Raising the bar?

LAKEWOOD, COLO. — The American Animal Hospital Association (AAHA) will begin accrediting referral hospitals next month, a move encouraged by some but deemed unnecessary by other industry insiders.

Aiming to improve the overall level of care delivered by referral practices, AAHA is to announce the plan officially at its annual meeting next month in Tampa, Fla.

"They are along the lines of our traditional standards. We understand that specialists are capable of handling their areas of expertise in a hospital, but what AAHA offers is the delivery of care to be brought to a much higher level by the entire team," says Thomas Carpenter, DVM and AAHA president. "All of the things that you typically see in regular standards are addressed, so it helps to improve the entire service-delivery mechanism."

With accreditation standard specifics under wraps until the official launch, Carpenter revealed only general areas that will be assessed: anesthesia, client services, contagious disease, continuing education, dentistry, diagnostic imaging, emergency critical care, examination facilities, human resources, housekeeping, maintenance, lab, leadership, pain management, patient care, pharmacy, safety and surgery.

Created through a task force that included specialists from multiple areas of medicine, the standards are voluntary protocols that will help an entire practice team deliver care, not dictate how DVMs perform their specialty, Carpenter says.

"We understand specialists are fully capable of handling the medicine aspects. We establish them as an accredi-ted referral practice, which will mean they meet consistent standards so that the quality of service and delivery of care will be there," he says.

How practices respond remains to be seen. "It will be interesting to see if people get on board. It will take time on AAHA's part to show the benefit to the referral practice owner," says Bonnie Lefbom, DVM, Dipl. ACVIM cardiology at the Regional Veterinary Referral Center in Springfield, Va.

With few universally accepted standards of care for veterinary medicine, the creation of an accreditation plan that seeks to improve care could prove very difficult, says Gary Block, DVM, Dipl. ACVIM, delegate for the American Veterinary Medical Association (AVMA) and owner of Ocean State Veterinary Specialists in Rhode Island.

"That said, anything (or any organization) that attempts to identify and recognize systems and processes that might help create a foundation upon which to build, and provides benchmarks for practices to strive for, cannot be anything but a plus for our profession as a whole," Block says.

Necessity debate

Until the program's full scope is known, there is uncertainty over its need in the profession.

"Anything we can do to elevate the quality of medicine in this practice is a good thing. From that viewpoint, I'm not unhappy," says Howard Rubin, CEO of BrightHeart Veterinary Centers, a nationwide network of advanced-care referral hospitals.

"I think the issue is that I don't know the details of the standards. There can be some healthy debate about what can be the standard and delivery of care. I'm not sure they are going to be needed, but without seeing the details it is hard for me to judge," he says.

Wanting to first review the standards in their entirety before making an assessment, Michael Pavletic, DVM, Dipl. ACVS, says, "it might be a good idea." But he remains skeptical.

"AAHA already accredits hospitals," says Pavletic, director of surgery at Angell Animal Memorial Center in Boston. "I'm sure most specialty practices are looking forward to seeing what the proposal is."

With many successful models available for delivering effective care in a specialty, meeting the standards may not be a main consideration when general practitioners are guiding their clients to referral practices, Block says.

"The historical and cultivated relationship generalists have with specialists, combined with geographic proximity of the specialty hospital, will always be the most important factors in where generalists decide to refer their patients," Block says.

And while the standards may improve interaction and communication with clients, how it will truly impact the level of care administered remains unclear.

"While system and process evaluation may improve the client experience and perhaps even the bottom line, I am not convinced that the AAHA accreditation process will necessarily affect quality of patient care," Block says. "In fact, AAHA states in its own literature that 'accreditation is not a guarantee of the appropriate level of patient care.'"

They could be helpful if utilized as a kind of basic quality-control practice evaluation, he says. Evaluation costs ranging between $1,000 and $3,000 fall far below what most practice consultants currently charge for specialty- practice services.

"This might be particularly useful for brand-new practices that want to have a baseline for how their practice is functioning," Block says.

Deemed much different from those applied during general accreditation, Carpenter further defends the importance of the standards.

"These standards were designed by the specialists initially with the realization that they already know how to manage the medical care within a discipline," he says. "They incorporate all the things that would help their team and the whole hospital. We are accrediting the whole hospital, the overall function, care and delivery of service by the hospital, not just the specialist."

Weighing the impact

Debate over the benefits and drawbacks of the accreditation label exists, even before the release of the standards, and how the profession will choose to settle among the arguments remains to be seen.

"There are no drawbacks," says Ned Kuehn, DVM, Dipl. ACVIM and owner of Michigan Veterinary Specialists. "I think it is a good learning experience for the hospital employees to go through the entire accreditation policy. The program allows you to evaluate or re-evaluate what you are doing within the hospital. It pushes you to be at a higher level of overall management."

The standards aim to reflect the thoughts and input of specialists, set a par for consistency in health care and act as another means to identify top-notch clinics.

"We feel this will be more functional for the specialty referral practice. If I'm a primary-care hospital, I now know I will be able to have a better idea of the way a referral hospital delivers their care," Carpenter says. "As more and more referral hospitals arise, everyone wants to be able to differentiate the hospitals that do it well."

Yet while the push to improve overall care will benefit patients, whether owners will become aware of the accreditation and what it means remains uncertain.

"There are so few ways to measure one hospital from the next from a client's perspective. Having AAHA certification gives them a level of comfort that there is some standard met," Lefbom says.

But others aren't as confident in believing pet owners understand accreditation and correlate its presence with better care.

"There is not a lot of awareness on the part of pet owners. What it really becomes is something the veterinary community knows and other veterinarians know, and so that may help in maintaining the kind of medicine that you practice," says Rubin, voicing an opinion also supported by Block.

"The public, for the most part, does not understand or appreciate the significance of AAHA accreditation for small-animal general practices, and until a more effective public-education campaign is undertaken, the same will likely be true for specialty-practice accreditation," Block says.

Even with the questions and mixed reviews, many specialists say they are open to the accreditation standards.

"I think we'll certainly study them and hope that we are already meeting the standards. There may be some things we can learn, so we wouldn't be opposed to them," Rubin says.

Planning to seek accreditation for his clinic, Kuehn expects others to follow suit. "I would think other hospitals would embrace this, particularly those already associated with AAHA."

"If nothing else," Block contends, "AAHA accreditation can be a source of considerable pride for the doctors and employees at the hospital."