LEWISTON – Fewer Maine hospitals these days are seeking national quality and safety reviews, industry experts say. Despite the change, those same experts say patient care is not being affected.

About one-third of the hospitals in the state do not carry the seal of approval given by the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO.

Of 41 hospitals, 28 are JCAHO approved, down from the high 30s, said Louis Dorogi, director of licensing and certification division at the Department of Human Services.

Because participation is voluntary and can be costly, many smaller hospitals in the state are foregoing that stamp of approval. State and federal certifications, by contrast, are required.

As the number of so-called critical access hospitals grows – those that house no more than 25 beds and provide emergency treatment in rural areas – fewer are spending the tens of thousands of dollars and investing the manpower required to undertake the often time-consuming process.

Rumford Hospital no longer looks to JCAHO for approval, said CEO John Welsh. When the hospital changed its designation in 2002, its new status triggered annual state reviews rather than a review once every three years reserved for non-critical-access hospitals.

Two years ago, JCAHO did not perform reviews of hospitals that carried the critical-access designation. Although that organization now offers accreditation to those hospitals, such review would be redundant, said Rumford’s chief executive officer. The last time JCAHO performed its survey, it cost the hospital roughly $75,000, money he now can put toward other needs, Welsh said.

He prefers the yearly state scrutiny because it keeps the hospital up to date on standards and methods, Welsh said. “We find them very helpful. So, we just stayed with that.” The state’s survey is “very thorough,” he said.

JCAHO spokeswoman Charlene Hill said fewer hospitals nationally are seeking accreditation from her organization. Participation is down 4 percent over the past three years, to 4,579 in 2003, she said.

JCAHO accreditation “used to be much more the standard than it is now,” said Sandra Parker, general counsel for the Maine Hospital Association.

Although Hill could not explain each hospital’s reasons for dropping review, it likely is due, in part, to the federal law passed in 1997 that created the new “critical access” category of hospitals, such as Rumford’s. The category carries with it an alternative Medicaid and Medicare reimbursement formula that was more appealing to smaller hospitals.

Parker said the areas subject to review by JCAHO and the state are “much the same,” an observation shared by Welsh. For that reason, patients are not likely to notice any difference during their hospital experiences, she said.

While some hospitals are dropping the voluntary review, Dorogi said most long-term care facilities in Maine already choose not to pursue the review.

Only about 10 percent of the roughly 120 nursing homes in Maine undergo JCAHO accreditation, said Rick Erb, who heads the Maine Health Care Association.

Administrators at the St. Marguerite d’Youville Pavilion nursing home in Lewiston, the largest in the state, decided recently to discontinue JCAHO reaccreditation, saying it would not be a good use of time and staff resources, said Sean Findlen, spokesman for Sisters of Charity Health Systems, the nursing home’s parent organization.

“The standards and quality issues for the state (review) are just as stringent in most areas if not more stringent” than JCAHO, he said.

Nursing homes are being squeezed for money as the gap between actual costs and reimbursement costs from Medicare and Medicaid continues to grow, Erb noted.

The Lewiston nursing home does not “have a lot of extra money around,” Findlen said.

Whereas JCAHO accreditation for hospitals carries with it automatic Medicare and Medicaid approval, it does not do the same for nursing homes. Therefore, there is less incentive for nursing homes to seek accreditation, officials said.

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