whom they can’t provide appropriate services. I talk with people who are licensed, including nurses and doctors and tell them that they never want to work in a place that is not accredited because it provides a bit of a safety net for your license if something goes haywire. And it will.
In behavioral health they can come after you, but in most cases you will be protected because the heart of the argument is “what kind of place is this?” Is it a ragtag outfit or a professional medical environment? All you need to know is that it’s accredited.
There’s always going to be resistance to accreditation in the beginning due to the amount of work. And yeah, it’s more work, but it’s not insurmountable. With The Joint Commission, there are many ways you can meet a standard, they’re not dictatorial. Accreditation gives you and your staff accountability in this highly unpredictable, litigious field of work.
Does accreditation help with your marketing? Do parents know about it?
We’re small and we’re almost always full, so we don’t do much marketing. But we do speak with parents all the time who ask “why should I leave my child here? What can we expect?” And accreditation is a big part of that conversation.
I actually show them The Joint Commission manual and tell them “here are the things for which we are held accountable” and I let them spend as much time as they want asking me about our internal processes, making sure that something in the manual is happening.
It’s a big part of helping parents feel comfortable putting their child here. They know that there is some system in place that we have been doing for years and our standards of care are at the same level as the best providers across the country. It’s comforting for them.
Spokane is a small place, so if something bad happens, people talk about it and if it turns out that a place has no accreditation, I use it as an opportunity. I tell people that I have this written road map about how to care for people ethically and efficiently. Then, outside people come in and put you under the microscope and say “are these guys doing this or not?”
We’re licensed in Washington state five ways and the license reviews and audits are really specific. They’ll look at the fridge or run a white glove over something, but they’re not getting the full picture of care. Accreditation does.
So when there’s an incident in town, you spring into crisis coordination mode?
People inevitably ask “how could that happen?” The worst answer you can give is that the system broke down. If you can answer that a person made a mistake or willfully performed a bad act, people are more understanding because as humans, those things can happen. The public is less understanding of people who run something where the system allows a mess.
You had no background in accreditation when you took over at Tamarack, right?
I was a clinical guy and knew little about the management side of nonprofits, but The Joint Commission laid out what I had to do if I’m managing the thing properly.
Like everything, there was a learning curve, but the key – when I look back – is to understand the philosophy of each standard. What’s really important is that once you get this, then the whole accreditation process makes ten times more sense.
You ask yourself, “is it really important to do that?” If the answer is no, then ask, “why not, if that’s the standard?” You’d be amazed how many times we ask “is it important to do that?” and at first people might say “that’s stupid, we don’t need that.” And then, inevitably, you look around the table and people are shaking their heads saying “yeah, this makes sense.”
For new young management like me, the standards themselves served as a mentor or guiding force.
To learn more on how achieving accreditation can help elevate your organization, call us at 212.209.0240 or email Rocio@AccreditationGuru.com for assistance in setting up a commitment-free phone call with our CEO, Jennifer Flowers.
Since late February 2020, child welfare agencies and behavioral health care organizations have been forced to focus on two critical functions – infection control and emergency management. Depending on the services provided and location of the organization, providers have been forced to change their operations in ways that include having all employees work remotely, provide telehealth services or even “closing the gates” and delivering residential services without people going on or off the property.
In these trying times, the framework provided by implementing national accreditation standards certainly helps service providers better manage the necessary pivot in operations and service delivery in this time of crisis.
Accreditation Standards – Detailed Plans and Strategic Safety Net
Accreditation standards that address risk prevention and management, infection prevention and control, performance and quality improvement, technology and information management and staff training are all being put to the test these days.
Effective risk management controls include, but are not limited to, emergency response preparedness. An accredited agency is required to have a written disaster plan for evacuation and relocation of staff and clients, parent-child reunification following a disaster, as well as specific plans to meet the needs of individuals with disabilities and other special needs during emergencies. The organization must also address coordination with governmental authorities and emergency responders. Further, staff needs to be trained on how to respond to medical threats and emergencies and how to handle potential safety risks they may encounter on the job.
Accreditation (maintenance and preparation) guides an organization through a thoughtful, structured and planned process to create an infrastructure for risk management and performance improvement that can be seamlessly implemented during times of crisis like this one.
The accreditation process also helps organizations review and strengthen their policies and practices through compliance with national standards of care. This includes creating processes for gathering and using data for continuous improvement of the quality of the services provided. It is not enough to collect and analyze data related to outputs such as the number of clinical sessions provided or the total number of clients served, but they also must identify, observe and measure the effects of a program’s services on clients.
“Plan and procedures for disaster readiness are a lived concept for CARF-accredited organizations. The readiness mindset of our programs has helped organizations and their staff to transition services to better support children and families during this pandemic.” – Leslie Ellis-Lang, MMFT, Managing Director, CARF Child and Youth Services *
Technology-Based Service Delivery – AKA Telehealth
Due to the pandemic and resulting COVID-19 funding legislation that now expands coverage for telehealth services for Medicaid and Medicare beneficiaries, a vast number of service providers were given the opportunity to make a seemingly overnight shift to employees working remotely and providing telehealth services.
The existing accreditation standards in place that address the management of technology-based service delivery allow companies to reference their strategic plan and immediately embrace the full-time use of this technology.
Any accredited organization that engages or plans to engage service recipients in technology-based service delivery needs to develop policies and procedures to guide telehealth service delivery to address privacy and security measures. They must also assess the appropriateness of technology-based service delivery for each individual and monitor effectiveness of using this model.
Accreditation standards further address competency-based training for personnel on the use of equipment and software, privacy and confidentiality issues, and recognizing and responding to emergency or crisis situations from a remote location.
While many organizations may not have developed a detailed pandemic response plan, wouldn’t it have been helpful to have already addressed and planned for the use of telehealth services and having employees work remotely under the framework of accreditation standards?
Accreditation Drivers
“Accreditation is not just a box to tick and this is even more apparent during times of crisis,” says Jody Levison-Johnson, President and CEO, Council on Accreditation (COA). “COA has standards that address key preparedness and response issues. These fall under the broad standards categories of human resources management, safety and security, and emergency preparedness – all of which are critical during times of crisis.” *
The three major accrediting bodies for human service organizations (CARF International, Council on Accreditation and The Joint Commission) research and develop their unique set of accreditation standards that address a commitment to helping child welfare and behavior health care organizations provide safe and high-quality care, treatment or service. Applying the standards often leads to an increase in consumer confidence in service delivery. Read “Increasing Consumer Confidence Through Accreditation“.
“(The Joint Commission) recognizes the challenges behavioral healthcare organizations are facing during this difficult time and we want to hear from all behavioral health care providers what else we can do to help.” – Julia Finken, Executive Director, Behavioral Health Care Accreditation *
This Too Shall Pass
“This too shall pass” is comforting and indeed it will (or be better controlled). But, as the pandemic stretches on and businesses start to develop a “new normal” for addressing the various health and economic needs of the public at large, a pre-laid foundation of strategic plans and detailed response initiatives can provide a more effective pivot for a company.
Is your organization one of them? By scheduling time to focus on accreditation, you can address key initiatives now and stay ahead of the game in the future. Don’t delay your preparation for achieving accreditation. Develop a work schedule that includes accreditation preparation whether you are applying for the first time or maintaining your status.
Keep Your Momentum Going!
*For additional information from the accrediting bodies:
Individuals, agencies and associations in the child welfare space have been preparing for the initial implementation date of the Family First Prevention Services Act (FFPSA) even before it was signed into law in February of last year.
This act, which aims to change the face of child welfare in the United States, required implementation by October 1, 2019, unless a particular state opted to delay enforcing its provisions for up to two years. At last count, only nine states, plus the District of Columbia, are planning for early (2019) implementation of FFPSA.
For more than a year, Jennifer Flowers, CEO of Accreditation Guru, has delivered numerous presentations around the country about FFPSA’s accreditation mandate for a new category of congregate care providers: Qualified Residential Treatment Providers (QRTPs).
It’s fitting that on October 1, the birthday of FFPSA’s implementation, Jennifer moderated a panel at the Texas Child Care Administrators Conference, which included panelists representing the three approved accrediting bodies as well as Kristene Blackstone, Associate Commissioner for Child Protective Services in Texas – one of the largest CPS programs in the nation. Following Jennifer’s summary of FFPSA and what it means to become a QRTP, the panel launched into a lively discussion about accreditation and the rollout of FFPSA in the State of Texas.
For more information about FFPSA, visit AG’s webpage devoted to this topic. And, for inquiries about assistance with preparing for national accreditation or for information about Jennifer Flowers speaking at your event, please contact Rocio@AccreditationGuru.com.
Individuals reach out to relatives, friends and other trusted advisors for relationship, financial or career help all the time. So why are many businesses reluctant to hire a consultant?
Some reasons for this resistance include institutional inertia, fear of seeming weak or ineffective and a lack of awareness that a different perspective can provide big dividends.
Companies that consider – or are required – to seek accreditation may think that the process is just a rubber stamp and underestimate the task ahead.
Though many boards and executives only contemplate hiring a consultant when things go south, there are many good reasons to get advice from an experienced consultant when the situation warrants.
Growing Pains
Here’s a familiar scenario in the non-profit world: the board is raising money, staff is hired and the vision is being executed. However, growing demand for services outstrips the capacity of the organization to scale up.
In other cases, the mission expands into new, related opportunities that pull non-profits into unforeseen directions.
These seem like good problems to have, but when you’re faced with an unexpected crisis or an overload of decisions to be made, having a consultant who can see through the fog and help vet options is invaluable.
Few non-profits possess the capacity to undertake their own competitive and/or market research to support decision-making, help your team develop an action plan and set goals and priorities.
Conflict Resolution
It happens all the time: two powerful individuals or factions within an organization clash over direction or policy. Is providing human services to the vulnerable enough or should the non-profit lobby for new laws to deal with the underlying issues causing the problems?
There is a reason why arbitrators, mediators and the court system exist: to serve as neutral, unbiased third-party judges to either make a decision or help develop an agreement for moving forward.
When different opinions hinder the ability of board and staff leaders to settle on priorities, paid consultants can help organizations move beyond the debate, try to develop a consensus and get back on track to fulfill the organization’s original mission. And they cost a lot less than lawyers.
Navigating the Unknown
Leadership transitions or succession issues can tear non-profits apart. This is one reason why sports teams have coaches: when the top players move on or retire, the deck has to be reshuffled. Professional facilitators can help develop a strategic plan and prepare your board and staff leadership for seamless change and determine the best path to ensure future stability.
Through the Viewfinder
When competing priorities or sudden crises emerge, consultants can help focus on the most important ways to deal with adversity. They can be tasked with developing a ranked, detailed action plan throughout the collaboration so that there’s buy-in from every level of your organization.
For help getting everyone to share goals, implement effective tactics, develop timelines and achieve measurable outcomes, consultants are in a unique position to rally the forces and foster lasting growth and sustainability.
Time Savings
When it comes to navigating the accreditation process, hiring the right consultant can save time (and money).
At Accreditation Guru, our team experts have gained valuable and actionable experience in the field. They know exactly what the accrediting bodies are looking for and how best to compile organization data and information.
But achieving accreditation is an involved process that will require your employees to spend less time on their day-to-day responsibilities. To ensure efficient time management, our consultants go beyond providing training functions and serve as sounding boards to answer questions from staff so no one is spinning their wheels or getting lost in a rabbit hole trying to figure out what the accreditation standards mean.
Rather than serve as a sign of weakness, hiring consultants marks a bold, brave move that can provide lasting benefits far beyond the immediate cost. And achieving accreditation will help increase credibility and stability. Don’t leave your destiny to chance!
To schedule a call with Jennifer Flowers for your accreditation needs, contact us at Info@AccreditationGuru.com or 212.209.0240.
On May 15, it was announced that EAGLE Accreditation Program is recognized by the Department of Health and Human Services as an approved accreditor for Qualified Residential Treatment Programs (QRTPs) under the Family First Prevention Services Act (FFPSA). As we have discussed here, FFPSA, which passed in February 2018, allows federal funds to be spent on preventative services to help keep families together and also restricts funding on congregate care or group homes for children and youth who require removal from their families. In part, FFPSA mandates that all residential treatment providers convert to QRTPs, a new licensing category, in order to be eligible for reimbursement through Title IV-E foster care funds after the first two weeks of child placement.
EAGLE, which stands for Educational Assessment Guidelines Leading toward Excellence, is the only faith-based accrediting body in the country. It focuses on ministries serving older adults, children, youth and families, and those with developmental disabilities with emphasis on excellence, quality and how applicant organizations incorporate their Christian mission, religious heritage and values throughout the organization and its daily operations. EAGLE accreditation has provided an option for faith-based organizations since 1984.
The EAGLE Accreditation Program is operated by the United Methodist Association of Health and Welfare Ministries (UMA).
“We are proud of this recognition for EAGLE,” said Mary Kemper, president and CEO of UMA. “As an accreditor of faith-based organizations for more than 40 years, EAGLE has a solid history of promoting excellence with the added focus on organizations’ faith-based mission, vision and values.”
For questions about EAGLE or other accrediting bodies and for assistance preparing your organization to become a Qualified Residential Treatment Program, please contact Accreditation Guru at Info@AccreditationGuru.com.
Tracy first became familiar with the accreditation world when she began working for Gateway Foundation in 2007. Gateway Foundation is accredited by The Joint Commission, and she became familiar with TJC behavioral health accreditation during her 6 years as executive director for Gateway Aurora.
Her knowledge of accreditation became much stronger as she became Executive Director of The Joint Commissions Behavioral Health accreditation program, as she had the opportunity to work closely with the accreditation team, behavioral healthcare leaders, and advisory members. Now that she is back in the field, she continues to value accreditation as a road map to leading a safe, high quality organization. She believes this is critical for engaging a team that is invested in providing the best care possible to people in need. Her Joint Commission experience has been so valuable to her as a leader – it reinforces her resolve to provide the best possible leadership to her team in support of the care that people deserve to receive.
She enjoys spending time with her two teenage boys, husband, and dog. Her boys are both involved in sports, so much of their free time is spent cheering on their baseball/basketball teams locally or on the road. When at home, they love watching movies together or hanging out with friends.
She also enjoys outdoor activities – gardening, walking her dog, running, golfing…boating when they have a chance to get to a lake… hiking when she visits her brother in Oregon or sister in Arizona…and skiing when it snows in the Midwest or when they travel to visit her siblings. Both her husband and Tracy are from big families, so there is often a birthday, holiday, or other event to celebrate as well!
When she has downtime, she loves to read (or listen to books on Audible when driving), particularly suspense books, historical fiction novels, and leadership books.
We are happy to have Tracy on the Accreditation Guru team!
Some human service agencies view accreditation as a luxury. Others see it as a hassle. Yet the benefits are undeniable.
Achieving national accreditation announces to the world that your organization strives to be the best it can be. That’s hard work, but the process sets you on the course for long-term greatness.
Attempting to cultivate a culture of excellence and reach lofty goals enhances your reputation, but accreditation also offers more practical benefits: it’s a reliable way to increase revenue and decrease costs, objectives that are valued by almost every human service agency.
Accreditation Requirements
Due to the advent of the Family First Prevention Services Act (FFPSA), many child welfare organizations that provide residential, out-of-home care and seek federal government funds are required to be accredited, a mandate that takes effect beginning in October of this year (though states have the option to delay the process for up to two years).
Several states also require that various types of service providers become accredited as a qualifying step toward earning their license or receiving higher reimbursement rates.
Culture of Excellence
Without question, accreditation signals to potential funders and clients that your organization adheres to high standards, internal cohesion and exemplary service delivery.
Other benefits include improved internal and external stakeholder communication and enriched staff training programs that, in part, lead to enhanced services to clients.
The results of a questionnaire sponsored by the Council on Accreditation affirm these assertions:
* 94 percent of respondents agree that the process “improves transparency and accountability”
* 86 percent contend that it “improved outcomes for the people they serve”
* 90 percent acknowledge that it “improved their quality of services”
Gaining accreditation from a prominent agency also demonstrates your commitment to reach beyond the minimum licensing standards and maintain strong management, program consistency, financial controls, outcome measurements and continuous improvement.
Financial Incentives and Quality Improvement
Beyond the cultural benefits to earning accreditation, there are more practical reasons to seek this distinction. According to The Joint Commission, a prominent accrediting agency, the accomplishment beefs up your bottom line by increasing reimbursement rates, in part by reducing paperwork preparation time.
Accreditation forces organizations to focus on quality improvement and measure outputs and outcomes of deliverables, which both funders and stakeholders are increasingly demanding.
Planning service offerings and maintaining meticulous documentation can attract additional recognition and funding sources from governments, foundations, grant makers and individual donors.
It also boosts referral volume. The Joint Commission contends that other positive outcomes include an increased “ability to work with a broad array of clients” that improves “an organization’s ability to participate in referral networks, thus potentially increasing the value of referrals.”
The Joint Commission further found that “payers want to work with organizations that provide high quality services, which helps elevate their brand” and pay public relations and marketing dividends.
Accreditation decreases risk due to the development of management plans, which in turn lowers liability and insurance costs. Data collection, an increased effectiveness of care and improved intake billing also streamline costs.
A recent study sponsored by CARF International, another accrediting body, compiled startling statistics demonstrating that CARF-accredited programs experienced a 26 percent increase in persons served annually, a 37 percent increase in conformance to quality standards and a 37 percent increase in annual budget dollars programs from before their first survey as compared to their latest survey.
Accreditation in Action™
“The accreditation and re-accreditation process helped us raise the bar for our staff and the population that we serve,” said Hughes Johnson, managing director of compliance and performance improvement at Memphis-based Youth Villages, which operates in 14 states across the country, shared his organization’s experiences with accreditation.
“It’s a tough process with a large number of standards, but it helped us develop a defined policy that holds us accountable.”
According to Elizabeth Carey, president and CEO at Starr Commonwealth, which offers programs for children and families in Albion, Michigan, her organization is dedicated to “performing at the highest levels for the children, families and communities we serve.” Therefore, “achieving and maintaining accreditation is a critical factor to ensuring high quality.”
The Payoff
Many human services agencies claim that they adhere to upholding high ethical and client service standards.
Far from being a chore, achieving accreditation has become a necessity for all human service organizations participating in today’s competitive environment. In addition to sending a definitive sign that quality and consistent professionalism permeate your organization’s culture, it offers tangible benefits that pay dividends every day.
For more information or for assistance with becoming nationally accredited, contact us at info@AccreditationGuru.com.
With detailed digital data available just a few clicks away, non-profits are being held accountable for measuring their service outcomes. In fact, all organizations seeking to gain and maintain accreditation are required to record and report outcome statistics as part of their performance improvement programs.
For example, while The Joint Commission has always required organizations to assess outcomes of care, treatment or services, organizations are now required to accomplish this through the use of a standardized tool or instrument. By utilizing “measurement-based care,” The Joint Commission “believes these standards enhancements will help accredited customers meet the growing demand to demonstrate the value of their services and increase the quality of the care, treatment, or services they provide.”
For health and behavioral service providers, the focus on process – or fee-for-service arrangements – is obsolete: the new priority centers on positive patient results, which must be documented.
This approach rejects fee-for-service reimbursement, where “individual providers are incentivized to order more tests and procedures and manage more patients in order to get paid more, regardless of patient outcomes,” according to the New England Journal of Medicine.
Value- and performance-based models aim to rein in ballooning costs. The outcome-based orientation is partially designed to help lower spending.
Another broad goal is to improve care and help patients efficiently navigate the health care system. Collaboration and customized services are replacing the top-down model, where experts determine the procedures and patients follow along.
Many major insurance companies are reorienting their reimbursement schedule to reflect this data-driven model. According to national accrediting body CARF, Cigna, Aetna and U. S. Healthcare plan to increase value-based payments to as much as 90 percent of all reimbursement spending in the next few years.
Beyond private insurance companies, state and federal mandates are also pushing patient care toward outcome-based services.
The Centers for Medicare & Medicaid Services (CMS) has begun implementing value-based changes, for example. Under Section 223 of the federal Protecting Access to Medicare Act, moreover, the Substance Abuse and Mental Health Services Administration initiated a pilot program in eight states to introduce value-based outcomes in certified community behavioral health clinics.
The program includes technical specifications and data-reporting templates requiring the collection of 21 measurable data points.
Participating states are mandated to “collect and report on encounter, clinical outcomes, and quality improvement data,” according to CMS. “The statute also requires annual reporting by the states that will entail collection of data which can be used to assess the impact of the demonstration program.”
In addition, fee-for-service reimbursement is being replaced by the prospective payment system (PPS), which is based on the quality of care rather than services provided.
Another new initiative implemented by CMS, Bundled Payments for Care Improvement, links “payments for the multiple services beneficiaries receive during an episode of care.” Acute care hospitals, skilled nursing facilities, home health care agencies and inpatient rehabilitation facilities, “enter into payment arrangements that include financial and performance accountability for episodes of care.”
CARF reports that state regulators are also spurring the shift toward performance-based models and criteria by promoting prevention and methods that consider social determinants of heath.
“The future is undoubtedly in favor of providers that can implement strong performance management practices,” according to CARF. Agencies that reorient their practices in this new direction will be well-positioned to achieve and maintain accreditation status.
Contact Accreditation Guru to help put your organization on course to thrive in this brave new world of outcome-based measurement.
We are happy to announce that Tracy Collander, LCSW a nationally regarded accreditation expert, is joining Accreditation Guru as our newest Accreditation Consultant! A former executive with The Joint Commission, she brings deep knowledge and experience to her position as accreditation consultant.
A leader in the behavioral health field for more than 25 years, Tracy has amassed extensive experience in child welfare, addiction treatment, psychiatric inpatient treatment, and community mental health services.
Her credentials include serving as executive director of behavioral health, Linden Oaks at Northwest Community Healthcare, and as executive director of the Behavioral Health Accreditation program at The Joint Commission, one of the largest accreditation agencies in the country.
Tracy is a wonderful addition to our growing team!!
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