JCAHO's voluntary program aims to offer an independent, comprehensive evaluation of companies' abilities to provide competent staffing services. Four groups of standards—leadership, human resources management, performance management and improvement, and information management—address such topics as credentials verification, competency assessment, staff placement, and monitoring staff and service performance.

The Joint Commission invited—and acted on—input from many staffing companies and others in the healthcare industry during the development of its standards, forming an Advisory Council and a Health Care Staffing Task Force to offer feedback and guidance. Less discussion, however, occurred on the pricing model. A draft, provided to committee members in September for review, received push back from some of the larger per diem companies and smaller agencies. As before, JCAHO listened to concerns, revised the language, and republished fees with the announcement of the program's launch. The October 15 Staffing Industry Report notes that industry input was effective in reducing final pricing from that found in draft stages. However, the existing fee structure—and the program's annual renewal schedule—remain points of contention for many staffing firms.

Dissecting the fees According to JCAHO's pricing summary, a travel company with one office that provides placement in three or fewer states will pay a $5,000 base fee for a one-day minimum on-site review. A single site firm placing professionals in more than three states will be charged a $10,000 base fee for two days of review (minimum). And a corporate location with multiple offices will pay a $10,000 base fee for scheduled review plus $5,000 per day for unannounced review of a quarter of its total sites. Additional review days, at $5,000 each, may be necessary if a firm places different disciplines, has clients in a number of states, or has more than 30 office staff at its site location. With the Joint Commission's program, franchises are eligible for review under Option 1 or 2 only, while corporate systems, which fall under Option 3, can elect to pursue certification for each of their sites under Option 1.

David Savitsky, chief executive officer of ATC Healthcare, a publicly traded staffing company with 52 offices in 23 states, notes that most travel companies will fall under Option 2 of the three-tiered system. "Large agencies with one office, servicing all 50 states, would probably need an additional week of review at their locations, which translates into a $10,000 base fee plus $5,000 per extra day, or an estimated $35,000 annually. In my company's case, the pricing structure calls for a base rate of $10,000 plus the cost to review a quarter of the offices (13) at $5,000 per day, or an anticipated $75,000 per year. As the number of sites increase, so do the costs. An agency with 140 offices, for example, could expect to pay $185,000 annually."

This type of variation in costs between companies is only one aspect of the pricing structure that has insiders talking. Citing turnover in the industry as the reason to adopt an annual review process, the Joint Commission has created additional disparities between its current and prospective clients. For many, the funds needed to certify healthcare staffing services firms seem daunting when compared to JCAHO's accreditation fees for full service, critical access, small, or psych and rehab hospitals over a three-year period. Mr. Savitsky explains, "The Joint Commission's website reports an average cost of $23,000 triennially for a full-service hospital, with accreditation fees for the other types of institutions hovering just over a quarter of that amount, at $5,950. During the same time period, the smallest of staffing firms would pay $15,000 (virtually 21/4 times the fee small hospitals would be charged) while larger companies could expect costs to be at least $7,000 more than those for full-service facilities, ranging from $30,000 to over $500,000, depending on the number of offices."