National Quality Forum recently endorsed four behavioral health quality measures. The measures address maximum hours of physical restraint use or seclusion, and separately address timeliness of follow-up after an emergency department visit for an alcohol or other drug abuse or dependence, and timeliness of follow-up after an emergency department visit for mental illness or intentional self-harm. The latter two measures had previously been a single measure.

The endorsed measures are:

• 0640 HBIPS-2 Hours of Physical Restraint Use: This process measure for facilities was recommended for continued endorsement. It refers to the total number of hours that all individuals admitted to a hospital-based inpatient psychiatric setting were maintained in physical restraints. The data comes from electronic and paper medical records. The measure is reported as the number of times that physical restraints are used for more than two hours divided by the number of psychiatric inpatient days.
• 0641 HBIPS-3 Hours of Seclusion Use: This process measure for facilities was recommended for continued endorsement. It refers to the total number of hours that all individuals admitted to a hospital-based inpatient psychiatric setting who are held in seclusion. The data comes from electronic and paper medical records. The measure is reported as the number of events divided by the number of psychiatric inpatient days.
• 3488 Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence: This process measure for health plans was recommended for continued endorsement. It is a maintenance measure because it was previously part of an endorsed measure that combined mental health and addiction disorder emergency department follow-up visits. Data for this measure comes from claims for members ages 13 and older who have an emergency department visit with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence and who have a follow-up outpatient visit for AOD. Two rates are reported: the percentage of emergency department visits for which the member receives a follow-up visit within seven days and the percentage of follow-up visits within 30 days of the emergency department visit.
• 3489 Follow-Up After Emergency Department Visit for Mental Illness: This process measure for health plans was recommended for continued endorsement. It is a maintenance measure because it was previously part of an endorsed measure that combined mental health and addiction disorder emergency department follow-up visits. Data for this measure comes from claims for members ages 13 and older who have an emergency department visit with a principal diagnosis of mental illness or intentional self-harm who have a follow-up visit for mental illness. Two rates are reported: the percentage of emergency department visits for which the member receives a follow-up visit within seven days and the percentage of follow-up visits within 30 days of the emergency department visit.

The recommendations were issued in “Behavioral Health and Substance Use, Spring 2019 Review Cycle: CDP Report” by National Quality Forum (NQF). During the spring 2019 project cycle, the Behavioral Health and Substance Use Standing Committee evaluated six measures. The following two measures were not endorsed during this cycle: NQF  0560 HBIPS-5 Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification; and NQF 1922 HBIPS-1 Admission Screening for Violence Risk, Substance Use, Psychological Trauma History and Patient Strengths Complete. Each Behavioral Health and Substance Use project cycle aims to endorse measures of accountability for improving the delivery of behavioral health care in the United States.

NQF is a consensus-based healthcare organization created in 1999 that works with all members of the healthcare community to drive measurable health improvements. Its mission includes promoting and ensuring consumer protections and healthcare quality through evidence-based measurement and public reporting. NQF-endorsed measures are used by the federal government (Medicare and Medicaid), states, and private-sector organizations to evaluate performance and to share information with consumers. To endorse measures, NQF committees evaluate the evidence-base for measures submitted by measure developers. NQF reconsiders endorsed measures and considers new measures during project cycles. Previously endorsed measures relevant to the project are reconsidered to assess their ongoing importance, validity, reliability, feasibility, and utility .

The full text of “Behavioral Health and Substance Use, Spring 2019 Review Cycle: CDP Report” was published in February 2020 by National Quality Forum. A free copy is available online at http://www.qualityforum.org/Publications/2020/02/Behavioral_Health_and_Substance_Use_Final_Technical_Report_-_Spring_2019_Cycle.aspx (accessed March 30, 2020).

OPEN MINDS last reported on this topic in “National Quality Forum Endorses Four Behavioral Health & Addiction Disorder Safety Measures,” which published on June 13, 2018. The article is available at https://www.openminds.com/market-intelligence/bulletins/national-quality-forum-endorses-four-behavioral-health-addiction-disorder-safety-measures/.

For more information, contact: Information Office, National Quality Forum, 1099 14^th Street Northwest, Suite 500, Washington, District of Columbia 20005; 202-783-1300; Fax: 202-783-3434; Email: info@qualityforum.org; Website: http://www.qualityforum.org/.

Accreditation is identified as a component of value-based reimbursement in the OPEN MINDS VBR Readiness Assessment. Organizations can leverage accreditation in their contract negotiations with payers.

Benefits of Accrediting Behavioral Health Organizations

Achieving health care accreditation lets your consumers, payers and the community know that your organization has a commitment to quality and meets industry quality standards. Benefits of accreditation:

1. Provides a clear structure for behavioral health services to build infrastructure that will facilitate quality of care and outcomes.
2. Increases accountability to the community and policymakers.
3. Facilitates quality to be integrated in the organization’s governance structure, down to the front line. It improves management processes.
4. Enables organizations to be more competitive in payer negotiation, particularly with value-based payment agreements. It may support other funding opportunities.
5. Standardizes operating and clinical policies and procedures, thus increasing quality, improving efficiencies, and reducing costs.
6. Enhances consumer satisfaction, by adherence to patient-centered standards and monitoring.
7. Improves patient safety through the implementation of industry standard infection control, mediation safety, diagnostic accuracy, and clinical documentation.
8. Improves care coordination and transitions of care.
9. Demonstrates compliance with all regulatory requirements.
10. Establishes greater accountability and reduced risk for lenders.
11. Provides quantifiable results and demonstration of ongoing clinical quality improvement.

Common Accreditation Bodies in Behavioral Health

• Accreditation Association for Ambulatory Health Care (AAAHC)
• Commission on Accreditation of Rehabilitation Facilities (CARF)
• Council on Accreditation (COA)
• The Joint Commission (TJC)

Emerging Accreditation

The National Committee for Quality Assurance (NCQA) has recently granted its first accreditation for electronic clinical quality measures (eCQM) Certification of quality reporting software. NCQA is also known for its Patient Centered Medical Home (PCMH) recognition. The Utilization Review Accreditation Commission (URAC) was the first organization to accredit telehealth services, formally launching its telehealth standards in 2016.  Alternatives to The Joint Commission for acute hospitals to demonstrate Conditions of Medicare Participation DNV GL, which incorporates ISO 9001 standards, and The Center for Improvement in Healthcare Quality (CIHQ).

Choosing and Accreditation Organization

Accreditation costs money both in application and survey fees, as well as leadership, consulting and clinical staff resources. It’s important to choose wisely. The preferences of your major payers is a critical consideration. Also consider how the standards of different accreditation bodies apply to the scope services that you offer in outpatient, inpatient and residential settings. Most accreditation bodies require an onsite survey, (except for NCQA PCMH recognition). The tone of accreditation surveys can vary greatly. Some are consultative and others may lean towards inspection and being more punitive.

Preparing for Accreditation

Preparing for accreditation generally takes about 12 months. Most accreditation bodies will offer live or online workshops on the accreditation process and overview of their standards. You will begin by conducting a gap analysis of the standards and then develop a plan for building the infrastructure to meet them. A mock survey is highly advised prior to completing the final application so that an organization can be confident that they are meeting the standards and that leaders have practiced the rigors of a survey. Most accreditation agencies want to observe that staff follow operating procedures related to their standards. Ongoing staff orientation to accreditation standards and procedures is important.

Accreditation Fees

All accreditation bodies will charge an application fee. Application fees range from $750 to $1,700. Onsite survey fees may vary according to organization size and the number of surveyors required. Some accreditation bodies will assess additional fees for improvement plan reports if deficiencies are found; others will merely follow-up on deficiencies in the next survey cycle.

Length of Accreditation

It may take a few months between the time a survey is completed, and formal accreditation is granted. Once accreditation is approved, it will generally last for 3 years. Provisional status (one year) may be granted for start-up organizations that do not yet meet all operational requirements, such as experience with quality and process improvement. Provisional status may also be granted to organizations with significant deficiencies, and a survey must be repeated with in a designated amount of time.

Below is a crosswalk of accreditation bodies for review. All accreditors serve health and human service organizations. Further detail on their scope is listed. Links to their Web sites are listed for readers to further review their benefits and market position.

Accreditation Crosswalk