As hospitals and healthcare facilities move toward an uneasy “new normal” and move to re-initiate services and procedures, accrediting organizations will also be ramping up their operations to pre-pandemic levels. However, review processes and standards are likely to reflect issues arising from the COVID-19 pandemic; as such, providers should plan accordingly for new procedures and questions designed to assess the safe provision of care.

IN DEPTH

Hospitals and healthcare facilities are well acquainted with the time and resources it takes to prepare for and respond to surveys and inquiries by accrediting organizations like The Joint Commission, DNV Healthcare, HFAP and the Center for Improvement in Healthcare Quality (CIHQ) (collectively, the AOs). During the public health emergency caused by the Coronavirus (COVID-19) pandemic (PHE), AOs took the unprecedented step of ceasing surveys for all but the most urgent activities, recognizing that providers were overextended given the emergent nature of the pandemic response and that their own survey teams could be put at risk in healthcare facilities treating COVID-19 patients or in group environments where asymptomatic spread was of heightened concern.

As some of the most dire predictions about national morbidity and mortality have not yet materialized, and as facilities and providers have started moving toward an uneasy “new normal,” those facilities and providers are now getting back to work providing elective procedures and routine care and re-opening offices and service lines. Consistent with that shift, the AOs have also determined that it is time for them to return to work—even if that work looks a bit different than it has in the past.

DNV Healthcare led the AO pack with its May 13, 2020, announcement regarding remote surveys for most provider types, and requested that providers still facing a COVID-19 surge or other special challenges related to the PHE reach out to ensure the organization knew what issues might impact the ability to participate in the survey process. DNV reiterated the importance of accreditation surveys in a time when increasing health care capacity—particularly for inpatient care—was needed, noting that remote surveys would be “followed up with full onsite surveys when it is safe to do so.”

HFAP soon followed, with an advisory on May 15, 2020, announcing its plan to re-initiate survey activities after considering a provider’s COVID-19 information and prioritizing surveys based on “past deficiency reports, regional and local outbreak ‘hot spots,’ geographic location of available surveyors to compose an appropriate team, and state and/or local travel restrictions, among other criteria.”

The largest AO released its plans on May 27, 2020. On that date, The Joint Commission (TJC) announced it would restart surveys and investigations effective in June 2020. Surveys will look different, inasmuch as surveyors will employ physical distancing practices, limit the numbers of individuals in group sessions, increase the use of audio or video conference calls to expand the number of attendees, and involve the use of masks and/or other personal protective equipment (PPE) provided by the facility or provider. Additional processes anticipated to be part of the survey process include electronic medical record reviews and a preference for simulations to replace live demonstrations that are not deemed safe.

Of likely interest to providers accredited by The Joint Commission, the organization has indicated that it will “focus on a thorough assessment but will not retroactively review compliance,” suggesting that the renewed survey activity will not be focused on imposing a “20/20 hindsight” standard that could prove problematic given the exigencies that providers had to deal with at the height of the PHE. As noted in its May 27 announcement on the resumption of survey activity, surveys will focus on how providers have “adapted to the pandemic” and review current practices to assure provision of safe care in a safe environment.

CIHQ has not posted a position statement on the resumption of survey activity, but is understood to have begun the process of performing reaccreditation surveys on a case-by-case basis.

Key Takeaways

As health care providers and facilities move to re-initiate services and procedures, AOs will also be ramping up their operations to pre-pandemic levels. Though neither the industry nor the AOs will be in “business as usual” mode any time soon, both look to adjust to the realities that the current state of the pandemic permits. In addition to concerns regarding the resources needed to prepare for and complete survey and investigation activity as AOs return to more typical operations, many providers are concerned about AOs retrospectively reviewing their processes and procedures during the height of the PHE without taking into account the realities in place at the time. While TJC has stated that it will “focus on a thorough assessment but will not retroactively review compliance”, it is not clear whether backlogged complaints or other triggers could lead to increased scrutiny of facilities’ pandemic operations, or if other AOs will take the same approach.