Competitor to Joint Commission approved by CMS.

The Center for Medicare and Medicaid Services (CMS) announced the approval of DNV Healthcare Inc. as a deeming authority for hospitals. Effective September 26, 2008, this announcement recognized DNV as a national accreditation program for hospitals seeking to participate in the Medicare or Medicaid programs. This news positions DNV as an alternative accreditation body for hospitals across the country, and as a competitor to The Joint Commission (TJC) and the American Osteopathic Association (AOA).

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For the past three decades, TJC has been the pre-eminent accrediting body for hospitals, responsible for more than 90 percent of hospital accreditation in the country. A little known fact is that accreditation by TJC is not a requirement. Hospitals have the option of accreditation by AOA or survey by CMS to validate compliance with the CMS Conditions of Participation.

DNV Healthcare is a division of Houston-based DNV USA, which is a subsidiary of Det Norske Veritas, based near Oslo, Norway. Founded in 1864, DNV originally was responsible to rate seaworthiness of ships. The company currently focuses on risk management and training in several industries, and it has recently moved into health care. DNV has developed their accreditation program by combining the CMS Conditions of Participation with ISO 9001 quality management. ISO 9001 is a quality system standard maintained by the International Organization for Standardization. While not common in health care, it is widely used in the manufacturing industries. There is also a large emphasis on leadership and accountability.

DNV calls their program the National Integrated Accreditation for Healthcare Organizations (NIAHO). DNV's goal is to make the accreditation process more streamlined, as well as identify means for improving current standards and promoting continual improvement. Previously, DNV provided consultation services to hospitals preparing for survey by TJC. They have discontinued this service upon receiving deeming authority.

The impact of DNV's NIAHO on TJC's stronghold in the hospital accreditation business is not known, but they are poised to make an impact. Late last year, TJC received notice from CMS that the Critical Access Hospital accreditation program does not meet the requirements in the Medicare Conditions of Participation. They risked losing CMS' approval if revisions were not implemented.

Also, TJC has come under criticism because of its relationship with Joint Commission Resources, the consulting and education arm of TJC. Lastly, health care organizations have long perceived that TJC was rigid, inconsistent, and cumbersome, with some hospital officials commenting on the negative attitude and behavior of TJC surveyors. However, TJC is widely recognized as the "gold standard" in health care, and it is the largest health care accrediting body in the world. TJC is well known to those in healthcare as well as insurance providers, regulators, and government officials.

In addition, TJC has partnered with many various stakeholders for both the accreditation and certification programs. One of the major partners has been the American Hospital Association (AHA). The AHA released a statement saying, "We recognize that having a choice of accrediting organizations could be good for patients and for hospitals. Both The Joint Commission and DNV Healthcare will work with hospitals to reach their goal of quality improvement-they'll just take different paths to get there."

The President of DNV, Yehuda Dror, stated that he wants hospitals to view the accreditation process as a strategic tool. "For them, it should be the way they do business."

According to Dror, NIAHO uses a hospital's own practices as a foundation of its written policies and procedures. Hospital leaders decide what to focus on and write their own plans of action, and DNV works with the facility to ensure it is following its written plan. Also, hospital staff members become trained as "auditors" for continuous monitoring of operations. DNV conducts annual surveys to verify ongoing compliance.

To date, 27 hospitals in 22 states have been accredited by DNV using the NIAHO program. Many hospitals across the country are now learning more about DNV and considering the advantages and disadvantages of switching from the better known and entrenched TJC.

The cost of health care accreditation is always a concern for hospitals. The price varies greatly depending on the size of your organization, number of sites and services provided. TJC annual fees range from $1,780 to $36,845. DNV considers their pricing comparable to TJC.

The introduction of DNV to the hospital accreditation business will no doubt change the landscape of accreditation. Only time will tell the significance of this impact. For further information on DNV's NIAHO program, you may visit its Web site at www.dnv.com/industry/healthcare/.

by David Gourley, MHA, RRT, FAARC 

David Gourley, MHA, RRT, FAARC, is the assistant vice president of regulatory affairs at Chilton Memorial Hospital in Pompton Plains, N.J.