My answer? No. I believe the most effective way to regulate is to create a single agency designed to help create laws and regulate all healthcare organizations, from pharmacy, to hospital, to long term care facilities. Creating one regulatory body would not only allow for more efficient adoption of new policies, it would also be much easier to later unify the various sectors together in the forthcoming technology age. My reasoning is this: too many regulating bodies creates too much confusion. Just take a look at our current healthcare regulation. If you look at just pharmacy, each pharmaceutical business is first regulated by the federal government, ie. FDA and DEA, before then subsequently being regulated by the individual state boards of pharmacy. When it comes down to the states, state laws on pharmacy cannot be more lenient than a federal law, it CAN ONLY be more specific than federal law. So then you have to ask yourself, why doesn’t the federal law just become more clear and efficient?
Now some may argue that because each state is run differently and operates under different circumstances (ie. drivers for that state’s revenue), each state should thus be it’s own regulating body. Well yes I would agree for general business, but when we are talking about healthcare, it’s not the business we need to focus on, but the quality of care. The minimum standard for care should not be a variable, but an established baseline across the board. So then why not just have the federal government regulate all of healthcare? Not only would there be a faster adoption rate for any new policies or procedures, instead of wallowing around waiting for the states to come up with an approval or a law more specific, we would also reduce the number of potential errors that occur from misinterpretation of the federal guidelines, or not noticing the more strict modifications placed by the state. What’s more, the states base their own regulations off the federal statutes anyway, so why not just create a system that works for every state? This regulatory model would benefit all industries in the sector, including more importantly hospital.
Hospital regulation is, in effect, a mess because there are numerous organizations that regulate hospital organizations. Besides federal and state regulations from the Centers of Medicare and Medicaid Services (CMS), there are also private organizations each offering accreditation or prestige associated with an award from said respective organization. One of the largest of the private organizations, the Joint Commission for Accreditation of Hospital Organization (TJC or JCAHO), has almost 5,000 hospitals and almost 10,000 other healthcare facilities participating. The other two include the Healthcare Facilities Accreditation Program (HFAP) and Det Norske Veritas Healthcare, Inc (DNV). All three regulating bodies have been given “deeming authority” by CMS. What I notice when I look at how these organizations work, is our government has effectively given authority to these private organizations to essentially do it’s job for them. What’s more, each accrediting body requires annual fees to be paid to the organization by each hospital organization. Hospitals looking to get accreditation from any of these organizations have to, in essence, pay to play. Annul fees are on average about $11,000 per year for TJC and $25,000 and $23,100 on average yearly for HFAP and DNV respectively. Those are only the top three organizations, I haven’t included the numerous local accreditation organizations, such as the California Hospital Association, and smaller national organizations such as the American Hospital Association, all of which offer similar accreditation.
So what does that all mean? It means if we allow individual agencies to have more authority, we will only create mass confusion. What we need is only one regulatory agency per industry, for the entire sector. With just one agency having authority, we reduce the chaos of having multiple policies and accreditation. Yes, I think accreditation is important, because that creates a drive for the hospital to constantly improve upon itself, or at the bare minimum, continue operating at an established baseline for patient safety and effective care. However, having too many different options for accreditation creates confusion for both patients and policy makers. Which organization creates better policies, or focuses on improving patient care the most? In my opinion, rather than creating a whole new system, we should roll these existing organizations into CMS, and allow that newly created branch to continue regulating the industry as a unified collective. We continue to allow accreditation but establish varying grades for each organization. After all, one of the biggest reasons for having an accreditation is to be able to be listed as providers with CMS. Well, why do we need multiple organizations handing out accreditation for approval of healthcare providers for CMS? Why not just streamline the process and just have one organization?