The Joint Commission is transforming its accreditation process by reducing the number of requirements by 50% — from 1,551 to 774 standards — in its most significant rewrite since Medicare was established in 1965.
The overhaul, first shared with Becker’s, underscores the organization’s effort to reduce the regulatory burden on hospitals and healthcare organizations, uphold public trust and help organizations achieve the highest level of safety and quality, according to Jonathan Perlin, MD, PhD, president and CEO of The Joint Commission Enterprise.
“We’re really excited about it, but the overall intent is twofold,” Dr. Perlin told Becker’s. “First and foremost, to drive better care. Second, it’s to reduce burden for all. We envision a future where, while accreditation requires boots on the ground to see certain things, some certifications may be evidence-based, data-driven, outcomes-oriented, and ultimately be awarded by virtue of measured performance. And we have to work to get there.”
The redesign, called Accreditation 360: The New Standard, features an updated manual with clearer definitions of CMS conditions of participation and the Joint Commission’s national performance goals, now distilled into 14 critical categories.
To streamline the accreditation process, the organization reviewed its hundreds of standards and asked: Is this requirement redundant? Is it operational? Is the evidence compelling? And is it obsolete — such as a standard on smoking, despite all U.S. hospitals being smoke-free by law?
“If there might be some utility but the effort was so disproportionate that the juice wasn’t worth the squeeze, we got rid of it,” Dr. Perlin said.
The Joint Commission accredits and certifies more than 23,000 healthcare organizations and programs in the U.S. Since 2023, it has removed or revised more than 400 standards.
In the accreditation manual rewrite, language has been simplified. For example, one standard on verbal orders previously included 10 subsections — called elements of performance — but it is now reduced to one standard with a two-sentence description.
Requirements for improvement are also prioritized rather than being “randomly listed,” Dr. Perlin said.
“We appreciate healthcare organizations and healthcare workers have never been working harder,” he said. “We have to reduce the regulatory burden of healthcare. We measure an awful lot historically. And as they say, if everything’s important, nothing’s important.”
Many of the organization’s leaders are all too familiar with healthcare’s regulatory burden. Before joining the Joint Commission in 2022, Dr. Perlin served Nashville, Tenn.-based HCA Healthcare as chief medical officer and president of clinical operations. Other members of the C-suite held roles at health systems including Cleveland Clinic, Somerville, Mass.-based Mass General Brigham, and Clearwater, Fla.-based BayCare Health System.
The accreditation manual will become effective Jan. 1.
Accreditation 360 also brings a stronger focus on data. Hospitals can benchmark performance against similar facilities, both within and outside their systems. Another industry-wide effort is the Survey Analysis For Evaluating STrengths (SAFEST) Program, which will aggregate best practices into a database for surveyors.
The Joint Commission wants healthcare organizations to not simply prepare for surveys but to develop leadership mechanisms that keep them continuously prepared, Dr. Perlin said. For organizations wanting more support, the Joint Commission is introducing an optional continuous engagement model.
Separate from Accreditation 360, the Joint Commission and its affiliate, the National Quality Forum, is piloting new certification models in four high-impact areas: maternity care, hip and knee procedural care, spine procedural care, and cardiovascular procedural care.
These certifications aim to be evidence-based, data-driven and heavily focused on outcomes. The goal is to align incentives across payers, hospitals and clinicians, ultimately improving patient outcomes while minimizing administrative complexity.
“360 allows us to look not only in the rearview mirror of what didn’t work,” Dr. Perlin said, “but to look forward to what works best.”
