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PRACTICE MANAGEMENT

Physician Practice Accreditation - General Information

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Background
Increasingly, ambulatory endoscopy centers (AECs) are being forced to open themselves to external assessment and review in order to provide services to patients. Because such assessments come in several forms, it is important to understand the different terms which are used. “Licensure” refers to the role of the states in approving health care entities for operation; although requirements vary by location, this generally requires an on-site survey of the organization. An AEC must have a state license to operate legally in most states. “Certification” is the process by which health care entities are approved for participation in the Medicare and other federal payment programs. Although governed by federal criteria, certification is also administered at the state level. At a minimum, licensure and Medicare certification are necessary in most AECs. In contrast, “accreditation” is a voluntary process through which an organization is able to compare the quality of its services and operations against nationally recognized standards. The accreditation process involves self-assessment by the organization, as well as a thorough review by the accrediting body’s surveyors. The accreditation certificate is a symbol that an organization is committed to providing high-quality health care and that it has demonstrated that commitment by measuring up to externally recognized standards.

Why seek accreditation?
Ultimately, the decision to seek accreditation should be motivated by the organization’s desire to demonstrate its commitment to high quality patient care and to learn ways to improve the quality and efficiency of its operations. The steps involved in applying for accreditation and preparing for the survey encourage a detailed self-assessment of center policies and procedures. Such assessment commonly results in changes, including improvements to facilities and center processes which can enhance patient safety, compliance with external regulations, and economic efficiency. Successful accreditation recognizes the organization’s willingness to examine itself critically and to make changes to comply with recognized best practices.

There are also many more practical reasons for seeking accreditation. These may include, at the most basic level, the ability to legally operate an AEC in the first place. Accreditation by a recognized outside party is required for licensure of ambulatory surgery centers (ASCs), including AECs, in many states. Currently, more than thirty states and the District of Columbia require or recognize accreditation of certain types of ambulatory surgical organizations. The number of states that recognize accreditation as fulfilling certain regulatory requirements continues to expand each year. Accreditation is also becoming an increasingly marketable achievement. Earning an accreditation certificate demonstrates that the organization has a commitment to providing the highest quality health care, which is meaningful to insurance companies and other third-party payers, government agencies, as well as the general public. Highly publicized adverse events, such as the infection of patients with HCV in certain centers, has brought patient safety concerns into the limelight. Well-educated patients look to markers of quality such as accreditation in selecting where to receive health care services. Accreditation may also help level the playing field for AECs to compete with hospitals that also offer endoscopic services.

Accreditation may also enhance the AEC’s success as a business. The accreditation process involves a top-down examination of the endoscopy center’s operations. To be accredited, the organization must implement sound management practices, demonstrate stable cash flow, and adopt a transparent organizational structure. This process pays long-term dividends in operational efficiency and profitability.

Many centers seek accreditation in the hopes that such recognition may improve their negotiating position with payers. It is difficult or impossible to verify claims that accredited AECs are able to parlay it unto higher reimbursement rates. However, insurers and managed care plans increasingly have demonstrated recognition of the value of accreditation and in many areas have required organizations to be accredited in order to be eligible for ASC contracts.

Finally, liability insurers recognize that accreditation emphasizes and enhances risk management efforts. In this way, accreditation may improve the availability or decrease the cost of liability insurance coverage.

- Lawrence Kim, MD

Member Feedback
If you have feedback or concerns for ASGE regarding accreditation please feel free to send your message or inquiry to the ASGE practice management e-mail address at practicemanagement@asge.org