Editor’s note: Read “Unraveling the mysteries of accreditation, part 1” on dentaleconomics.com.
As discussed in part 1 of this article, accreditation is a confusing landscape. The same word, “accreditation,” is used to describe a category of programs that have similar goals but different audiences and objectives. Here I’ll examine voluntary national and international accreditation programs, the benefits of accreditation, and whether it brings value to your dental services.
The finer points of accreditation
Accreditation is an independent, third-party evaluation for a provider that yields insights for overall service improvement. This should be a collaborative learning experience for the provider rather than a “check the box” approach. The value is to build on the provider’s existing continuous quality improvement (CQI) system of Plan–Do–Check–Act, and to integrate the new standards to expand improvements to clinical and nonclinical services.
Accreditation programs are based on standards derived from a combination of national and international best practices from organizations such as the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), American Dental Association (ADA); scientific research from peer-reviewed publications such as Journal of the American Medical Association (JAMA), British Medical Journal (BMJ), and Journal of Dental Research (JDR); and experience from health-care providers, subject matter experts, patients, and quality experts. These sources are translated into standards that form the basis for each accreditation program.
Accrediting organizations exercise their judgment as to the topics and best practices to include in their programs; therefore, there are similarities and differences among programs not only in the content of the standards but also in the logistics of the accreditation process. A comparison of four accreditation organizations for dental providers highlight the approaches taken by each one.
Similar steps in the accreditation process
These organizations, Accreditation Association for Ambulatory Health Care (AAAHC), American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Joint Commission International (JCI), and Temos International Healthcare Accreditation (Temos), have similar steps to the accreditation process (figure 1).
All four programs offer accreditation that is valid for three years and require interim updates and progress reports to ensure that the conditions verified at the time of accreditation remain current. All four have procedures in place for revoking accreditation for failure to maintain standards and other noncompliance requirements.
Different accreditation processes
While the steps are similar, the implementation of the process is different among the four organizations. Three of the four organizations—AAAHC, AAAASF, and JCI—to some extent rely on hard copies of the applications, supporting documents, and handbooks that are required or recommended to applicants. The handbooks add to the expense of the process since many dental practices order more than one handbook for staff to use.
Temos’ accreditation process, including the registration and application, self-assessment tools, and standards, are all provided online. Also, this approach is part of Temos’ commitment to the United Nation’s sustainable development goals for sustainable cities and communities and responsible production and consumption. The paper-free approach is better for client experience and the environment.
AAAHC, AAAASF, and JCI classify dental services as ambulatory care clinics and do not distinguish among dental practices, dental clinics, and dental hospitals, which offer different services in different settings. These three programs are built on the services offered by ambulatory care clinics with elements added that apply to dental clinics.
Temos offers four categories of accreditation programs designed specifically for dental practices, dental clinics, and dental hospitals. The programs are “right-sized” to fit the services offered at each distinctive venue. Dental hospitals, for example, have more standards due to the complexity of services offered compared to clinics and practices.
Each organization uses its own proprietary methods and practices to build the standards that are the core of the accreditation process. All of them look for applicants to implement and practice CQI. They all include standards relating to patient safety and risk management as well as leadership and management, infection control, medications management, documentation, and billing.
After these core topics are addressed, the programs address clinical and nonclinical areas of practice management and business management in different ways. AAAHC and AAASF focus on surgical and dental-related standards and cover fewer topics than JCI and Temos. JCI also addresses performance improvement, record keeping, patients’ rights, and transplant safety. Temos includes dental and diagnostic services, continuing education and training, sustainability, ancillary services, and topics related to international patients in addition to the core topics.
Each organization has its unique character and approach to accreditation. For those considering accreditation, it is worthwhile to explore each program to determine which one offers the best fit in terms of the size and scope of the practice and patients served as well as the organizational and business goals of the practice, clinic, or hospital.
Cost is an important factor when considering accreditation. These programs all charge an application/accreditation fee plus expenses for assessors/surveyors traveling for an on-site evaluation. AAAHC, AAAASF, and JCI may charge for additional products and services such as accreditation manuals or consulting services. These should be factored into the budget.
AAAHC requires contacting the organization to obtain a price quote; AAAASF provides a pricing schedule on its website; JCI requires a request for pricing to be submitted but states that the average cost is $12,000; the Temos website hosts a fee calculator for potential clients to estimate the cost of accreditation.
Return on investment (ROI)
The price of accreditation is important to calculate the expected ROI. Since all four programs are valid for three years, the ROI on accreditation can be spread over 36 months. Typically, ROI can be determined by realizing increased revenue, cost savings on expenses, and increase in the number of patients. While there are intervening factors that influence these three items, accreditation is designed to help dental practices improve all of these business metrics.
Here is an example. If the accreditation fee is $12,000, then the dental services will try to reduce expenses or increase revenue $4,000 per year from existing or new patients. Assume that the average patient generates revenue of $500 per year. The dental services will need at least eight new patients each year for three years to recoup the cost. Another approach is to amortize the cost of accreditation per patient over the three-year period of accreditation. If the dental practice sees 1,000 patients per year, the cost of accreditation is $4 per patient. The important point is to determine what to measure and then measure year-to-year to determine if the practice is meeting its business goals.
Accreditation is often sought by dental providers that want to attract international patients as a sign of quality that they’re verified by an international accreditation organization. It is often used by providers globally for marketing purposes as a badge of excellence and differentiation.
Treating international patients requires additional services as well as legal and ethical considerations, which may or may not be included in the standards. AAAHC and AAAASF focus primarily on the US market and offer limited services for providers outside of the US. JCI focuses solely on the international market, while Temos’ programs are available to providers that treat both national and international consumers.
Among all four programs, Temos contains standards that specifically pertain to the patient experience as well as the special issues that apply to patients traveling for dental care.
Is accreditation a good investment?
Accreditation can help dental services improve their efficiency and effectiveness to increase revenue, reduce costs, and improve standards of care. It requires committed leadership as well as willingness to rigorously follow CQI principles. Treating international patients requires additional responsibilities. The information for owners and managers to decide is available to make the right decision for them, their employees, and their patients.
ELIZABETH ZIEMBA, JD, MPH, is the regional director for the Temos office serving the US, Mexico, Latin America, and the Caribbean. Ziemba has a passion for increasing the quality of and access to health-care services around the world. In addition to her work with Temos, she consults with governments and health-care providers to provide market research, marketing, and organizational development services. Contact Ziemba about accreditation by phone/WhatsApp at (857) 366-1315, or at [email protected]