CMS Scales Back Quality Standards

Baltimore

CMS whittled more than 100 pages of proposed requirements down to 14 in its final version of Medicare supplier quality standards released last month.

“We’re under considerable shock,” said Accreditation Commission for Health Care President Tom Cesar. He noted that a staff member in his office, puzzled by the brevity of the final version, asked, “Is that all there is?”

All DMEPOS suppliers will have to meet the quality standards to become accredited, which will be required first for those in the 10 yet-to-be-named cities where DME competitive bidding will begin in 2007. The requirement will eventually expand to include all Part B suppliers.

After the proposed standards draft was released last year, CMS said it received more than 5,600 comments, including many complaints that the standards were too prescriptive. Based on those comments, the agency said, “we have made significant revisions to reduce [the] burden on small suppliers and ensure quality services for Medicare beneficiaries.”

In one of the most drastic cutbacks to the final document, the agency cut the number of product-specific standards that had been proposed in its draft from 15 to three. Initially covering stringent requirements in areas ranging from beds and support surfaces to diabetic supplies and commodes, the final document includes product-specific standards only for respiratory equipment, wheelchairs and custom-fabricated orthotics and prosthetics.

In the final document, CMS said it clarified requirements for performance management to allow suppliers flexibility in determining indicators related to their products and services.

For example, a proposed requirement for a provider to be open for 40 hours a week was replaced with a requirement to maintain posted business hours, and a requirement for a toll-free number to assist beneficiaries was eliminated.

Although providers still will have to implement financial management practices that ensure accurate accounting, they won’t have to bring in an independent party to conduct financial audits.

Reaction from industry experts was mixed.

“By issuing the 14-page document, CMS did listen to the industry and accreditors who took issue with the initial draft,” said Bob Floro, senior associate director, home care accreditation, for the Joint Commission on Accreditation of Healthcare Organizations. “This will really have a positive impact on the industry.”

However, others say that CMS oversimplified the standards.

ACHC’s Cesar said that while the first draft was “overkill,” there’s “not enough meat” in the final version. “They’ve gone from something extreme to mediocrity,” he said. “What they have released in our minds does not meet the intent of traditional health care accreditation. If the intent was to raise the bar, to upgrade quality and professionalize the industry, those 14 pages aren’t going to do that.”

Accreditation consultant Mary Ellen Conway, president of Capital Healthcare Group, Bethesda, Md., said there are a number of gaps in the scaled-down standards. “The standards are a lot less prescriptive and severe than in the proposed guidance,” she said. “But they leave so much open for interpretation; we need more clarification.”

According to Conway, there are also important elements missing from the final version. Some parts of the draft section on human resource management, which specified criminal background checks and health screenings for workers, were left out. Safety precautions and infection control are other significant areas that aren’t addressed.

CMS’ next step is to name accrediting bodies to apply the quality standards.