American Academy of Pain Management Accreditation Helps Pain Organizations Meet JCAHO Standards

Pain is the number one reason individuals seek healthcare; 50–70% of doctor visits are pain-motivated. Yet, of the 800,000-some physicians in the United States, fewer than 7,000 are specially trained in pain management or affiliated with any of the major pain organizations, according to B. Eliot Cole, MD, MPA, of the American Academy of Pain Management. The shortage is clear, particularly in light of the recent JCAHO accreditation standards that call for pain evaluation and treatment.

Comprehensive pain management standards recently instituted by JCAHO require that healthcare programs and facilities seeking JCAHO accreditation must demonstrate through documentation that a whole patient assessment is completed. Patients must be assessed for the presence of pain, along with the patient's presenting problem. If pain is present, JCAHO requires the pain be assessed and treated.

The assessment includes patient history, a physical examination, assessment of psychosocial, family and cultural aspects, and a pain assessment including a medical history and previous treatment that has helped the patient's pain. The documentation must then include diagnosis and reassessment. The JCAHO standards also require that the healthcare organization have clear policy and procedures, a patient bill of rights, and clinicians with a demonstrated competency in pain management treatment.

According to Richard Weiner, PhD, Executive Director of the American Academy of Pain Management, “the fact that the Joint Commission has elevated pain management to a higher public policy recognition is part of a trend that means clinicians are going to have to retool and reeducate themselves into multi disciplinary and into whole patient assessment.”

The Academy, the largest multidisciplinary pain society and largest physician-based pain society in the United States, offers accreditation to both practitioners and organizations in the area of pain management. The accreditation process for pain organizations can also help the organizations meet the JCAHO standards.

Dr. Cole is administrator for the pain program accreditation service and for the National Pain Databank of the Academy, and director of the Academy's continuing education programs. Dr. Cole says that, whereas JCAHO's sphere has been around hospitals, nursing facilities and health system networks, the Academy is more focused on freestanding programs, some of which operate within a hospital, and is interested in accrediting all types of pain programs.

This article describes the credentialing program for organizations and benefits of accreditation, including how accreditation through the Academy can help clinics meet the JCAHO standards.

A thorough evaluation of paper, processes and people

First, an organization seeking accreditation must obtain an application and manual from the Academy. The completed application along with an internal self-assessment, and a copy of all the recording instruments the organization uses (history forms, consent for treatment forms, documentation for release of medical information), mission statements, program descriptions, resumes of personnel, marketing material, fact sheets, and patient education brochures are submitted to the Academy for review.

A consultative site survey may result in helpful suggestions

If, after preliminary review, the packet is satisfactory, a site survey is scheduled. The site surveyor conducts a comprehensive on-site review, will talk to patients and employees, review files and make recommendations. By design, the survey is a consultative process. The reviewer can make suggestions or offer ideas based on what other offices are doing to help the site with their procedures or documentation. The reviewer cannot, however, consult in patient treatment.

Dr. Cole reviews the site reviewer's recommendations and makes his recommendation to an advisory council. If approved, the application proceeds to the board of directors of the Academy. The board makes one of three decisions: a three-year accreditation if the site meets the standards, a one-year provisional accreditation, or refusal.

Academy accreditation supports JCAHO requirements

A clinic accredited by the Academy can meet JCAHO accreditation standards through its documentation, policies and procedures, trained clinicians, patient's bill of rights and outcomes measurement.

1. Documentation. JCAHO standards call for clear documentation throughout the process: assessment, diagnosis, reassessment and outcomes. The Academy accreditation process includes a review of the recording instruments the organization uses. Academy credentials indicate clean, thorough documentation.
2. Clearly documented policies and procedures. All JCAHO accredited clinics and programs must have policy and procedure documentation. The American Academy of Pain Management has a policy and procedure manual available to purchase either in hardcover or on disk. It can be purchased by section or in its entirety and an electronic version allows clinics to modify the forms to carry the clinics' names.
3. Specialty-trained, quality clinicians. Certain training and credentials of a clinic's clinicians must be met to earn Academy accreditation. Continuing staff education is a component of the JCAHO standards; it is also required to maintain credentialing through the Academy.
4. A patient bill of rights. JCAHO standards require a patient bill of rights within the healthcare organization's documentation. Organizations accredited by the Academy can use the Academy's bill of rights and their code of ethics to demonstrate that they've met the mandate of JCAHO.
5. Outcomes measurement. Reassessment and documentation of outcomes measurement are required of the JCAHO standards. Academy accreditation is wrapped around outcome measurement with its National Pain Databank. Inclusion in the databank is a benefit of Academy accreditation, but nonaccredited pain specialists can use it as well for a fee. With approximately 15,000 cases currently in the databank, clinicians can use it to obtain aggregate data, to provide benchmarks, and to provide feedback to payers and regulators, and for staff training.

A future trend

To conclude, Dr. Cole foresees the Academy's credentialing and JCAHO's credentialing becoming more similar as health systems move toward being required to operate more pain management programs. He also foresees hospitals and healthcare systems purchasing the time and services of pain pro grams as a future trend.

“Multidisciplinary pain management clinicians have a predilection for under standing the need for whole pain assessment,” he states. “Hospitals needing JCAHO accreditation are going to turn to them; they don't need to reinvent the wheel.”

Furthermore, he says, “Those hospitals and facilities that can identify pain management professionals are going to be 20 steps ahead. The pain management professionals [that have earned Academy credentials] will have the expertise to put together the package that the clinic or hospital needs to be in compliance, and that includes policy and procedure manuals, identification of quality personnel, training, accreditation and outcomes measurement.”

If you are interested in accreditation or other tools available from the American Academy of Pain Management, visit their website at www.aapainmanage.org.

Resources Available Through the American Academy of Pain Management:

• Accreditation for Pain Specialists
• National Pain Databank
• Continuing education focused on pain management
• A virtual library of pain-related articles
• On-line discussion board

Visit the Academy's website at www.aapainmanage.org or call 209-533-9744.

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