Setup for a Comeback

In his wonderfully warm and witty book Battling the Beast Within — Success in Living with Adversity, (The Cleveland Clinic Press), David T. Williams offers sage advice to all of us who will be providing durable medical equipment services under the Medicare Modernization Act (MMA).

Williams, who recently retired as director of governmental relations for Elyria, Ohio-based Invacare, chronicles his personal story in dealing with the physical changes he has faced secondary to multiple sclerosis. Among the many important life messages he presents in the book, two of his personal lessons will be essential for professionals in DME to heed in the coming years as our industry undergoes dramatic changes.

From his experience with MS, Williams said, he discovered that “a setback is a setup for a comeback.”

For professionals providing honest and ethical service to those who truly need power mobility, the headlines of the past year revealing blatant fraud and abuse by a very small, but now very visible, segment of our industry have been viewed as a setback in our quest to project DME service provision as a profession.

However, this setback is shaping up to be the comeback we need.

The Centers for Medicare and Medicaid Services has recognized that part of the problem in the power mobility market has been the very poorly differentiated K0011 code, a code that describes almost all products on the market, regardless of actual performance or price. The agency directed the head of the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC), Dr. Doran Edwards, to propose a redraft of the power wheelchair coding system.

Edwards collaborated closely with industry experts, including members of the National Coalition for Assistive and Rehab Technology (NCART) and the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) to draft the new codes, which, released in early February, more closely reflect and describe the broad spectrum of power products currently on the market, including pediatric products.

SECTION 302

Williams’ second message describes three phases of the course of his disease:

1. “What is it?”
2. “You can’t do that.”
3. “Let’s try this.”

How do these questions and reactions apply to the MMA? Within the specific MMA legislation passed by Congress, there is Section 302. Your first question may be, “What is it?” It is the language that directs CMS to establish and implement quality standards for suppliers and services, including DME and prosthetics and orthotics. Suppliers will be required to comply with these standards to receive or retain a provider number and to be paid for services rendered.

Your reaction may be, “They can’t do that.” Well, they did, so “let’s try this.”

Let’s learn some vocabulary so we can understand what CMS may propose. With some understanding today, hopefully you can be proactive in addressing these quality standards and not find yourself in a completely reactive mode when the new standards are disclosed.

The following information was written in 1995 by Joan E. Knapp, Ph.D., CEO of Knapp & Associates International, for the Association Educator’s Toolkit 1995, American Society of Association Executives. Knapp works with associations and credentialing agencies on certification programs, and was RESNA’s consultant in developing the Assistive Technology Supplier/Practitioner (ATS/ATP) credential.

What is credentialing? The purpose of credentialing programs is to elevate the credibility and professionalism of the members of the associations developing and promulgating the standards and to elevate the quality of products and services delivered by certified individuals.

Licensure — The process by which an agency of the government grants permission to persons to engage in a given profession or occupation by certifying that those licensed have attained the minimal degree of competency necessary to ensure the public health, safety and welfare.

Accreditation — The process whereby an association or agency grants public recognition to a school, institute, college, university or specialized program of study having met certain established qualifications of standards as determined through initial and periodic evaluations.

Certification — A voluntary process by which a non-governmental agency or association grants recognition to an individual who has met certain predetermined qualifications specified by an agency or association. Such qualifications may include graduation from an accredited or approved training program, acceptable performance on a qualifying examination and/or completion of some specific amount or type of work experience.

Standardization — The process by which a product or service is assessed against standards or specifications (such as the Underwriters Laboratory UL seal of approval).

Certification and licensure are for individuals. Accreditation is meant for programs or organizations. Standardization is directed toward products or processes.

Why certify?

1. To identify qualified individuals
2. To ensure recognition of expertise
3. To enhance credibility and prestige
4. To provide a vehicle for professional development
5. To establish professional practice standards
6. To protect the public
7. To increase influence on society

Why accredit?

1. To recognize program performance and outcomes, thus motivating programs to comply with standards
2. To increase confidence in education and training programs
3. To provide a minimum set of curriculum requirements
4. To help define the content of the profession and scope of practice
5. To increase the credibility of the profession
6. To ensure consistency of training outcomes

In reviewing Knapp’s definitions and list of reasons why to certify or accredit, we as professionals need to acknowledge the complete lack of required quality standards in our industry. To truly gain recognition as professional service providers, we need to work together to identify/establish pertinent quality standards, and to encourage, not resist, the implementation of these standards.

CMS is working to identify currently available accreditation or certifying programs, as well as to identify new standards that will enhance the quality of goods and services received by Medicare beneficiaries.

LET’S TRY THIS

What can you do? Let’s try this. Try learning about accreditation and accreditation programs for companies providing DME or rehabilitative services.

Following is a limited list of independent accrediting programs that can furnish further information: ACHC, Accreditation Commission for Health Care, www.achc.org; CHAP, Community Health Accreditation Program, www.chapinc.org; and JCAHO, Joint Commission on Accreditation of Healthcare Organizations, www.jcaho.com.

For information regarding credentialing for an individual provider, check out the RESNA Web site at www.resna.org. RESNA and NRRTS (www.nrrts.org) are complementary organizations. A NRRTS member in good standing who successfully qualifies for and completes the RESNA ATS examination earns the credential CRTS, Certified Rehab Technology Supplier.

In addition to mandating the establishment and implementation of quality standards, Section 302 of the MMA instructs CMS to develop a Competitive Acquisition Program for certain DMEPOS products. The law provides the following timeline: A competitive acquisition program will be in place in 10 of the top metropolitan statistical areas (MSAs) by 2007 and in 80 MSAs in 2009. As we move further into 2005, 2007 is not that far off.

CMS has named and is currently meeting with its Program Advisory and Oversight Committee, which is advising the agency on the development of this new competitive bidding program.

Very few details of how the program will be structured or implemented have been shared with either the committee or the public at large. But the theme highlighting each of the committee’s first two meetings has been its complete support for CMS to develop the quality standards, and to begin implementation of those standards as soon as possible.

Over the next four to five years, the only constant we can count on is change. How we react to and embrace this change will forge the future direction of our industry. While we may not have much control over the types of changes our industry will experience, we do have control over our reaction to that change.

Start now to become proactive in learning about quality standards, and begin the process of self-improvement, both as an individual provider and as a company.

A member of the Program Advisory and Oversight Committee, Jean L. Minkel is an independent consultant in the field of assistive technology. Her company, Minkel Consulting, is located in New Windsor, N.Y. She may be reached at 845/496-5022 or by e-mail at [email protected].