Stark: GAO report confirms concerns about Joint Commission conflicts

"The report found that [The Joint Commission] exercises substantial control over its consulting subsidiary, JCR, providing numerous opportunities for conflicts of interest in the hospital accreditation process," Stark said in comments made through a spokesperson to a reporter for Modern Healthcare magazine.

"It reaffirms that Congress and the administration must conduct oversight of The Joint Commission," he said.

The GAO report does make any conclusions about whether a conflict exists, Leslie Aropnvitz, GAO's director of healthcare issues told Modern Healthcare.

"The reader has to make that determination, whether they think there's no smoking gun or whether they're uncomfortable with the substantial control that [The Joint Commission] has over JCR," she said.

The Joint Commission itself interpreted the report as vindication of the way its separate accrediting and consulting staffs do their work, with a firewall policy prohibiting the two staffs from sharing information about which hospitals pay JCR for consulting services.

The firewall has functioned effectively, Joint Commission President Dennis S. O'Leary, MD, said in a Jan. 16 statement published on The Joint Commission Web site.

"The Joint Commission does not provide JCR with any information that is not publicly available about accredited organizations, and JCR provides services independently and confidentially, disclosing no information about its clients to The Joint Commission or others," the statement reads.

The Joint Commission has substantial control over the governance of JCR through the powers retained by the Joint Commission in JCR's bylaws as well as through the Joint Commission's representation on JCR's Board of Directors, the GAO reported. Of the JCR's 17 directors, nine are also commissioners on The Joint Commission's board of commissioners.

 In addition, JCR manages all Joint Commission publications and educational activities, while the Joint Commission provides various support services and some management oversight to JCR.

Although the Centers for Medicaid and Medicare Services (CMS) has some limited oversight of The Joint Commission, by conducting surveys of hospitals through state agencies, it has no oversight of JCR.

Sources: "Statement from The Joint Commission regarding GAO Report, Hospital Accreditation: Joint Commission on Accreditation of Healthcare Organizations' Relationship with its Affiliate," Jan. 16, 2007.

"Joint Commission under fire: GAO study shows possibility of conflicts: Stark," Modern Healthcare, Jan. 22, 2007 (subscription required).