Accreditors Warn Stream of Late Applications Could Result in Flash Flood

ATLANTA–Accreditors who geared up for a flood of fall
applications from home medical equipment providers are facing the
same old same old, they said last week: a steady, but very slow,
trickle.

That could mean major trouble for some providers later on,
according to accrediting organizations.

“I had predicted and expected that come mid-October, we
would see a serious jump … that would just continue going
up,” said Sandra Canally, president of The Compliance Team,
Spring House, Pa. “And here we are in October and we are
seeing a slow and steady increase, but nowhere near what it needs
to be. Nowhere close.”

Bob Floro, director of the home care program for The Joint
Commission, Oak Brook Terrace, Ill., said his organization is also
seeing a dearth of applications. “I think providers really
demonstrated their propensity for waiting for the last deadline
when we were working on competitive bidding,” he said, noting
that when the competitive bidding deadline for accreditation was in
force, hundreds of providers applied to his organization only two
or three days before the deadline. “My gut reaction is that
they will wait again–even with a Jan. 1 deadline.”

CMS has laid out a calendar of accreditation dates for HME
providers serving Medicare beneficiaries:

–Suppliers enrolled with the National Supplier Clearinghouse
between Jan. 1, 2008, and Feb. 29, 2008, must submit accreditation
documentation to the NSC no later than Jan. 1, 2009;

–Active suppliers that enrolled prior to Jan. 1, 2008, must
submit accreditation documentation to the NSC by Sept. 30, 2009;
and

–As of March 1, 2008, suppliers seeking to enroll with the NSC
and obtain a supplier number to bill Medicare must be accredited
prior to enrollment.

In addition, the agency has advised providers that it cannot
guarantee accreditation for those businesses that apply after Jan.
31, 2009.

The difficulty, accreditors said, is the sheer number of
providers across the country that remain unaccredited–and they
believe that number is huge.

“What is it–20,000, 30,000? We are talking thousands of
providers, and there are only 10 accrediting organizations and only
six of us who do everything,” said Canally.

Mary K. Nicholas, MHA, executive director of Waterloo,
Iowa-based Healthcare Quality Association on Accreditation, also
likened the current climate to that surrounding competitive bidding
deadlines.

“It feels all too familiar to the round one deadlines in
that folks seem to be waiting once again,” she said.
“My fear is that next spring and summer will feel like
we’re all going to be trying to push a watermelon through a
straw surveying the sheer numbers needing to complete their
accreditation process.”

Accreditors offered several reasons why providers might be
waiting: confusion over the multiple deadlines; an expectation that
CMS will delay the Sept. 30, 2009, deadline; a lack of appreciation
for the value of accreditation; or fear of an added expense in the
current chaotic financial climate.

But Canally quashed the idea of a 2009 deadline delay.
“It’s the law,” she said bluntly.
“There’s no wiggle room. It can’t
change.”

The Jan. 31 deadline, she said, is a good guideline. “CMS
was trying to help providers by saying, ‘Get off the fence,
get your application in because it is going to take your company
time to meet these standards before the accreditor walks in the
door unannounced.’”

For those who are considering not getting accredited and bailing
out of Medicare altogether, Floro had a newsflash: “There is
going to be significant pull-through,” he said. “Those
organizations that are going to be dropping [Medicare] are likely
going to find that managed care and other organizations are going
to follow suit and require accreditation.”

Providers also might be banking on the notion that CMS will
exempt them as it has several other provider types, including
physicians, orthotists, prosthetists, pedorthists, occupational
therapists and physical therapists, among a list of “eligible
professionals” the agency announced Sept. 3. (See
HomeCare Monday, Sept. 8.)

But there was a good rationale for those exemptions, said Matt
Hughes, accreditation supervisor for the Accreditation Commission
for Health Care, Raleigh, N.C.

“I believe CMS is spreading out the workload to
accommodate the large number of Part B suppliers,” he said.
“Plus, the current quality standards are not a good fit for
these types of providers. It is possible CMS will modify the
quality standards to eventually include physicians, PTs,
etc.”

Nicholas agreed. “I believe that CMS has been pretty clear
that for now, those specific providers are exempt, but that down
the line, accreditation will become a mandatory reality for them as
well,” she said.

CMS has announced it is already drafting quality standards for
orthotists and prosthetists that should be proposed in 2009. The
other “eligible professionals” will remain exempt
unless CMS drafts quality standards specifically geared to those
groups.

In the end, will there be enough accredited HME providers to
service the ever-increasing number of Medicare beneficiaries?

If Sept. 30, 2009, were today, the answer would likely be no,
these accreditors said.

“Today, I do not believe that there are sufficient numbers
of providers accredited to serve the population,” said
Nicholas, adding that she couldn’t estimate what that number
that would be.

“It is hard to say how many providers will be needed [for
the future],” Hughes said. “Obviously, these coming
years will see a significant growth in the Medicare population
because of the baby boomers, so probably there are not enough
accredited providers to meet the need.”

There also could be a dwindling pool of providers, according to
the accrediting organizations, but not only because some providers
opt out of Medicare.

“My prediction is that the first six months of 2009 may
see record numbers of mergers and acquisitions,” Nicholas
said. “Accredited companies will be looking to acquire
non-accredited companies as those that miss deadlines will be
unable to continue with an often-time large portion of their
current business.”

However it shakes out, those who expect to remain in the
business need to set about the business of becoming accredited,
these accreditors stressed.

“We need folks to come forward and we need them to come
forward now and not wait until January,” said Canally.

While Hughes said ACHC expects a big bump in applications after
the holidays, Canally said she is banking on Medtrade at the end of
this month in Atlanta.

“I am hoping that Medtrade is where it really
peaks,” she said. “Maybe a lot of these folks are
waiting to come to Medtrade, talk to these individual organizations
and walk away with an application to complete and send
in.”

Perhaps, she suggested, accreditors might have to put people
wearing sandwich boards on the Medtrade floor. And what would the
sandwich boards say?

“Accreditation is not baloney,” said Canally.