Academic journal article Journal of Health and Human Services Administration

Is Accreditation Sufficient? A Case Study and Argument for Transparency When Government Regulatory Authority Is Delegated

Academic journal article Journal of Health and Human Services Administration

Is Accreditation Sufficient? A Case Study and Argument for Transparency When Government Regulatory Authority Is Delegated

Article excerpt

ABSTRACT

In Georgia and across the United States, there is a fundamental and perhaps dangerous disconnect between findings of regulatory authorities and private accreditation agencies when both are charged with aspects of oversight of quality of care in opioid treatment programs. Though accreditation plays an important role in the social norming aspect of quality improvement of many health care organizations, the proprietary nature of information gathered by accrediting bodies and the lack of communication among government regulators limits the effectiveness of the current quality assurance effort. This research uses publically available data from opioid treatment programs in the State of Georgia as a case example to examine the "regulatory fog" that obscures the ability of consumers and even state and federal governments to effectively assess quality and performance of opioid treatment programs. The authors conclude that delegation to accrediting organizations of the governments' regulatory responsibility should entail expanded public reporting and a lead agency for coordination of findings among the various regulators.

INTRODUCTION

In Georgia and most states across the United States, there is a fundamental and perhaps dangerous disconnect between findings of regulatory authorities and private accreditation agencies when both are charged with aspects of oversight of health care quality. Nowhere is this disconnection more obvious than in the current system of multi-layered regulation of methadone clinics. Though accreditation in health care is in theory a means of altering institutional and professional social norms to achieve the twin goals of improved quality and safety, failure to achieve these objectives often results from lack of communication among overseers due to the proprietary nature of accrediting bodies and overlapping but distinct domains of authority among the various federal and state regulators.

Crossroads Treatment Center in Ringgold, Georgia near the Tennessee border serves as just one example among many of the challenges of the multi-dimensional aspects of public and private oversight. Accredited for the maximum of three years as an opioid treatment program (OTP) by the Commission on Accreditation of Rehabilitation Facilities (CARF), the facility was cited by Georgia Health Facility Regulation surveyors between 2013 and 2014 for use of illegal standing orders, using an unlicensed pharmacist to fill orders, lack of a medical director trained in narcotics-addiction, and failure to conduct drug screens on a majority of staff members. State surveyors noted that failure to participate in the required central registry to prevent simultaneous enrollment across state lines could have led to the death of a client from methadone toxicity after five days of treatment at the clinic. As of January 2104, this clinic had over 900 clients (Georgia Health Facility Regulation Survey Reports) who are dependent on the clinic for daily $12 doses of methadone (Personal Communication), creating annual revenues of approximately $4 million in a clinic that operates five hours a day, six days a week (Personal Communication.)

This one example from Georgia's Health Facility Regulation website provides only a sample of violations of state and federal policy in the state's opioid treatment programs (OTPs) for which oversight is provided primarily by private accrediting agencies. Not only in Georgia, but throughout the U.S., state law often protects the confidentiality of accreditation agency findings, thereby limiting access to quality and safety reports for consumers and other providers. Due to the federal requirement for accreditation of opioid treatment programs, Georgia - like most other states--is less likely to survey its OTPs on a routine basis. Of 54 methadone clinics listed as operational in Georgia on the state's regulatory division website in October 2014, only 11 facilities had annual survey inspections in the period from May 2012 through September 2014. …

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