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.