Strength in Compliance

Meeting CMS quality standards are the baseline requirement of accreditation services for the HME/DME market. Beyond the basics, accreditation services vary with a range of approaches and value-added features. Accreditors can improve an HME business, and they can help a business owner understand his or her business better. The process of accreditation can guide employees to excellence and can empower business owners to compete more effectively.

“Providers who see accreditation as a way to utilize best business practices are the providers who will withstand competitive bidding—they are the strong providers,” says founder and President Sandra C. Canally of The Compliance Team.

“Customers that embrace accreditation standards are engaged constantly in looking for ways to make improvements in their business,” adds Mary Nicholas, president/CEO of Healthcare Quality Association on Accreditation (HQAA). “I understand that accreditation can be the bad medicine, but with a spoonful of sugar it can create a culture where everybody is on the lookout to make improvements, cut expenses, to know when something is awry and to have a process in place to address it. The majority of customers who have embraced accreditation have found ways to go beyond the requirements.

“All the accreditation organizations have a responsibility to Medicare, so we are on an equal footing there,” she continues. “Beyond that, what other value does a provider want from their accreditor? If you create energy and synergy within the organization, it’s like a snowball and gets bigger and better.”

About the Experience

Beyond CMS requirements, accreditation helps companies adhere to standards that will improve management of their business, agrees Tim Safley, director of DMEPOS, pharmacy and sleep at the Accreditation Commission for Health Care, Inc. (ACHC). Also, some private payers only approve a handful of accreditors, compared to the 10 accepted by Medicare, so providers should choose carefully to make sure their accreditation is accepted by their various private and governmental payers.

Founded in 1986, ACHC is one of the oldest accreditation suppliers and started well before CMS began requiring accreditation. The national, independent, not-for-profit organization was developed by home care and alternate-site health care providers. ACHC is accredited by ISO 9000 quality standards. “We hold our company and ourselves to a certain level,” Safley says.

“Each accreditor offers various systems and processes. Some only require what CMS requires, but others take a look at the whole gamut of ideas and requirements to make the business better. The issue isn’t who’s the cheapest, but what can accreditation bring to a provider that they don’t already have?” ACHC has accredited more than 13,000 locations, including sleep labs, pharmacies, infusion programs, behavioral health programs and home health agencies, as well as DMEs.

When selecting an accreditation service provider, Safley says an HME/DME should choose a company that is accepted by all its payers and that helps them understand the standards and requirements. ACHC provides workshops and workbooks to aid understanding of accreditation requirements. The ACHC website also provides education, both about accreditation and about the various regulations in different geographic areas, to keep HME/DMEs informed of changes that might affect their day-to-day-operations. “If the law changes, we feel we need to keep companies informed as their accreditor,” Safley says. ACHC uses proprietary standards that incorporate CMS quality standards as well as private payer standards and state-specific requirements.

“It’s not all about the stringency, it’s about how the accreditation company works with the DME. It’s all about the experience. Rather than seeking the easiest pathway to accreditation, HME/DMEs should use accreditation as an opportunity to improve their business.”
“People see the value we bring to make a company better,” he says. “They should embrace it, not shy away from it. I heard someone describe accreditation as a necessary evil. If you think that, you may not have picked the right accreditor.”

Expert Assistance

The Board of Certification/Accreditation (BOC) offers an accreditation program that provides a step-by-step system with expert guidance and assistance to help facilities earn accreditation in all DMEPOS product categories, according to Wendy Miller, BOC’s director of facility accreditation.

BOC walks facilities through the entire process for an all-inclusive three-year price. Because of its emphasis on customer service, BOC recently received a Stevie Award for Sales and Customer Service. It has also created the Accreditation Survival Guide, which includes a series of videos, the most up-to-date BOC Accreditation Standards Guide and site survey checklists (available at bocusa.org/survivalguide).

“BOC’s site surveyors are acknowledged industry experts who genuinely want to see facilities earn their accreditation,” says Miller. In 2013, BOC introduced a certification for DME professionals, the Certified DME Specialist (CDME), which recognizes experience in the industry and provides an additional assurance of compliance.

HME/DME facilities need assistance understanding and following the standards that apply to them, based on the services and products they provide. They should expect excellent customer service and responsiveness from application to determination, according to Miller. “The site survey process shouldn’t be burdensome because an accrediting organization should provide facilities with the tools they need to be successful, and they shouldn’t have to wait more than 90 days to find out whether or not they have become accredited.”

A new development is that chiropractors who sell DME products must become accredited by June 1, 2013, Miller says. BOC is working with chiropractors to become accredited by the deadline. In addition to ongoing issues of competitive bidding, facilities must reevaluate their compliance to recent modifications to HIPAA.

Issues of DMEPOS accreditation extend beyond the requirements of CMS; many third-party payers also require accreditation. Accreditation demonstrates compliance with federal and state regulations that ensure safe practice environments, which is why CMS requires site surveys to be unannounced as an additional assurance. Once a facility has become accredited, their accreditation is valid for three years, as long as they remain compliant.

“We often receive calls from facilities who are concerned they will not become accredited because of deficiencies found during their site survey,” Miller explains. “Our goal is to help facilities become accredited, and a deficiency during the site survey doesn’t mean they won’t be accredited. Our job is to help facilities make the required corrections to have a successful accreditation.”

Fast Response

Healthcare Quality Association on Accreditation (HQAA) offers an electronics-based system to manage the accreditation process. All accreditation documents—including standards, checklists, audit tools and resources—are maintained in a “workroom” on the HQAA website, and an accreditation coach works with the provider to prepare for the accreditation. Each document is reviewed as it comes in, and the coach is notified to confirm within 24 hours whether the document meets the intent of the standard. Access to the website anytime enables managers to prepare for accreditation after hours. After the workroom information is compiled, a surveyor arrives onsite unannounced to validate that practices reflect the paperwork. HQAA has 25 full-time staff members, and accreditation surveyors are independent contractors.

Nicholas says HQAA responds quickly to customer inquiries and offers a variety of feedback mechanisms. Customers can instant-message their coaches or fax documents, for instance. “We partner with our customers throughout the three-year period,” Nicholas says. “The ongoing partnership simplifies the reaccreditation process. Define what value you want for what you are paying. There is a variety of value out there.”

Operations-Based Approach

The Compliance Team provides Exemplary Provider-branded accreditation services to thousands of providers nationwide, including some customer companies that have used the service for 10 years. Founded in 1994, it was the first certified woman-owned health care accreditation organization to hold deeming authority from CMS. Founder and President Sandra C. Canally is the principal architect and author of all nine Exemplary Provider accreditation programs.

Canally says The Compliance Team’s simplified approach to accreditation focuses on what matters most to the patient—safety, honesty and caring. The company provides its standards free to the public to enable HME/DMEs to shop around for standards appropriate to their business. The Compliance Team’s standards are written based on company operations. “Anyone in an organization can pick up our standards, look at their role listed there and very easily and quickly see what they need to do to comply.”

The standards are also written in plain language, so there is no need to hire a consultant to interpret them, which can add cost. Accreditation goes hand-in-hand with a provider’s daily operation, should be easy to incorporate and should not be seen as a separate function from business operations. Canally says accreditation should not emphasize “minutiae” or be overly burdensome, but should be about what matters most, the patient. “Simplification doesn’t mean less comprehensive but written in a way that is easy to understand and implement,” she says.

Exemplary Provider accreditation requires a 90 percent or better score. The Compliance Team created product-line specific standards covering various specialties in 1998. When CMS began deeming accrediting supplier companies, they performed a “crosswalk” between CMS quality requirements to existing standards, including The Compliance Team standards, ensuring that standards addressed CMS quality concerns.

Canally attributes her company’s focus on patient care to her background as a registered nurse. “We concentrate on what matters most to patients.” As a for-profit, privately owned business, The Compliance Team shares the same entrepreneurial mindset as its customers, Canally says. “We’re lean, mean and we can turn on a dime.”

The Compliance Team also provides electronic benchmark data to track patient satisfaction, which enables a provider to see how they perform and compare with other providers. The information can provide a marketing benefit when shared with referral sources.

In the changing competitive bid environment, Canally says providers should be especially attentive to issues of licensure, for example, if a company in Texas begins shipping to Oklahoma or New Mexico. Licenses are needed in any state where a provider does business. Also, if expanding into orthotics and prosthetics (O&P), state requirements vary on the need for a certified fitter. Accreditors provide CMS with a report of categories for which a provider is accredited, which is tied directly to billing. Providers should discuss any business category or geographic expansions with their accreditor to ensure all the requirements are in place.

Adapting to Change

Community Health Accreditation Program (CHAP) has provided accreditation for a variety of health-related providers since 1965, and medical equipment providers (DME) make up about a third of their customer base. Others include nine kinds of services, from home health care (the largest) to hospital, pharmacy and infusion therapy. CHAP implements the same philosophy of accreditation across multiple related fields, including some referral sources for DMEs.

“In choosing an accreditor, you want someone who can speak on a collegial basis who has an understanding of what your accreditation needs are,” according to Gwen M. Franzgrote, director of education. CHAP offers a self-study tool to help providers prepare for accreditation, and a regional director serves as a contact person to discuss the standards, how they apply and how providers can adapt them.

CHAP also provides resources including webinars to educate providers on processes they should have in place before accreditation. “The biggest value of CHAP is that when they ask a question, they will get a timely answer,” Franzgrote says. CHAP provides personalized, direct resources to help HMEs understand their standards and to support them throughout the accreditation process.

“Customers often say that going through the accreditation process helped them understand their business better and enabled them to put in place a framework of checks and balances to stay on top of what’s happening and keep their people compliant,” she says. “It’s one of the greatest compliments we receive.”

CHAP accreditation standards are in four sections: structure and function, quality and performance, resources and long-term viability. The accreditation process looks both inward to provider operations and outward to factors impacting customers. The long-term viability aspect of accreditation helps providers look to the future and position themselves with a strategic plan. “That’s where the CHAP standards go above and beyond,” Franzgrote explains. “We want to be there for the customer for the long run.”

A challenge for accrediting organizations is to provide “on-demand” resources to help organizations respond to changes in the market, such as new practice models in the Patient Protection and Affordable Care Act. “How do we help our customers know that their CHAP requirements will help them when those changes come?” Franzgrote says. “In our strategic planning we are looking to adapt our model to be more receptive and responsive to changes.” Accreditation is a tool to ensure quality measures are in place and are being reported. Accrediting organizations—and the market as a whole—will have to adapt as the climate changes.

Visit Virtually

Accreditation Commission for Health Care, Inc. (ACHC)
www.achc.org

Board of Certification/Accreditation (BOC)
www.bocusa.org

Community Health Accreditation Program (CHAP)
www.chapinc.org

The Compliance Team
www.thecomplianceteam.org

Healthcare Quality Association on Accreditation (HQAA)
www.hqaa.org