Martin Luther King/Drew Medical Center Accreditation Status

Martin Luther King/Drew Medical Center Accreditation Status

The accreditation status of Martin Luther King-Drew Medical Center was threatened by the commission in charge on the assessment on the quality and safety of care at hospitals (Herrera, 2004). This was due to the number of times that the said hospital failed to comply with the rules by the commission to improve health care many times after numerous inspections. This status has affected most of the hospital's operation and resulted to a number of serious problems.

Accreditation and Certification

Accreditation improves quality in two ways. The first involves establishing practice guidelines, performance standards, and expected outcomes for key clinical, financial, and service areas (Neuman and Ptak, 2003). The second method involves making the accreditation results publicly available on "report cards." Report cards facilitate comparison shopping among consumers and purchasers of plans.

Accreditation Standards

More than 60 standards are examined in on- and off-site reviews during the accreditation process. The original accreditation standards were written for medical health care services, but in 1996 separate standards for managed behavioral health organizations (MBHOs) were developed.

An accreditation score is predominately determined by reviewing the organization's performance in six categories:

1. quality management and improvement in clinical outcomes

2. member rights and responsibilities

3. utilization standards, including decision-making standards and clinical protocols

4. preventive health interventions

5. credentialing and recredentialing

6. medical records

The remaining portion of the score is determined by reviewing the organization's performance on a set of nationally standardized clinical and financial outcomes (Neuman and Ptak, 2003). NCQA presents the results on a "report card" called the Health Plan Employer Data and Information Set (HEDIS). More than 50 measures are addressed in HEDIS, including the management of cancer, heart disease, smoking, and diabetes. A standardized member satisfaction survey is also incorporated.

Accredited managed care organizations are required to have a written plan for all utilization review activities. This plan must outline the process for authorizing and denying services, appealing decisions, and the roles and responsibilities of the provider and MCO (Neuman and Ptak, 2003). The plan must specify the clinical protocol or criteria used to by the MCO to assess acuity and authorize services. The needs and characteristics of the local community must be factored into the decision-making protocol, which must be developed in collaboration with providers and reviewed and updated every two years. Interrater reliability between physicians and nonphysician reviewers, such as case managers who make decisions with the protocol, must be assessed. Typically, standardized clinical protocols such as those developed by Milliman and Robertson (www.milliman-hmg.com) and Interqual (www.interqual.com) are modified by the MCO to make them organization- and population-specific (Neuman and Ptak, 2003).

Certification

Certification is one method by which professions express collective ideals and a sense of responsibility, strengthen this sense in members, and improve practice (Imrey, 1994). Certification can also be a powerful tool of public education, increasing awareness of a profession's technical contribution and framework of values. A voluntary certification program in this spirit, providing a means of recognizing practitioners with substantial statistical capability