172: Hospitals & Health Equity: Addressing health disparities is both a moral imperative – and a patient safety and quality issue
Racial and ethnic minorities and other underserved groups receive unequal medical treatment, contributing to the myriad disparities in health outcomes that we see today. This notion is supported by a growing body of research stemming back decades.
The Joint Commission has recognized the horrible impact of health disparities in America, and the group is taking action, says Kathryn Petrovic, vice president for accreditation and certification product development at the Joint Commission.
The accrediting organization launched a new health care equity certification program in 2023 that recognizes hospitals that are “making health care equity a strategic priority, and collaborating with patients, families, caregivers, and external organizations to identify and address needs that help translate equitable health care into better health outcomes,” Petrovic says.
Health Disparities podcast host Claudia Zamora speaks with Petrovic to learn more about TJC’s health equity initiatives. Petrovic also explains how resolving healthcare disparities is both a moral and ethical requirement, and fundamental patient safety and quality of care imperative.
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The transcript from today’s episode has been lightly edited for clarity.
Kathryn Petrovic: Organizations can use data about their patient population to determine whether there are differences in the care provided to one group of patients versus another. Healthcare disparities are pervasive for members of racial / ethnic minorities, patients who prefer to speak a language other than English, women, older patients, and people with disabilities. Therefore, it is essential for organizations to conduct analyses to understand the specific disparities that may exist at their institution.
Claudia Zamora: You are listening to the Health Disparities podcast from Movement Is Life. I'm Claudia Zamora, your host for today's episode of the podcast. I'm the founder and CEO of Zamora Consulting Group. I'm also a health equity advocate. I serve on the Board of Directors for the National Hispanic Medical Association, and the board of directors for Movement Is Life.
Hospitals and health systems have an important role to play in addressing health disparities. It's the focus of our latest podcast series. It is well established that racial and ethnic minorities and other underserved groups receive unequal medical treatment, contributing to a disparities in health outcomes that we see today. And we have known this for a while.
Two decades ago, the National Academy of Medicine published the report titled, Unequal Treatment: Confronting racial and ethnic disparities in healthcare. And a lot of that unequal treatment occurs in hospitals. So I'm very excited today to interview Kathryn Petrovic, vice president for accreditation and certification product development at the Joint Commission. For those of you not familiar with the Joint Commission, it is a very important group. The Joint Commission is responsible for certifying quality and safety of more than 22,000 hospitals and health organizations in America. And many insurance companies require hospitals to be qualified by the Joint Commission. So bluntly speaking, the Joint Commission is a very powerful group. And they have recognized the horrible impact of health disparities in America, and they're taking action. So let's talk with our guests to learn more. Kathryn, welcome to the Health Disparities podcast. Thanks for being with us today.
Petrovic: Thank you, Claudia. I really appreciate this opportunity.
Zamora: So Kathryn, before we dive into the work you're doing to address health disparities, let's talk about the mission of the Joint Commission. Broadly speaking, your organization makes standards for hospital accreditation. Tell us more about that work.
Petrovic: Well, the Joint Commission is the nation's oldest and largest standard setting, and accrediting body and healthcare. It was started nearly 75 years ago by physician leadership organizations and the American Hospital Association. Today, we continue to bring a strong clinical voice to advocate for safe, effective, efficient, equitable, and compassionate care in the United States and 76 countries. The Joint Commission's mission is to continuously improve health care for the public in collaboration with other key stakeholders by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. Our organization accredits and certifies more than 22,000 health care organizations as you've as you have stated, Claudia, and programs in the United States, including hospitals and health care organizations that provide ambulatory and office based surgery, behavioral health care, home health care, laboratory and nursing care center services. So we really do influence across the entire continuum of care. We set standards for accreditation and certification programs for healthcare organizations and survey them on their performance and adherence to those standards. Our goal is that the Joint Commission accredited healthcare organizations provide patients with the safest and highest quality care.
Zamora: I'm actually very familiar with the Joint Commission. I work on accreditation types of projects, and I've done JCAHO and JCI abroad and I know that they're very you guys are very powerful organization, because I've actually cited hospitals when it comes to my families, two of my sisters, my brother had an issue, we're in the hospital, they didn't want to treat them. And then I just said, you need to adhere to the JAHCO standards when it comes to patient care. And it was like night and day, they turn the light, they started doing everything they needed to do. So I think hospitals are very scared when you say, you're not adhering to JAHCO standards, so thank you for that, for the work that you guys are doing. I understand the Joint Commission does not want to overburden hospitals, with an ever increasing number of standards. So you're often asking yourselves, which standards can we get rid of. But a couple of years ago, the Commission decided to add a new standard about health care disparities. Why is that?
Petrovic: So the Joint Commission's goal is to evaluate and eliminate requirements that no longer add value. We want to have fewer but more meaningful requirements that best support safer, higher quality and more equitable health outcomes. Approximately 400 standards were eliminated as part of this recent standards simplification project, which evaluated our requirements throughout our accreditation programs, resulting in the removal of several redundancies, so healthcare organizations can focus on crucial patient safety priorities, such as health care equity.
We introduced our new health care equity standard, which was subsequently elevated to a National Patient Safety goal in July 2023. This new requirement addresses health care disparities as a quality and safety priority for all hospitals, and critical access hospitals, as well as certain services provided within our ambulatory care organizations, and Behavioral Health and Human Services accredited organizations. Aligning with the Joint Commission's vision that all people always experience the safest, highest quality and best value health care, we also introduced the health care equity certification program, which distinguishes those organizations making health care equity a strategic priority, and collaborating with patients, families, caregivers, and external organizations to identify and address needs that help translate equitable health care into better health outcomes.
Zamora: Oh, thank you for that. In a report about this new health disparity standard from the Joint Commission, it says although healthcare disparities are often viewed through the lens of social injustice, they are first and foremost a quality of care problem. Unpack that idea for us.
Petrovic: Yes, health care equity is not only an issue of social justice, but also a fundamental issue of patient safety and quality of care. This is why it is a top priority for the Joint Commission to advance health care equity. COVID-19 sharpened health care's focus on the fractures in care that are unacceptable, are new accreditation standard further reinforces our vision that all people always experience safe high quality care. The health care equity certification program distinguishes those organizations making health care equity a strategic priority, and are collaborating with patients, families and other key stakeholders within their communities to identify and address needs that help, that translate equitable health care into better health outcomes.
Zamora: Alight, so, the standards for healthcare disparities are broken up into several components. And I'd like to walk through each of these. The first is aimed at designating individuals to lead activities to reduce healthcare disparities, develop and standardize structures and processes to detect and address healthcare disparities. Why is that important?
Petrovic: Well, to improve health care equity, an organization must first create a structure to support such initiatives, which starts with leadership prioritization, and oversight and integration of the steps necessary to identify inequities to ultimately improve health care equity. Accredited organizations are required to identify an individual to lead and oversee activities to improve health care equity, assess patients health related social needs, identify health care disparities and as patient population by stratifying quality and safety data using the socio demographic characteristics of the organization's patients. They're to develop an action plan to improve the health care equity by addressing at least one of those disparities identified in his patient population. They are to monitor the action plan results and act when the organization does not meet the goals. And finally, inform key internal stakeholders about progress to improve health care equity. Everyone deserves a chance for safe, equitable and meaningful care. As such equity must be the foundation for safety and quality in health care. By elevating the existing standard to a national patient safety goal, we are emphasizing the importance for health care organizations to ensure oversight and accountability for health care equity.
Zamora: So as you just mentioned, another component of the standard is identifying health-related social needs, trying to get to the root causes of disparities in health outcomes. How will the implementation of this requirements affect the way providers engage with patients?
Petrovic: So health-related social needs refers to the social and economic needs that individuals experience that may affect their ability to maintain their health and well being. They include things such as food insecurity, difficulty paying prescriptions, and medical bills, and access to transportation to name a few. Treatment plans may not be safe and effective if patients cannot afford their medications, lack transportation to get to appointments, or have adverse drug reactions because they cannot afford food. Healthcare organizations should work to understand these needs and identify possible resources and services for patients in order to provide optimal care. Many healthcare organizations have system sets have successfully taken up this challenge and are implementing routine screening for health related social needs and referring patients to community resources as a part of their treatment plan.
Zamora: Okay, so the health disparities standard also includes data collection requirements, with a focus on identifying healthcare disparities. The hospital organization will need to stratify quality and safety data using social demographic characteristics, and then use that data to drive action. This would include making sure patients medical records include data on race and ethnicity. Talk about the importance of this kind of data collection.
Petrovic: Organizations can use data about their patient population to determine whether there are differences in the care provided to one group of patients versus another. Healthcare disparities are pervasive for members of racial ethnic minorities, patients who prefer to speak a language other than English, women, older patients, and people with disabilities. Therefore, it is essential for organizations to conduct analyses to understand the specific disparities that may exist at their institution. If the stratified data shows differences in outcomes across groups, based on socio demographic characteristics, organizations should work to understand the root cause of the differences and develop those action plans to address disparities when they are identified.
Zamora: So what kind of requirements are in place for making sure there's follow through on these efforts to address healthcare disparities?
Petrovic: As part of the requirements, healthcare organizations are expected to assess if they are reaching their action plan goals to reduce the healthcare disparities that they have identified. Similar to other performance improvement activities, this analysis will help inform healthcare organizations if they implemented if their implemented actions are driving positive change or if they need to revise the plan.
Zamora: So based on what you've just mentioned, what kind of response have you seen from the hospitals since rolling out this new health care disparities standard?
Petrovic: Well, overall, the feedback has been overwhelmingly positive from health care organizations all over the country. As we continue to assess compliance with our new requirements during the accreditation and certification, survey and review processes, we are inspired by healthcare organizations' commitment and progress towards improving health care equity.
Zamora: So Kathryn, you just mentioned earlier, the Joint Commission also created the voluntary certification in health care equity. What do hospitals have to do to earn that certificate?
Petrovic: So the Joint Commission launched a voluntary health care equity certification, which became effective in July 2023. The Advanced Certification recognizes hospitals and critical access hospitals that strive for excellence in their efforts to provide equitable care treatment and services. Improving health care equity is a quality and safety priority at the Joint Commission. This healthcare equity certification builds on the Joint Commission's accreditation requirements. The new certification requirements emphasize the structure and processes.
Healthcare organizations need to decrease healthcare disparities in their patient populations, promote diversity, equity and inclusion for their staff within five domains: leadership, collaboration, data collection, provision of care, and performance improvement. The health care equity certification is available to all Joint Commission accredited hospitals and critical access hospitals, as well as non-Joint Commission accredited hospitals and critical access hospitals that comply with applicable federal laws, including the Centers for Medicare and Medicaid Services Conditions of Participation. The health care equity certification program will distinguish those organizations making health care equity a strategic priority, and are collaborating with patients, families, caregivers and key external stakeholders to identify and address needs that help translate equitable health care into better health outcomes.
Zamora: So, how many hospitals are currently currently working towards this new certificate?
Petrovic: Well, 14 hospitals have already achieved the health care equity certification. And several hospitals, including health systems have expressed interest in achieving our healthcare equity certification.
Zamora: Can you give us some examples of those hospitals and walk us through the kinds of changes they're making to earn this health care equity certificate?
Petrovic: Sure, Claudia. Massachusetts is the first U.S. state in which all hospitals have taken the meaningful step to close health care disparities by meeting the Joint Commission's new health care equity accreditation standard. The Massachusetts Health and Hospital Association led this impressive achievement to further the state's commitment to health care equity. These hospitals plan to achieve the Joint Commission's health care equity certification by 2025. The Joint Commission distinction is one element of the Commonwealth's groundbreaking 1115 Medicaid waiver program, which empowers hospitals to embed health care equity efforts at the point of care, make services more accessible for patients and reduce persistent disparities. This historic commitment was led by the state's Executive Office of Health and Human Services, that worked extensively with Massachusetts hospitals to establish concrete health equity goals, and establish processes to better understand and care for all patient populations.
The Meridian health plan of Illinois became the first Medicaid health plan in the United States to offer incentives to help hospitals achieve health care equity certification from the Joint Commission. Meridian will reimburse a portion of the certification fee for in network Illinois hospitals that complete the Joint Commission's health care equity certification program. Meridian is actively encouraging participation in the certification. The health plans support of the program aims to ensure in-network hospitals formalize structures, processes and goals for identifying and addressing healthcare disparities in the communities they serve. Reimbursement of the annual application fee will be 25% for safety net, and critical access hospitals, while all other hospitals will be reimbursed 15%. There are up to 197 in-network Illinois hospitals, and critical access hospitals that could elect to pursue and attain our healthcare equity certification.
Zamora: So, as you mentioned, when you rolled out the standard, what timeline did you give hospitals and health organizations to meet that standard? Is that by the time the next time they do their survey?
Petrovic: That is correct. So we announced our accreditation requirements. And then we also let organizations know what that implementation date will be. So all organizations are expected to be compliant with those requirements at the time of implementation. So then, during their next triennial survey, we will evaluate to ensure that they are compliant with those requirements.
Zamora: But if they don't meet the requirement, will they get put on probation, or that's just a small part of the survey?
Petrovic: So, they will receive a report. So we identify noncompliance with all of our requirements. And those are what we call requirements for improvement are documented and provided to the organization. They will then have 60 days after that survey event to respond to us with an evidence of standards compliant written plan, which will then state how the organization has now met compliance and is in compliance with those requirements.
Zamora: Fantastic. Now, I understand the Joint Commission's CEO, Dr. Perlin, often invokes the following quote about healthcare inequality, attributed to Reverend Dr. Martin Luther King, Jr. and it states: Of all the forms of inequality, injustice in health care is the most shocking and inhumane. Can you talk about how this underlying belief drives the work you all do?
Petrovic: While it is evident that resolving healthcare disparities is a moral and ethical requirement, it may not be clear that inequities are fundamental patient safety and quality of care imperatives. That is why Dr. Perlin, our president and CEO, emphasizes that Martin Luther King's words remain true, that of all the forms of inequity injustice in health is the most shocking and inhuman because it often results in physical death. The Joint Commission aims to equip all accredited health care organizations with the necessary resources and tools to meet our new requirements. Most importantly, we believe that these requirements will help healthcare organizations provide high quality and equitable health care for all to help healthcare organizations meet the accreditation and certification requirements. The Joint Commission developed the health care equity resource centers, which provides practical strategies, toolkits, templates, brief synopsis and videos.
Zamora: Thank you for that, Kathryn. Well, that brings us to the end of another episode of the Health Disparities podcast from Movement Is Life. I'd like to thank my guest Kathryn Petrovic with the Joint Commission for being with us today.
Petrovic: Thank you so much, Claudia.
Zamora: If you like what you hear, please be sure to subscribe or wherever you get your podcasts and take a moment to leave us a rating. It really makes a difference. And mark your calendars for our upcoming annual summit. This year's summit will be in Atlanta, Georgia, on Thursday, November 14, and Friday, November 15, at the Whitley hotel in the Buckhead area of Atlanta. For more information, please go to our website, www.movementislifecommunity.org to register. I am Claudia Zamora. Until next time, be safe and be well.