From The Wall Street Journal: “More than 100 psychiatric hospitals have remained fully accredited by the nation’s major hospital watchdog despite serious safety violations that include lapses linked to the death, abuse or sexual assault of patients, a database investigation by The Wall Street Journal has found.

The Joint Commission, an Oakbrook Terrace, Ill., nonprofit that evaluates most of the nation’s hospitals, revoked or denied full accreditation to fewer than 1% of psychiatric hospitals it oversaw in fiscal 2014 and 2015, the latest date for which detailed federal data is available. State inspectors found about 16% of those hospitals each year, or about 140 institutions total, operated with such severe safety violations they could put federal funding at risk.

Troubled hospitals have promoted their continued accreditation to attract new patients, in some cases even after the federal government terminated their Medicare funding due to recurring safety risks.

Psychiatric hospitals kept their accreditation after patients said they were raped or assaulted; died by suicide; or slept on chairs due to crowding, among other incidents, according to a review of hundreds of pages of state inspection reports.

The Joint Commission, a private body authorized by the government to review hospital performance, has long held an accrediting monopoly. It inspects almost 90% of the nation’s psychiatric hospitals, and the federal government relies on its findings. The commission determines whether hospitals comply with federal safety-related regulations. Hospitals determined by the commission to be in compliance get accreditation.

A lot of money is at stake: Medicare payments to inpatient psychiatric facilities reached $4.5 billion in 2017, growing an average of 1% each year since 2006, according to federal data.

The Joint Commission is currently the only accrediting organization with a federally approved psychiatric-hospital accreditation program for Medicare. It also accredits nearly 1,900 behavioral-health organizations such as group homes and addiction-treatment centers.

The Journal previously reported that the Joint Commission continued to accredit a variety of hospitals despite safety violations. In the case of inpatient psychiatric hospitals, the patients and staff are especially vulnerable, because so many of the patients are suicidal and cared for in the absence of family members who often act as patient advocates.

Psychiatric centers, like other hospitals, pay the Joint Commission for its inspections, and some hire consultants from a commission subsidiary to help them pass those reviews, which many ethics experts consider a conflict of interest.

Commission officials said that their surveys of hospitals shouldn’t be considered regulatory inspections and that they work collaboratively with psychiatric hospitals to help them improve.

‘It is important to acknowledge an uncomfortable reality: There are no perfect hospitals anywhere in the world,’ the Joint Commission said.

Some mental-health experts say the current system features the wrong incentives.

‘Accrediting bodies can’t make the standards too high or no one will ever pay for it,’ said Benjamin Miller, chief strategy officer at Well Being Trust, an advocacy group on mental health and wellness. ‘Accreditors are all in the business to make money.’

The Journal found 141 psychiatric hospitals, out of roughly 490 across the country, that were accredited by the Joint Commission and cited by state officials from fiscal 2014 and 2015 for serious violations.

For most of the 141, those violations weren’t the first; they had an average of eight serious violations in the years going back to 2011, according to state inspection records and Hospitalinspections.org. Some had dozens of previous violations.

‘I am very concerned about the data. It’s showing us there is a disparity between their surveys and ours,’ said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. ‘You want to be sure accreditation means something.’

CMS checks accreditors’ work using a formula known as a disparity rate to gauge how often safety issues were overlooked. Its data shows the commission’s reviews of psychiatric hospitals had a 57% rate, which officials described as concerning and the highest of all types of hospitals.”

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