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Review: Strong-arming agencies

Roy Vera, RT, MBA  VIS Medical
Nov 2006
Strong-arming agencies
By Melanie Evans

JCAHO gets into the staffing certification business

Hospitals paid little heed when the Joint Commission on Accreditation of Healthcare Organizations began
certifying one of their more important kinds of vendors: staffing agencies. But that may soon change.

The Oakbrook Terrace, Ill.-based not-for-profit is considering a change to its comprehensive inspection criteria
for hospitals that would waive certain requirements if hospitals contract with Joint Commission-certified
staffing agencies. The Joint Commission's clout--it contracts with 97% of U.S. hospitals to provide
accreditation, which is necessary for Medicare and Medicaid payment--may leave staffing agencies with little
choice but to undergo evaluation as well. Hospitals looking for any relief in the exhaustive accrediting process
may pressure staffing agencies, through rates or contracts, to earn certification.

Incorporating its year-old staffing agency certification into its primary business of hospital accreditation "will be
the shot heard 'round the world," said Franklin Shaffer, senior vice president and chief nursing officer of Cross
Country Staffing. Shaffer advised JCAHO as it drafted 24 standards for the $11.2 billion healthcare staffing
industry. He now sits on two Joint Commission advisory boards and acknowledged hospitals remain largely
unaware of JCAHO's quality and performance measures for temporary nurse and allied health agencies, or
locum tenens firms.

Little pressure from customers to adopt certification exists, said Shaffer, though it is growing. Instead, it is
certified agencies along with the Joint Commission that have championed the credentials, though there is
some evidence staffing agencies with a so-called gold seal may gain a competitive edge, see liability rates
drop or earn slightly more from customers. The U.S. Air Force recently sought bids for a $10 million temporary
healthcare staffing contract that stipulated certified agencies would be given preference.

Industry experts say the Joint Commission's year-old healthcare staffing certification program is the first
national effort to set quality standards for the industry, which is rebounding (Oct. 17, p. 6). To date, more than
50 agencies received certification, and three agencies attempted and failed. Certification costs anywhere from
$5,000 to $15,000 to start, and may include an additional $5,000 in fees depending on the agency's size and
number of locations.

The industry has been involved in shaping the Joint Commission's healthcare staffing certification program
from the beginning. Success of the venture hinges on the JCAHO's ability to grasp the intricacies of a new
industry and convince staffing vendors to undergo voluntary certification, said Chuck Mowll, JCAHO's executive
vice president for business development, government and external relations. It's not unusual for the Joint
Commission to consult with industries it evaluates, but other industry participants also sit on JCAHO's
advisory councils and board of commissioners.

Still, the healthcare staffing advisory council, which can include up to 18 people, already includes 15 industry
representatives, Mowll said. Achieving credible standards without alienating the industry isn't easy for an
organization whose certification is voluntary, Mowll said. "It's a difficult process to strike that balance," he said
of the Joint Commission's multiple certification efforts.

The JCAHO has added five specialized certification awards since 2002 and expects to launch two more before
mid-2006. Jeanene Martin, senior vice president of human resources for three-hospital WakeMed Health &
Hospitals, Raleigh, N.C., said hospitals mostly rely on references and experience to evaluate staffing
agencies' quality.
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