Accreditation Options: Understanding the Healthcare Facilities Accreditation Program

In this article, our second in the "Accreditation Options" series, which reviews some of the options for hospital accreditation by regulatory bodies with deemed status from CMS, we will discuss the Healthcare Facilities Accreditation Program.

HFAP is the accreditation process that has grown out of the former hospital approval process of the American Osteopathic Association. Founded in 1945, this accreditation program has experienced growth well beyond its traditional base of osteopathic hospitals to encompass over 200 acute-care hospitals, plus 200 other accredited entities. HFAP also provides accreditation services for critical access hospitals, ambulatory surgical centers, ambulatory care/office-based surgery, behavioral/mental health facilities and clinical laboratories. HFAP provides certification in the disease management program/centers of excellence for comprehensive, primary and Stroke Ready Center certification.

1. Standards
HFAP's organizational mission is to "advance high quality patient care and safety through objective application of recognized standards." The standards meet or exceed CMS' Conditions of Participation, with which they are aligned closely in intent and execution. In fact, 80 percent of the HFAP standards "cross-walk" to the CoPs for each type of facility it surveys. In addition to meeting the CoPs, HFAP structures its standards with a focus on patient treatment, quality improvement, patient safety and environmental safety. In the hospital accreditation manual, there are 32 chapters with four reserved for future use.

2. Survey process
Once a hospital or healthcare organization has decided to pursue HFAP accreditation, it must first submit an application, followed by a survey. HFAP surveys are performed on-site every three years, on a cycle similar to that of The Joint Commission = surveys. Survey teams are composed of a physician (allopathic or osteopathic) — who serves as team leader — a nurse, a hospital administrator and life safety specialist. Surveyors are paid volunteers drawn from current HFAP-accredited organizations, who are oriented to the survey process through extensive and ongoing HFAP-sponsored education. In the hospital setting, surveyors focus on the hospital meeting core functions of assessment, patient participation, treatment, nutrition, medication use, discharge coordination, environmental safety, patient safety, infection control, quality improvement and information management.

The length of the HFAP survey is determined by the hospital's size and complexity. HFAP surveyors' assessment of compliance is straightforward: compliant, not compliant or non-applicable. When deficiencies are identified, surveyors discuss compliance options with hospital staff. Organizations then submit a plan of correction in response to identified deficiencies. Upon completion of the survey, the survey team makes a report to the HFAP Central Office, which then reviews the report and makes a recommendation to the AOA Bureau of Healthcare Facilities Accreditation, which then makes the final accreditation decision. Decision categories for HFAP accreditation are as follows:

•    Full accreditation
•    Interim accreditation
•    Denial of accreditation

Recently, HFAP implemented the "10 and 10" methodology for granting accreditation, which means that the final report will be available to the organization within 10 business days and that the organization must respond with a plan of correction for all deficiencies, or appeal the findings, within 10 calendar days. Once a POC has been accepted by HFAP, the facility will be required to submit interim progress reports in order to demonstrate continued movement toward compliance and/or sustained compliance, as outlined by the written process for IPRs. Though summary statistics for accreditation results are not publicly shared, there have been no reports of accreditation denial.

3. Costs
The HFAP facility accreditation survey fee is based on the size and volume of the organization being surveyed. Participating hospitals pay a triennial registration fee. In addition, they are required to reimburse the direct costs of performing the survey itself. This area is where the variability in pricing comes into play, as costs of conducting the survey depend on the number of surveyors assigned to the hospital or health system.

HFAP provides the hospital free access to an online manual, which is also accessible as a PDF. Like TJC and unlike DNVHC and CIHQ, HFAP also charges participating hospitals for a hard copy of its Accreditation Standards Manual. Though they do not appear to be aggressively marketed, HFAP does provide additional consultations and workshops for free.

4. Benefits
HFAP advertises its program as "a straightforward approach to accreditation," and to a large extent, their standards and survey process appear to support their claim. By "cross-walking" its standards to CMS' CoPs, HFAP makes clear how HFAP accreditation supports CMS compliance. In addition, because HFAP surveyors discuss strategies to mitigate deficiencies when they are identified during survey, hospitals may have a greater opportunity to achieve compliance.

An exclusive feature of HFAP is that hospitals are provided a copy of the manual, which includes the surveyor scoring procedure. At the time of survey, there are no surprises, as the interpretation of standards is consistent amongst surveyors and standards interpretation staff.

Unlike other accrediting organizations, hospitals do not need to be accredited by HFAP to be certified by HFAP for the disease management program/centers of excellence. This is especially advantageous for hospitals that wish to receive state designations.

Ultimately, HFAP accreditation shares much in common with accreditation by other regulatory agencies, but it may present an attractive option to hospitals wishing to pursue accreditation as a means of supporting CMS compliance. More information about HFAP can be found at

Victoria Fennel 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, Ms. Fennel manages the quality of accreditation and compliance engagements and directs client education and advisement.

Other Articles in this Series:
Accreditation Options: A Hospital CEO's Strategic Choice

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