Regulatory And Cq2 In Health Care Case Study

Managing Financial Impact of Regulatory and CQI in Health Care When it comes to managing the financial impact of regulatory and CQI in healthcare, accreditation and licensure are two important factors. They are both needed in ensuring the qualifications of physicians, nurses and the facilities in which they provide healthcare. They also confirm the safety of the facilities as well. Accreditation and licensure, although similar are different and needed for different purposes.

Accreditation is the proof that the person or place an individual is seeking service from is creditable. It is the official assertion by an expert that an organization, service, or individual has the proper competency, and or credibility to meet a particular set of

AMTA, 2014 states, “Licensure is a non-voluntary process by which an agency of government regulates a profession. It grants permission to an individual to engage in an occupation if it finds that the applicant has attained the degree of competency required to ensure the public health, safety, and welfare will be reasonably protected.” Licensure is always done by a governmental agency, not private. Licensure is law based. These laws make it illegal for healthcare professionals to operate in their field without a license. Licensure is done state by state (AMTA, 2014). This means the conditions to obtain a licensure can be different for each state since it is not done on a federal level. To obtain a license, healthcare professionals must first have certain credentials. These credentials are a college degree (bachelor and/or masters, depending on the profession), the passing of national tests i.e. NCLEX, NBME, FLEX or USMLE (for medical doctors) and successfully passing the licensing test provided by the state. Once this happens the healthcare professional will be deemed competent in their area and will be issued a license making them eligible to provide care in the state they received the license

The first regional accrediting agencies formed in the 1880s and paid particular attention to educational criteria and the admission processes (ACICS, 2010). The first accreditation of a facility in the United States was in 1917 (Sollecito & Johnson, 2013). In 1918 The American Council on Education (ACE) was formed in efforts to standardize higher education institutions. The American College of Surgeons created the “Minimum Standards for Hospitals”. This association ultimately led to the creation of The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 1951. In 1965, accreditation was regulated in the United States by the Higher Education Act which is reviewed by congress (ACICS, 2010). When the Medicare program was first being developed in 1971, the concerns of quality care were expressed through licensure and hospital accreditation. If Medicare was going to be a successful program it had to make sure its beneficiaries received quality care. By 1975 the rise of self-regulation accrediting agencies emerged (ACICS, 2010). These self-regulation accrediting agencies wanted to help improve the accreditation