The system of operating and managing hospitals used in the U.S. will soon make its way to China, thanks to Nashville's Frist family. An initial agreement for the joint venture will see China Healthcare Corp. based in Nashville, while a new hospital will be constructed in, Ningbo, a city near Shanghai.

If you manage a medical tourism organization and are looking to emphasize the legitimacy of your services to prospective patients, you can soon submit your application to the Medical Tourism Association and in return you could get a nifty gold seal of accreditation to put on your company's Web site.

As I noted in last week's column, a prepared statement from the Medical Tourism Association says this new accreditation program will focus only on "medical tourism" and is not intended to accredit quality or replace any accreditation system; instead it complements existing accreditation systems that an organization might currently have in place.

Some in the industry have complained to me over the past couple of weeks that the term "accreditation" carries such a powerful connotation of quality healthcare delivery that they object to any lesser form of accreditation. Regardless, it appears that the bar for being an accrediting body really isn't that high. I checked with some lawyer friends of mine, and they are not aware of any laws that restrict an association from saying it is an accreditation agency, as long as those claims are truthful and don't violate state consumer protection statutes.

I wrote last week that I felt the Medical Tourism Association's announcement of the accreditation program—with a press release, a Web page explaining the benefits of accreditation, and the aforementioned gold-seal logo—was premature because it offered so few specifics about its accreditation standards. I don't see a whole lot of value in calling an external review of non-quality-related processes and procedures an "accreditation program."

If you want, call it a certification, designation, or seal-of-approval—just not accreditation.

Anyway, a couple of nice folks from the Medical Tourism Association disagree with me. In fact, Chief Operating Officer Renee-Marie Stephano took me to task for raising the matter at all. She says the association's accreditation standards, which she expects will be available online in a week or two, will clear up any confusion I might have. She was kind enough to answer some of my questions about this new program. Here are the highlights of that conversation:

Johnson: If there's anything you think I got wrong in my column last week, this is your opportunity to correct me.

Stephano: I think the whole thing is a little bit misleading, like nobody knows what's going on, and we're not qualified to be accrediting on quality. We're not accrediting quality. We're working with establishing standards and best practices for medical tourism companies, for hotels, for clinics, and hospitals specifically in the area of international patient services, which is facilitation services primarily, which is communication services, which is informed consent forms. It is procedural and not involved at all with infection rates and quality indicators or anything that really JCI or any other accreditation system is doing.

Johnson: You say that you're accrediting medical tourism companies, but what specific types of organizations are you going to accredit?

Stephano: We will provide accreditation for hospitals' international patient departments. For hotels, do they have appropriate after-care facilities? If they are marketing themselves as a venue for patients to recover in, do they have a sterile environment? Do they have access to nursing care? Have they created special dietary menus for certain types of patients? This is something that can affect an overall patient experience. It's great to go to a JCI-accredited hospital in say Costa Rica, but then where are you recovering? If you're recovering at a recovery resort that doesn't have the appropriate environment for you that's where the adverse result is going to occur. Does the facilitator follow up with the patient a couple months afterwards? All of these things are questions that are out there right now, and many of these are questions patients don't even know to ask, but they will be able to identify what our system is and what those services are and the organizations that are accredited through it. And I think that will definitely provide a value added to international accreditation agencies like JCI that are looking at hospitals.

Johnson: Your Web site's accreditation page says that putting the right processes and procedures in place can reduce the likelihood of errors and problems happening with foreign patients and increases the chance of positive outcomes. Aren't those things related to quality?

Stephano: No, it is not related to quality. One thing that you'll learn if you talk to many of the hospitals and facilitators, and I receive patient inquiries or patient reports or patient stories or patient complaints all the time, and I would venture to say that 95% of the negative outcomes are a result of a lack of processes. For instance, the failure of communication between the hospital's international patient department and the patient, or the failure of communication between the facilitator and the patient, or not putting into place or encouraging a dialog between the international [physician] and the national [physician]. All these things are not related to quality. They are processes and procedures and standards that you can use that will really improve the patient outcome.

Johnson: Can you describe how the accreditation process is going to work for these medical tourism companies?

Stephano: It's an application. Obviously there's an interview. There's due diligence. There are surveyors; we call them surveyors, but they really are not surveyors. They are people who evaluate, if there's a site visit that we feel is required. There's an evaluation of the Web site. It's initially an application process, where [medical tourism companies] provide a tremendous amount of information. As it is now, the facilitators provide the MTA with a lot of information on their applications, and we do due diligence on the members. . . . We have to know a lot about their protocols. And so we're already doing some of this, but we're [going to do] it to a higher level, particularly in this area of after care and communication, because even on my monthly teleconferences with the medical tourism companies you see that some of that communication is lacking, and it needs to be emphasized. If we need to require it through accreditation, I think then it's going to become a standard that's going to be ultimately beneficial to the patient.

Johnson: Are the site visits recommended or required for everyone?

Stephano: I think it will be on a case-by-case basis.

Johnson: What will determine when a site visit is required?

Stephano: If there is some concern. For instance, I think all but one of our members I have personally seen and personally talked to. So, just from our membership perspective it's going to be [that] if we've seen them before and we've been to the hospital before or the clinic before [a site visit] wouldn't be required, but if you take a cosmetic clinic that we've never seen before that . . . you just can't judge from a doctor's CV then maybe it would require a site visit. It would be up to the evaluator to determine whether they feel a site visit is required.

Johnson: And your Web site says the accreditation review is conducted by health leaders, but who specifically is going to do the reviews?

Stephano: I'm not going to give you the names of the surveyors, because we have two now that we're working with, and we're adding them on as we move forward with it.

Johnson: Is there a reason why you won't say who they are?

Stephano: Well, because they are not under contract yet, so I don't want to say for sure that those are going to be the people. There are two people we're talking to that we think have an extensive amount of experience that we think would be qualified to do it, and until they are under contract I wouldn't be comfortable releasing their names.

Johnson: What happens if a medical tourism company applies for accreditation but doesn't meet your standards?

Stephano: We will work with them to help them develop what they need to develop to achieve accreditation.

Johnson: Will these organizations need to recertify?

Stephano: Yes, annually. And this is particularly important for medical tourism companies, because as their patient numbers increase or decrease their practices can change . . . so I think it's important that we do a recertification each year.

Johnson: Who actually came up with your accreditation standards?

Stephano: We've been developing this through the course of the year. Primarily we have monthly teleconferences with the medical tourism companies. I speak with member hospitals through their international patient departments. We've put this together through the membership. It's something that we've been culminating over the last year.

Johnson: As you put together the standards, do you have people reviewing them for you?

Stephano: Well, we've put them together, and we have a huge number of physicians who have given us input on this, and I've asked a number of specialists in different areas to give their input. I'd say there's a total of four or five people who have helped to write it, but it's really been written and reviewed by everybody that's participated in it.

Johnson: Do you have a list of the committee members who created and reviewed your accreditation standards?

Stephano: I can't say that because everybody has given their input at some point in time. Really it stems from the membership, and all the members have provided input at some time, I would think. I have telephone conversations every day in this area, and I gather the data; I receive e-mails all the time from members in certain areas with problems, and from that stems another standard that ought to be put in place. So we're not really looking at it from, here's a committee that sat down and drafted everything. . . . We have several committees throughout our organization, and this accreditation was never a committee. It's just been a culmination of data through the course of a year. It's never been a specifically structured entity or group of people.

Johnson: Your press release states that this program complements existing accreditation systems. Will MTA's accreditation program require prior accreditation?

Stephano: No.

Johnson: Do you think that from the standpoint of a patient or the press there could be some confusion about what this accreditation means?

Stephano: No, I think it's going to be pretty clear. Right now, our people use the MTA logo because they are a member of the MTA, and it's clear what membership means. When we have the accreditation portion up [on the association's Web site] it will be very clear who is accredited and who is just a member of the MTA. We've never required members of MTA to have any accreditation. We can have hospitals without accreditation, and we have a number of clinics that would never be a fit for JCI. So this gives them the opportunity for patients to say this is what MTA accreditation means, because this is what it says it means, and here's the list of the MTA accredited members, and here's another list that's just the other members of the MTA. It will be very clear. We're not very concerned about that at all.

Johnson: Until we had this conversation, I don't think the press release and the way your Web site explains your accreditation program clearly laid out what this program is about or even what exactly it is that you're accrediting . . .

Stephano: Well, I don't think until we actually start doing accrediting [that] we're required to have our entire accreditation system spelled out. Once we start accrediting, it's absolutely necessary, but at this point our launching of the program is something that we felt was important to announce and to generate an interest in. And the Web site with the exact specifications and description of what accreditation means will be up before we do any actual accreditation.

Johnson: Was there any concern that the press release and the Web site as it stands might cause confusion?

Stephano: No.

So, readers, those are the Medical Tourism Association's thoughts on the matter. As a healthcare writer and editor, word choice matters a lot to me. From my outsider's perspective this discussion is really about what should and should not be called "accreditation."

You tell me.