Accreditation decisions, Part 2

In our last article, we discussed the accreditation decisions that may result from an initial site visit. This column specifically addresses the decisions that may result from subsequent site visits; we refer to these as reaccreditation visits, even though Webster's Dictionary does not recognize reaccreditation as a word.

Medical transport services that are awarded full accreditation must apply for accreditation again in 3 years. At this point, the Commission on Accreditation of Medical Transport Systems (CAMTS) has some services that have been accredited since 1992 and have gone through this process 5 times over the past 14 years. Of course, the standards have changed over that period, as well. When we revise standards, our intent is to raise the bar with each revision and reflect the dynamic changes in the medical transport environment. We will publish the 7th edition in the fall of 2006.

Approximately 9 months to a year before an accreditation certification expires, the program receives an updated policy manual, current accreditation standards, and a new program information form (PIF), along with formal notification of the PIF's due date. We now require the PIF to be submitted at least 120 days before the tenure of accreditation expires, because of the increased number of applicants, and we have scheduled our board meetings 3 times each year.

When a program applies for reaccreditation, it can receive one of the following accreditation awards or actions:

Full accreditation is awarded to a program that currently holds full accreditation when it has demonstrated, on review, that it continues to be in substantial compliance with the accreditation standards.

Probational accreditation is given to a program that has held full accreditation, but, on a scheduled review for reaccreditation, has more concerns and deficiencies than cited during the previous certification period or has unresolved concerns or deficiencies from the previous tenure of accreditation.

Probational accreditation lasts 2 years. Programs may advertise themselves as accredited and are also listed on the CAMTS website, but they have the financial impact of budgeting for accreditation again in 2 years rather than 3 years.

A program may not hold probational accreditation for more than 4 consecutive years, meaning no more than two consecutive probational accreditations are permitted. If the program does not achieve full accreditation after two consecutive probational accreditations, accreditation will be withdrawn.

Accreditation may be withdrawn when a program has held full or probational accreditation but is not in compliance with accreditation standards. Accreditation can also be withdrawn at any point during the tenure of accreditation if the program:

When accreditation is withdrawn, the program is not eligible to submit a PIF for at least 6 months. Programs whose accreditation is withdrawn because of false or omitted information are not eligible to reapply for a minimum of 1 year from the date of withdrawal and a maximum of 5 years at the sole discretion of the board of directors.

One of the most disappointing trends we have seen is an increase in the number of probational accreditations. Accredited medical transport services are expected to maintain compliance with standards throughout the tenure of accreditation. Over the past year, the board has reviewed more and more programs that not only have recurring and unresolved deficiencies from the previous site visit but also have new deficiencies because they have not maintained compliance with current accreditation standards. For example, at the October 2005 board meeting, we reviewed eight new applicants. All eight (100%) were fully accredited. We also reviewed nine reaccrediting programs. Of those nine, only five (56%) were awarded full accreditation.

One of the reasons for a program “slipping” could be the rapid expansion and number of constant changes that are reported, especially among rotor-wing services. Growth and expansion that are not properly planned take attention away from the mission at hand and focus energies on the changes.

One long-time accredited service suggests that a program assign one person or a committee (if it is a larger service) to ensure that it stays in compliance with the accreditation standards no matter what else is going on in the program. Indeed many programs that have achieved full accreditation in succession over the years have one individual who is responsible for keeping vigilant with CAMTS policies and standards.

We understand that accreditation is a major accomplishment, but the process does not end with receiving the accreditation certificate. Accredited programs would benefit by asking, “What if CAMTS came to visit today; would we be ready to demonstrate that we are in substantial compliance with the accreditation standards?”