Accreditation Fastball: It’s ‘Bottom of the Ninth’

ATLANTA — With just over two weeks remaining until the
Oct. 1 deadline for mandatory accreditation and nearly 30,000
DMEPOS providers yet unaccredited, various stakeholders stepped up
efforts last week either to delay the date or get their sector
eliminated altogether from the requirement.

Without either legislative or regulatory intervention,
stakeholders said, thousands of providers would not be able to bill
Medicare, leaving untold numbers of patients without needed
supplies and services. The National Supplier Clearinghouse reported
that 29,698 providers were unaccredited as of Aug. 24.

On Sept. 8, a consortium of pharmacy organizations sent a letter
to key leaders in the House of Representative urging them to exempt
pharmacies from accreditation and surety bond requirements (the
bonding deadline is Oct. 2).

The letter called on representatives to merge two bills —
H.R. 616, authored by Rep. Marian Berry, D-Ark., which would
eliminate pharmacies and pharmacists from accreditation, and H.R.
1970, authored by Rep. Zachary T. Space, D-Ohio — and move
the resulting bill forward prior to Oct. 1.

The letter was signed by representatives of the National
Community Pharmacists Association, the National Association of
Chain Drug Stores, the Food Marketing Institute and the National
Alliance of State Pharmacy Associations.

As of Friday, there was no response to the letter. “We haven’t
got a specific read on it yet,” said Kevin Schweers, vice president
of public affairs for NCPA. However, he noted, there has been
bipartisan support in Congress for exempting pharmacies, and “the
encouraging part is that pretty much all of the various health care
reform bills have included it in some way, shape or form.”

Still, Schweers said, it was not likely that any health care
reform package would be passed by Sept. 30, and that fact impelled
the letter. If accreditation and surety bonds stand, he said,
thousands of pharmacies and their Medicare beneficiaries would be
affected.

“There are approximately 23,000 independent community
pharmacies, and 90 percent would qualify as [DMEPOS] providers,”
Schweers said, noting that diabetes supplies are the most common
DME product offered by those pharmacies.

“Of those that do provide DME, only about 10,000 — or
slightly less than half — are going through the accreditation
process,” he continued. “And of those 10,000, about 3,000 to 4,000
have not obtained their accreditation or are at risk of not having
it by Oct. 1.”

Some pharmacies have been confused as to whether or not they
need to be accredited, a topic CMS’ Sandra Bastinelli addressed in
last week’s Open Door Forum.

“If you are a pharmacy and you are billing a DME MAC for a
covered product, you must be accredited by Oct. 1,” she said.
Pharmacies billing Medicare only for drugs and biologicals do not
need to be accredited, she said.

The pharmacies weren’t the only ones seeking some relief from
the accreditation mandate. In a Sept. 9 letter to CMS Acting
Administrator Charlene Frizzera, the Center for Regulatory
Effectiveness called on CMS to extend the deadline by three months,
to Jan. 1, 2010.

“There has been a crush of DMEPOS providers that have been going
through the accreditation program resulting in unexpected
surveying/processing delays for at least some accrediting
organizations,” the CRE letter said.

Noting that this was a problem especially for rural providers,
the CRE added: “Unless the deadline for accreditation is extended
by three months, rural Medicare patients will find themselves cut
off from essential DME supplies.”

Providers Scrambling

Accreditors continue to field calls from providers scrambling to
get the process going but they say there is no hope of getting
through the process in time to meet the Oct. 1 deadline.

“They’re not going to make the deadline,” said Mary Nicholas of
the Healthcare Quality Association on Accreditation, noting that
it’s a six-month process and can take even longer depending on the
provider’s readiness. “But if they get the work done, they are
going to get accredited sooner or later.”

That means many providers will be out of the Medicare business
come Oct. 1. CMS rules state that providers who have not achieved
accreditation by that date cannot bill Medicare, and the agency has
advised providers to withdraw from the program voluntarily and
re-enroll when they meet all the CMS requirements. If they wait
until their Medicare number is revoked — the NSC will begin
sending revocation letters on Oct. 1 — they cannot return to
the program for a full year.

Even though there is no way providers just beginning the process
can be accredited by Sept. 30, Nicholas said her agency would not
slack off its efforts to get providers accredited as soon as
possible and thus, back into Medicare.

“We’ll continue to survey at 110 percent as long as there are
people who need to get accredited,” she said. “We’re not going to
stop because a deadline hit.”

Nicholas said she was surprised by the number of providers that
“didn’t get their work done in time to get into a survey
queue.”

She likened the DME scene to a baseball game. “The fastballs are
coming at people that aren’t prepared, and we are in the bottom of
the ninth in the World Series,” she said. “This is the way I look
at it. And it’s two strikes for those folks. But I am a die-hard
Yankee fan, so I’m not giving up on those folks.

“Sept. 30 is not going to be the end of the excitement,” she
added. “I think we’ll stay busy until the end of the year.”

Florida Numbers Shrinking

Still, for some providers struggling to stay afloat in the wake
of a 9.5 percent reimbursement cut twinned with a 36-month oxygen
cap that took effect Jan. 1, mandatory accreditation has already
become the final nail in the coffin.

“After working with accreditation consultants and industry
experts, I estimated that it would cost about $20,000 to go through
the accreditation process,” Robert Snyder, owner of O2 Etc. in
Hollywood, Fla., said in a letter to President Obama and Congress
that was released Friday by the Accredited Medical Equipment
Providers of America. “To maintain accreditation, we would be
required to have at least one full-time employee coordinate patient
compliance and survey patient satisfaction and work with
accrediting agencies to improve patient outcomes.

“The bottom line,” Snyder continued, “is that after calculating
an additional annual overhead expense of about 15 percent to
maintain accreditation, combined with the requirement to service
our long-term oxygen patients after 36 months for free, I realized
that it would be better to close my business without owing a large
debt to manufacturers and my financial institution.”

Snyder is not alone. According to a study conducted by AMEPA in
conjunction with the Florida Alliance of Home Care Services, the
number of South Florida Medicare oxygen providers has dropped
nearly 30 percent since March 2008, from 501 to 360 in the
tri-county area that makes up the Miami MSA. Much of that drop was
attributed to the threat of competitive bidding; however, more than
80 companies in Miami-Dade, Broward and Palm Beach counties are
still not accredited, according to FAHCS.

Sean Schwinghammer, executive director of FAHCS, said he
contacted each of the unaccredited companies and learned that most
will be leaving the Medicare program. While some providers contend
they are still attempting to get accredited by Oct. 1, he said,
others’ phones have already been disconnected and “some have stated
that they will be closing by the end of the month.”

See Commentary:
Nothing ‘Bona Fide’ about Rebid from AMEPA President Rob Brant
on the Round 1 rebid of competitive bidding.