This month, Behavioral Healthcare talked to four behavioral health accrediting organizations, two of which — The Joint Commission and CARF — named new executive directors — Michael Johnson and Tracy Griffin Collander — to head their behavioral health accreditation programs just this year. They, together with Brett Welch of ACHC and Patricia Barrett of NCQA, shared their views about health reform and its impact on accreditation-related products and offerings.
Michael W. Johnson, who took over as managing director of CARF International in March, thinks that how healthcare reform will affect accreditation “depends on who you talk to.” Historically, in the public sector, officials haven’t been trained in macro-economics, so running a large system that is suddenly managed is difficult. “Most places rely on the government and the state rules to tell them what hoops to jump through,” says Johnson, who was a county behavioral health administrator in California before joining CARF. Some states, such as Louisiana, say that any provider that bills Medicaid must be accredited, he says. Whether healthcare reform will evolve to that kind of environment isn’t clear, he says.
Managed care companies know that accreditation will matter in behavioral healthcare – if they are involved in providing it, says Johnson. “But if you are Blue Cross Blue Shield or some other company that does not have a robust behavioral health benefit, you don’t have the provider network.” So a behavioral health accreditation likely would not matter so much to them.
The government is in a bind when it comes to setting standards, because if they set the bar too high, care will be unaffordable. “They will set a floor, and say you can’t function below that,” says Johnson. If that standard were so high that, for example, a faith-based nonprofit couldn’t provide services, then the government wouldn’t be able to pay for care. That’s why accreditation has to set higher standards than those for the “floor” organizations.
CARF, instead of using specific measures of performance, applies standards to the programs offered by organizations. “We don’t prescribe what the measures will be – the organization will make those choices,” says Johnson.
Johnson, who worked as a surveyor for CARF for 17 years, says CARF standards have always been field-driven. He has worked in Florida, Georgia, and California, where he has seen the good and the bad in each. “Through all of that, I’ve been passionate about the use of data and evidence-based practices in our field,” he tells Behavioral Healthcare.
CARF passes along two fees to organizations seeking accreditation: $995 is the fixed fee for any organization, regardless of size. Then, based on the size of the organization, the number of surveyors will be determined. The cost per surveyor per day is $1,525. There is no additional fee for travel or lodging. “Our most typical survey is for two surveyors for two days – or four surveyor days,” says Johnson. CARF accreditation is for three years.
“Accreditation isn’t something you do next week,” says Johnson, noting that it takes preparation. “It takes a year for an organization to prepare.”
As our sources indicate, with the next phase of healthcare reform just around the corner, organizations should be thinking of moving accreditation higher up on their to-do list.