component 1: introduction to health care and public health in the u.s

Component 1:Introduction to Health Careand Public Health in the U.S.

Unit 6: Regulating Health Care

Lecture 1

This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

Lectures in This Unit

• Lecture 1: Regulatory Agencies and Professional Associations

• Lecture 2: Law• Lecture 3: Medicine, Professional Liability, and

Medical Malpractice• Lecture 4: Key Processes for the Confidentiality

and Safety of the Patient• Lecture 5: The Physician-Patient Relationship

Component 1/Unit 6-1Health IT Workforce Curriculum

Version 2.0/Spring 20112

Topics in This Lecture

• Nonprofit Accrediting Organizations– The Joint Commission– URAC (formerly called Utilization Review

Accreditation Commission) • Regulatory Agencies• Professional Associations



JC History

• 1910: The forerunner of JC is called the “end-result” system

• 1951: Joint Commission on Accreditation of Hospitals (JCAH) is created and starts accrediting and certifying health care organizations

• 1987: Name changed to Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

• 2007: Name simplified to Joint Commission (JC); currently accredits and certifies more than 18,000 organizations and programs in the U.S.



JC Mission

“To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value”

The Joint Commission.http://www.jointcommission.org/facts_about_the_joint_commission/



http://www.jointcommission.org/facts_about_the_joint_commission/

JC Accreditation• Earned by an entire health care organization

(hospital, nursing home, office-based surgery practice, etc.)

• Tools the JC uses to measure performance– Integrated Survey Process (ISP): Evaluates

performance across organization– ORYX: System for health care organizations

to report to the JC about patients with certain conditions (core measure sets)

• The core measure sets reported depend on the type and size of the organization



ORYX: Core Measure Sets• Examples

– Heart attack– Pneumonia– Inpatient psychiatric care– Children’s asthma– Stroke

• Each core set has performance measures– For example, the JC looks at whether children with

asthma received certain drugs in the hospital and were sent home with a management plan



JC Certification

• JC-accredited organizations and providers of health care staffing services can also earn certification for specific programs or services– For chronic diseases and conditions

• Examples: asthma, diabetes, heart failure programs

– Programs can be within the medical center or in the community



JC Patient Safety Activities

• National Patient Safety Goals• Universal Protocol• Office of Quality Monitoring• Speak Up™ program• Sentinel Event Policy



URAC

• Formerly known as the Utilization Review Accreditation Commission

• Mission: “To promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education” URAC. http://www.urac.org. Accessed April 12, 2011.

• Has more than 25 accreditation and certification programs for various types of health care organizations



http://www.urac.org/

URAC HealthIT Accreditation

• Outlines best practices for an effective compliance program, including:– Health websites– HIPAA (Health Insurance Portability and

Accountability Act) privacy and security• Designed for a wide range of organizations

involved in health care IT• See urac.org



URAC HealthIT Accreditation (cont’d)

• These health care organizations must comply with HIPAA:– Health plans—health insurance companies,

employer-funded health plans, and government programs that pay for health care, such as Medicare or Medicaid

– Health care providers that conduct certain business electronically

– Health care clearinghouse (organizations that processes health information)

Component 1/Unit 6-1 Health IT Workforce Curriculum Version 2.0/Spring 2011

12

Regulatory Agencies

• Public authorities at state or federal level, established by legislative act to enforce standards in a specific field in the private sector

• Agency’s regulations = laws• Agency might conduct hearings and hand down

judgments• Goal is consumer protection• Example: Food and Drug Administration (FDA)



FDA Overview• Part of Department of Health and Human

Services, charged with oversight of:



FDA Mission

• Protect public health– Regulates drugs

• Performs drug approvals• Provides drug safety information• Spreads the message about medication errors

– Helps speed up product innovations– Helps public obtain accurate science-based

information



Professional Association• A nonprofit organization that wants to support:

– A particular profession

– The interests of individuals engaged in that profession

– The public interest• Sets requirements:

– For entry into the profession—possibly requires license or certificate

– For maintaining membership in the profession• Members generally have a significant amount of education,

training, or experience



American Board of Medical Specialties (ABMS)

• Description: “An organization of medical specialty boards with shared goals and standards related to the certification of medical specialists”

• Member boards certify specialist physicians– Also subspecialists; for example, adolescent

medicine is a subspecialty of family medicine• Board certification differs from licensure, which

sets minimum competency for physicians



American HospitalAssociation (AHA)

• 5,600 organizational members• 41,000 individual members• Major programs

– Advocacy– Resource center (47,000 books on health care)– Health Planning and Administration (HEALTH)

database– Annual survey of U.S. hospitals– Reports and studies



American MedicalAssociation (AMA)

• 240,000 members– Physicians with an MD or DO degree, or a

recognized international equivalent– Resident physicians and fellows– Medical students

• Major programs– Resources for physicians– Advocacy– Publishing medical journals



Summary• Hospitals and other health care organizations are

accredited by the Joint Commission• The Joint Commission also certifies specific health care

programs and conducts patient safety activities• URAC accredits and certifies a wide range of health care

organizations, and it has an accreditation program for IT professionals

• Regulatory agencies such as the FDA protect consumers by setting and enforcing standards

• Professional associations govern their members but not the public at large



component 1: introduction to health care and public health in the u.s

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