Considering a switch to CHAP? Florida provider recounts its experiences
Considering a switch to CHAP? Florida provider recounts its experiences
Learn how things are done for one home health group
After years of working with the Joint Commission on Accreditation of Healthcare Organizations, a Florida hospital-based agency has switched its allegiance to the Community Health Accreditation Program (CHAP), an organization that specializes in home health and community health agencies.
Lynda Friedman, RN, CHCE, administrator of Gold Coast Home Health Services and Hospice in Pompano Beach, says she began considering the idea seriously in December 1999, when she began to look at the challenges of the year ahead. Gold Coast would be preparing for a three-year Joint Commission survey in October while implementing OASIS. And then there was ORYX, the Joint Commission’s new performance measurement system, now a requirement for accreditation. ORYX requires its own separate data collection process and the hiring of a vendor, or performance measurement system.
"As we began to look more and more closely at the ORYX implementation and the costs involved, I began to explore the idea of going with an accreditation body that would not require ORYX," Friedman says. "I felt that it was really an imposition on the agency, since we were simultaneously implementing OASIS."
She estimated the costs of continuing with the Joint Commission over the next three years at $60,000. Friedman says switching to CHAP will cost her agency less than half that amount.
It wasn’t an immediate sell to the North Broward Hospital District, which operates Gold Coast. Administrators there were concerned the move might jeopardize the hospital’s own Joint Commission accreditation. Friedman discovered that the Joint Commission and CHAP signed an agreement in 1997 recognizing each other’s home health programs.
Self-studies, unannounced visits
Maryanne Popovich, RN, MPH, executive for the Joint Commission’s home care program, says it’s not a completely reciprocal arrangement. When the Joint Commission evaluates a hospital system whose home health services have been surveyed by CHAP, it will accept the CHAP survey without doing its own. The home health portion will not be accredited by the Joint Commission, however. "You do not have accreditation by the Joint Commission for those services," she says.
But Friedman says that arrangement was enough to ease her company’s fears about CHAP accreditation. "People have in their minds that if your hospital is Joint Commission-accredited and you’re hospital-based, then you have no choice," she says. "That’s not true." She also learned that a managed care company that used her agency would accept CHAP accreditation. After getting permission to switch, Friedman filed an application last spring, and the organization sent back a contract for the first three years of service.
Friedman says CHAP’s process of surveying agencies is different from the Joint Commission’s. Before an agency receives its on-site visit, it first must spend up to six months working on a "self-study" packet. Friedman says it’s a comprehensive look at the operations of the agency.
"It’s a book that the agency goes through to see how they meet each of the [CHAP] standards," she says. "As you’re going through it, you’re collecting all the data and all the documentation to demonstrate how you meet the standards."
Ann O’Sullivan, OTR/L, rehabilitation manager of Community Health Services in Portland, ME, says her agency has worked with CHAP for about six years. She says the self-study questions are designed to look at the core of the agency — its structure, its functions, issues of quality, resources, and long-term viability.
"It has you apply a lot of questions in terms of what improvements or changes have you made in the past year that will affect the structure and function or the quality of the agency," she says. "What improvements or changes do you anticipate making in the coming year? CHAP’s got a really strong focus on viability, whether you are addressing future needs and responding to the demands of the environment. One of the good things about it is it makes you look at how you really do things, as opposed to how you say in writing you do things."
The document submitted by the agency runs hundreds of pages long. The self-study process took Gold Coast three to four months, using a team approach. "It was quite a good exercise for us," Friedman says.
Then came the wait for the first survey, which is not announced in advance.
CHAP president Jerold Cohen, MA, RN, says CHAP previously conducted unannounced surveys for all services it accredited. Now the agency announces when it will visit home medical equipment providers and nonMedicare programs. Cohen and Popovich say unannounced visits are required for Medicare deemed status. Popovich says the Joint Commission also conducts surprise surveys when required by Medicare, but Cohen sees an added advantage to such visits. "Our belief is that quality care is provided 24/7, unrelated to when a site visitor is coming," he says. "It shouldn’t make any difference to you if I come in today or tomorrow. There shouldn’t be anything you have to do to prepare because you should be providing quality care all the time."
Friedman notes that a representative from CHAP called to ask when key Gold Coast administrators would be on vacation. "They wanted us to give them dates so they could work around them, which I thought was nice," she says. "They really don’t want to come when people who are key to the operation are going to be away."
O’Sullivan and Karen Joblove, RN, vice president of patient services for the Visiting Nurse Association of Miami-Dade County, FL, both of whom have been through multiple CHAP surveys, describe them as a collaborative process.
The surveying team can range in size from one to 10 people, depending on the size of the agency, Cohen says.
O’Sullivan says CHAP surveyors do many of the same things that Joint Commission surveyors do — such as visit branch offices, pull charts, and accompany staff on visits. She says surveyors also provide valuable input, referring her to another CHAP agency with a program she might be able to emulate or helping her analyze a proposed new program.
"They kind of come with the attitude that we’re all in this together," she says. "We enjoy having them here. We do get a little nervous, but we do enjoy having them, and their exit interviews are just a treat. They pump up what they saw that they liked, and when they tell you what it is you need to do, they have really good reasons. The attitude is just wonderful."
Joblove says CHAP will send a formal written follow-up report, showing any deficiencies and comparing them to the standards.
Any Medicare deficiencies identified require a plan of correction within five days, Cohen says. CHAP deficiencies are handled according to their severity; one agency may only need to send in some paperwork, while another with patient-care problems may require a follow-up visit.
Keeping agencies on their toes
Although the general survey cycle is three years, CHAP could return one or two years later, depending on what was found in the previous inspection, Cohen says. "More and more agencies are falling into the three-year category," he says.
Joblove says the possibility of an unexpected survey is a powerful incentive to stay on top of things. "You need to be ready all the time," she says. "There are some months that you think, Oh my God, we’re behind in this. I hope they don’t come this month.’ It keeps you from putting things off."
Cohen, Joblove, and O’Sullivan suggest the following steps for agencies seeking to excel under the CHAP accreditation system:
• Be sure your staff are communicating. O’Sullivan says the self-study format forces an agency to develop its internal communication network.
At the VNA of Miami-Dade, a task force including representatives from finance, medical records, nursing, and education tackles the self-study every three years. "It’s so much easier to give somebody 25 standards to do as opposed to giving them 200," Joblove says. "We broke it up, and each person had their own responsibility to make sure their departments were following the standards and completing their section of the self-study."
• Commit to continuous preparation. When surveyors can come at any time, an agency can never become complacent about its readiness.
Joblove says that throughout the year, VNA staff discuss CHAP standards and how well they’re being met. As the organization updates its standards, it communicates with the agencies, and the agencies work to comply with those standards, just as occurs with the Joint Commission.
Fitting into the new format
Community Health Service in Portland reformatted its annual quality and clinical reports to fit the CHAP format, O’Sullivan says. "So when it comes time for the self-study, we’ve got a lot of stuff already thought through from the three years that we can just pull from, and we don’t need to rethink it in a new format," she says.
Cohen notes that it’s not necessary to retool everything to fit CHAP’s style. "If you’re [Joint Commission-] accredited, you don’t have to rewrite all your policies and procedures. We don’t tell you what format they have to be in. You just have to be sure you have policies covering the issues we’re looking for."
• Seek help if you need it. Cohen says the self-study is designed to be clear and easy to understand. "The standards are what they are. There are no trick questions. They shouldn’t be reading anything into the standards."
If you encounter something you’re not sure of, CHAP representatives can help. For more in-depth help, Joblove suggests using a consultant. She’s worked with one since she first began dealing with CHAP and has found it extremely helpful.
Cohen disagrees. He says consultants aren’t necessary and doesn’t recommend one unless an agency specifically requests a referral. "Often, you end up with a consultant who’s more knowledgeable about your agency than you are," he explains. "With a team approach, you get your staff questioning why they do things the way they do them. It’s more time-consuming, but you can get more out of it."
• Focus on the future. O’Sullivan says that with the home health environment changing so much from year to year, CHAP relies on agencies to be looking ahead and planning for future challenges. "The survey really looks at how you are adapting to the environment and how you are being proactive about the environment," she says. "A CHAP survey is really asking you to look forward and not think in terms of moment-by-moment survival but to think in terms of long-term viability and long-term quality."
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