Accreditation in healthcare is a formal evaluation process where an independent organization reviews a hospital, clinic, or health program against a set of quality and safety standards. It signals that a facility has met established benchmarks for how it delivers care, manages patient safety, and maintains its operations. For most hospitals in the United States, accreditation also determines whether they can receive Medicare and Medicaid reimbursement, making it both a quality marker and a financial necessity.
How Accreditation Works
The process follows a cycle that typically spans three to four years. It begins when a healthcare facility applies to an accrediting organization, submitting detailed information about its management structure, patient demographics, and the types and volume of services it provides. That data shapes what comes next: the accrediting body uses it to determine how many days the on-site survey will take, which reviewers to send, and which services to evaluate.
Before surveyors arrive, the facility conducts a self-assessment. Using tools like scoring checklists, staff evaluate their own compliance with applicable standards and develop plans to address any gaps. This internal review is a core part of the cycle, not just preparation for the main event.
The main event is the on-site survey, where trained surveyors visit the facility and measure compliance with accreditation standards as well as relevant federal safety requirements. Most surveys from the Joint Commission, the largest accrediting body in the U.S., are unannounced. Organizations can expect a surprise visit between 30 and 36 months after their previous full survey. Staff typically receive no advance notice, though exceptions exist for facilities where surveyors need security clearance or where size and caseload make coordination necessary.
After the survey, the facility receives its findings and must address any areas of noncompliance. Between survey cycles, accredited organizations continue self-monitoring through what the Joint Commission calls “intracycle monitoring,” an ongoing process designed to keep performance consistent rather than letting standards slip between visits.
Accreditation vs. Licensure vs. Certification
These three terms get used interchangeably, but they refer to different things. Licensure is government permission to operate. A state grants a hospital its license to open and treat patients, and it grants individual clinicians (doctors, nurses, therapists) their licenses to practice. Without it, you legally cannot provide care.
Certification applies mostly to individuals. It means a professional has demonstrated specific knowledge or skills, usually by completing coursework and passing an exam administered by a professional organization. Employers sometimes require certification even when it is not legally mandated for licensure.
Accreditation sits in between. It is a formal recognition that an institution or program meets defined quality standards, assessed by an external body. It is technically voluntary, but in practice it is often required for government funding, insurance reimbursement, or recognition by other organizations. A hospital can be licensed by the state yet still lack accreditation, though doing so limits its ability to participate in federal programs.
Why Accreditation Matters for Patients
The most direct financial consequence of accreditation is something called “deemed status.” When a hospital earns accreditation from a recognized organization like the Joint Commission, the Centers for Medicare and Medicaid Services (CMS) treats that accreditation as proof the facility meets federal participation requirements. The hospital does not need a separate government survey to bill Medicare and Medicaid. Facilities without accreditation or deemed status must undergo a separate CMS survey to participate in those programs, and providers with accreditation carry higher credibility when seeking Medicaid reimbursement.
For patients, this creates a practical signal. An accredited facility has been independently evaluated against standards covering everything from infection control to medication management to emergency preparedness. It does not guarantee perfect care, but it means the organization has cleared a baseline that unaccredited facilities have not been verified against.
The evidence on whether accreditation directly improves patient outcomes is mixed. Systematic reviews have found positive effects on organizational culture, clinical leadership, patient safety systems, and care delivery processes. However, the same body of research found insufficient evidence linking accreditation to measurable improvements in health outcomes, patient satisfaction, or economic performance. Accreditation appears to be strongest as a driver of organizational change and professional development rather than a direct lever on clinical results.
Major Accrediting Organizations
Several organizations handle accreditation in the U.S., each with a different focus:
- The Joint Commission (formerly JCAHO) is the largest and most widely recognized. It accredits hospitals, psychiatric facilities, substance abuse programs, ambulatory care centers, and more. Starting January 2026, it is replacing its National Patient Safety Goals with a new framework called National Performance Goals, covering fourteen high-priority topics designed to make tracking and improving patient safety outcomes more straightforward.
- National Committee for Quality Assurance (NCQA) focuses on managed care and health plans. It oversees HEDIS, a widely used set of quality measures for managed care organizations, though HEDIS data collection is not required for NCQA accreditation.
- URAC accredits utilization and quality management systems in managed care, covering programs that serve over 120 million individuals.
- CARF (Commission on Accreditation of Rehabilitation Facilities) specializes in programs serving individuals with disabilities, including alcohol and drug programs, mental health programs, and community-based rehabilitation. It accredits more than 11,000 programs in the U.S. and Canada.
- Council on Accreditation (COA) accredits behavioral health and social service programs, covering more than 50 service types including outpatient mental health, substance abuse treatment, foster care, and services for people with developmental disabilities. Its focus leans toward community-based programs rooted in a social services model rather than a medical one.
The International Landscape
Accreditation is not unique to the United States. The International Society for Quality in Health Care (ISQua), established in 1985, provides internationally recognized principles that accreditation bodies around the world use to develop their own standards. Standards from Australia, Canada, Egypt, England, and the Joint Commission International have all been evaluated against ISQua’s framework. This creates a layer of quality assurance for the accreditors themselves, confirming that the organizations setting standards are doing so at an internationally accepted level.
What Accreditation Costs
An Australian study that tracked the direct costs of accreditation across hospitals of different sizes found that expenses ranged from 0.03% to 0.60% of total hospital operating costs per year, averaged across a four-year accreditation cycle. Large teaching hospitals absorb the cost more easily because they have dedicated accreditation staff and established systems. Smaller rural hospitals face a proportionally heavier burden, spending up to twenty times more as a share of their budget.
The biggest spending spike comes during external survey years, when costs average about 0.4% of operating expenses compared to roughly 0.07% during self-assessment years. Beyond the direct costs of labor and materials, hospital staff consistently report intangible costs: unpaid overtime and elevated stress in the weeks leading up to and during surveys. Some hospitals have reduced this burden by adopting a “survey ready” culture, using technology to minimize paperwork and staying in continuous compliance rather than scrambling before a scheduled review.
These costs are one reason accreditation draws occasional criticism. But for most facilities, the alternative (losing access to Medicare and Medicaid reimbursement or undergoing direct government surveys) carries far greater financial and operational risk.