Accreditation, but at what price?

There are two types of expenses associated with accreditation: direct and indirect. Direct costs may include the survey fee (which may be an annual survey fee or triennial registration fee) plus the travel expenses. Indirect costs may include survey preparation.

This is part 8 of a 9-part feature on accreditation options for Hospitals and Health Systems. Read. Read previous articles below:
1. Accreditation options update: Going bare —The state option as an alternative to accreditation
2. Understanding the center for improvement in healthcare quality (CIHQ)
3. Accreditation options: Understanding DNV GL - healthcare’s national integrated accreditation for healthcare organizations program
4. Accreditation options update: Understanding the Joint Commission (TJC)
5. Accreditation options update: Understanding the Healthcare Facilities Accreditation Program (HFAP)
6. Accreditation: A hospital CEO’s strategic choice
7. Hospitals and health systems: Which is the best accrediting source for your organization?

To participate in the Medicare program, hospitals must agree to meet the Center for Medicare and Medicaid Services’ (CMS) Conditions of Participation (CoPs). For the most part, CMS contracts with state agencies to conduct the initial survey to determine eligibility. Beyond the initial survey, hospitals can choose to have the state agency conduct annual surveys or an accrediting organization that has deemed status and have annual, mid-cycle or triennial surveys.

Of course, we all want to provide safe, quality care to patients, but do we need to be associated with an accreditation brand to demonstrate that we do? Will that motivate us to become a better, safer hospital? Do the costs of accreditation vary between the accrediting organizations?

When considering the costs of accreditation, leaders should ask the following questions:
• How much does the survey cost? Is it payable upfront or in installments (typically, annually)? Are travel expenses included or billed separately?
• If we switch accrediting organizations, we will have to carry a dual accreditation until the new one goes into effect. When will the annual fee be due to the new accrediting organization (on the anniversary date one year later or at the beginning of each year)? How much notice are we required to provide to the existing accrediting organization of our intent to cancel our agreement?
• If a focused or follow-up survey is required, is there a survey fee or is the organization only billed for travel expenses?
• How many FTEs dedicated to survey coordination will we need? What are their salary expenses?
• Will we need to form committees to provide oversight of the accreditation process? How often will they meet? How many staff members will be involved? What are the salary expenses associated with these meetings?
• How often do the standards change? What type of training will be involved to keep the staff up-to-date? What are the projected expenses for training?
• What monitors will need to be put into place to assess compliance? What are the potential expenses associated with monitoring?
• If the accrediting organization requires data submission, how much does it cost?
• If we need to use outside consultants to help us prepare for the initial and ongoing surveys, how much does this cost?
• Are the standards available publicly, included in the accreditation survey fees or must they be purchased separately?
• To what extent do the standards exceed the minimum requirements of compliance with the CMS CoPs? What will it cost to be compliant above and beyond the minimum requirements?
• What training and resource materials are available at no charge to the organization?
• To be compliant with the accrediting organization's standards, what information systems changes will we need to make initially and on an ongoing basis?
• After initial accreditation, what will we need to do to sustain compliance? What are the projected expenses?
• What types of accreditation programs are available through the accrediting organization? Will we have to shop for multiple accrediting organizations to have all of our system components accredited? What are the expenses involved?

As you can see from the above questions, there are several cost-related factors to consider when switching accrediting organizations. Survey costs are important but are not the only expense that must be calculated. Additionally, the hospital should consider what benefits are available from the program and what additional resources the hospital will have to expend to sustain compliance.

This article was previously published in Becker’s Hospital Review. Compass Clinical Consulting has updated the content to reflect changes in the Accreditation Options since previous publication.

Victoria Fennel, PhD, RN-BC, CPHQ has more than 20 years of healthcare leadership experience. She has spent the majority of her career in nursing leadership roles and brings expertise in evidence-based practice, nursing education, quality management, performance improvement, accreditation, risk management, patient safety, and patient-centered care. As Director of Accreditation and Clinical Compliance for Compass Clinical Consulting, Victoria manages accreditation and compliance engagements, directs client education and advisement, and has led Compass’ efforts to help healthcare organizations prepare for scrutiny from accrediting bodies such as the Centers for Medicare and Medicaid Services (CMS), the Joint Commission (TJC), and Healthcare Facilities Accreditation Program (HFAP).

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