Accreditation agencies brace for the crush

Wednesday, August 31, 2005

When accreditation standards were announced as part of national competitive bidding, Tom Cesar knew his agency, the Accreditation Commission for Health Care, would be in demand like never before. So in late July, Cesar and his staff loaded up the truck and moved five miles down the road to an office with double the space.
Now that the ACHC has had time to settle into its 9,500 square feet worth of cubicles, Cesar said he's prepared to handle the anticipated surge of inquiries from HME providers seeking accreditation.
"We have a game plan and we'll be ready," he said. "As it stands right now, if people call us in January, we won't have to tell them to wait until July."
Cesar and his colleagues at other accrediting agencies characterize the current climate as an uneasy calm before a tumultuous storm. For ACHC, the flood of applications is steadily rising but the big wave won't hit until after CMS names the 10 metropolitan statistical areas selected for competitive bidding.
"Over the past five months the number of manuals we're sending out has jumped from 25 to 45 per month, so we're seeing some movement," Cesar said. "But the real crush won't begin until after CMS makes its announcement on sites and standards."
Likewise, the Joint Commission on the Accreditation of Health Care Organizations is seeing a swell of interest from HME companies, said Executive Director MaryAnn Popovich. This past May, in fact, was a bellwether month for Oakbrook Terrace, Ill.-based JCAHO, which counted more applications from HME providers than home health agencies for the first time in the 17-year history of its homecare program.
While the number of HME applicants didn't become the majority at the New York-based Community Health Accreditation Program, they did reach an all-time high at 46%, said CEO Terry Duncombe.
"We've seen a significant increase in the number of HME providers exploring their accreditation options and it's only the tip of the iceberg," she said. "It's going to mean a huge increase in business, it represents a major challenge, but that's a good problem to have."
Considering that fewer than 25% of HME providers are believed to have accreditation, the uptick in interest is barely perceptible compared to what will ultimately come. Yet those who are applying now will have an advantage over the others who are waiting until after the CMS announcement, Popovich said.
"I wonder if there are HME providers out there who understand that accreditation really is going to be required," she said. "It will take an act of Congress to stop it and we have no indication that that will happen."
While accrediting agency officials say they are gearing up for an onslaught, they are quick to point out that those who wait too long could be left behind once the 2007 deadline passes.
"It is up to every HME who isn't accredited to begin preparation now," Popovich said. "Get busy and do your homework. If you're not familiar with the accreditation process, be aware it takes on average four to six months just to get ready. So if you begin now, you're looking at being surveyed in March. I'm afraid that organizations will wait until the end of 2006 and by then they'll be too late."
The sooner they enter the queue, the better positioned providers will be to become accredited by the deadline. At this point, however, the number of HME procrastinators is "scary," said Sandra Canally, president of the Ambler, Pa.-based Compliance Team. The registration process should be much further along than it is and unless they move soon, there will be a lot of providers out there who fail to make the deadline, she said.
"Do they realize that there are thousands of companies out there that need accrediting and that there are only a handful of companies that can do it?" she asked rhetorically. "It's unbelievable how many people are putting it off. One myth going around is that if they're not in the 10 MSAs, they don't need to be accredited. But even if they're in Timbuktu, they need to meet quality standards and be accredited in order to bill Medicare. They need to check that box that says 'Accredited.'"
Mary Nicholas is executive director of the new Healthcare Quality Association on Accreditation, a non-profit organization financially backed by the VGM Group. She says she has spoken to providers across the country in an effort to get her program off the ground and is mystified by the number of laggards. She is letting them know the potential consequences by offering this admonishment: "I tell them that they are taking a big risk and that they need to weigh that risk logically and rationally."
Undergoing an accreditation review can be a stressful process and accreditation officials say they understand why providers would want to delay having to undergo that kind of pressure. Yet they contend that most providers are already doing things the right way and that accreditation merely validates it.
"If you focus on what matters - safety, honesty and caring - and excel in that, everything else is minutiae," Canally said. "To receive our Exemplary Provider Accreditation, you need to score a 90% or better on those things."
High anxiety over surveys is a big reason why Waterloo, Iowa-based VGM got into the accreditation business in the first place, Nicholas said.
"Our niche is user friendliness," she said. "We want to remove the stigma that makes peoples' blood freeze in their veins. We want to help them through it with the least amount of anxiety that isn't too hard on the checkbook and provides the best results."
Cesar added that providers should see accreditation as a positive experience that helps them improve.
"We're giving you standards that are best practices for both the business and clinical sides," he said. "It provides you with a marketing tool that you can use to show that quality is an important issue for you."
"Is it going to be crazy? Ohmigosh," Nicholas said of the expected application flurry. "I could be spending January and February doing nothing but interviewing [surveyor candidates]."
There's no shortage of job applicants, however, and Nicholas said she's confident that HQAA will mobilize effectively when it comes time for the rubber to meet the road.
"We'll start surveying when companies are 80% ready to have us come out," she said.
Popovich assures the HME community that JCAHO is well along in its surveyor training and hiring process and has ample resources to meet demand.
"We'll be able to handle 1,000 organizations in 2006 alone," Popovich said. "We've done as many as 1,300 surveys in a year. We'll be able to accommodate all providers who have their applications in by June '06, but after that we can't make any promises."