CMS Scales Back Quality Standards: ‘Is That All There Is?’

BALTIMORE–Last week CMS whittled more than 100 pages of
proposed requirements down to 14 in its final version of Medicare
supplier quality standards.

“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?”

As mandated by the Medicare Modernization Act, all DMEPOS
suppliers will have to meet the quality standards and become
accredited in order to do business with Medicare. Accreditation
will be required first for those in the 10 yet-to-be-named cities
where DME competitive bidding will begin in 2007, then eventually
will expand to include all Part B suppliers.

After the proposed standards draft was released in September
(see HomeCare Monday, Sept. 26, 2005), 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,
issued Aug. 14, 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.

According to CMS, other changes in the final version
include:

• eliminating unnecessary specificity and redundant
  information;
• modifying overly prescriptive requirements to focus on
  providing reliable quality service to beneficiaries; and
• clarifying 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. A requirement for a toll-free number to
assist beneficiaries was eliminated. A section on beneficiary
services now requires that suppliers respond to consumer complaints
in five days; a proposed requirement that oxygen providers respond
to a patient call within an hour has been dropped. And what was a
draft section on information management has dwindled to three lines
on HIPAA compliance.

Under the new standards, providers will have to abide by a
performance management standard that requires measurement of
beneficiary satisfaction. And although they 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, an issue that had disturbed some
providers, as set out in the draft standards.

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.”

The American Association for Homecare also applauded the final
standards. “We are pleased to see the standards have been
considerably streamlined since the initial draft,” said AAHomecare
Chairman Tom Ryan. “It is critical for the home care community to
continue to foster collaboration with CMS in this process.”

However, others say that CMS went too far and has 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 areas that aren’t included. “It’s
completely inappropriate to have accreditation for a health care
company and not address infection control,” she said.

Both Cesar and Floro said the HME provider standards presently
required by their accrediting organizations are more stringent than
CMS’ new requirements. They said they are awaiting further
clarification from CMS on whether they would be required to use
only the agency’s new standards for accreditation, or whether they
would be able to incorporate CMS’ standards into their current
accreditation programs.

If only CMS’ standards are used, it could speed up the time it
takes to accredit providers, Cesar said. What normally takes six to
nine months could be reduced to four to six weeks, he said.

CMS’ next step is to name accrediting bodies to apply the
quality standards. The agency published a notice in Wednesday’s
Federal Register inviting accreditation organizations to
apply for “deeming authority” as approved accreditors. Applications
must be received by Oct. 2.

To view the final quality standards, visit www.cms.hhs.gov/CompetitiveAcqforDMEPOS/04_New_Quality_Standards.asp.

CMS said that a document responding to the comments it received
on the draft standards also will be posted on its Web
site.