Accreditors can handle 'insane' demand

CMS may be expecting miracles if the as-yet-undisclosed spring accreditation deadline is set too early for providers in national competitive bidding's top 10 metropolitan statistical areas. Moreover, if providers procrastinate too long on complying with quality standards and getting their applications in, their accreditation status is not assured, accrediting agencies say. "The day is here to make sure you are compliant with the quality standards," said Maryanne Popovich, executive director of the Oakbrook Terrace, Ill.-based Joint Commission's homecare accreditation program. "Everyone who wants to continue with Medicare needs to get those standards into their own business model and comply with them. Then select your accrediting agency, whomever it may be, and--I can't emphasize this enough--get those applications in." Most agencies said they were caught off-guard by CMS's mandate that providers in the competitive bidding hot zones be accredited by early spring, and while they sound optimistic about handling the anticipated massive surge of applications to come, no one was guaranteeing that every provider would make the deadline. While accreditors may feel like CMS has put the onus on them to speed up an already frantic pace, ultimately it is the provider's responsibility to get in the queue on time, said Mary Nicholas, executive director of Waterloo, Iowa-based Healthcare Quality Association on Accreditation. "The reality is that providers have to walk that journey--not the accrediting organizations," she said. "If the provider finishes the process and is ready for survey, they get scheduled. I can't open the door and push people through." Sherry Hedrick, director of clinical compliance and accreditation for Raleigh, N.C.-based Accreditation Commission for Health Care, said her organization has shifted into high gear, re-engineering its accreditation management software system and streamlining internal processes to meet a faster pace. Still, she hopes "CMS would allow for some adjustment and that they wouldn't expect us to get everything done in only a couple of months." The Spring House, Pa.-based Compliance Team has developed a two-tiered process that consists of an "accelerated pace" track for those in the first MSAs along with a regular pace track for those with more time. Created specifically to serve small independent providers, the accrediting agency is dedicated to "doing everything we can to help these providers keep their Medicare numbers," said President Sandra Canally. In designing its crash course, providers are instructed to focus on "what matters most in terms of the onsite visit, including proper tracking, storage and patient services," Canally said. "We look for a three-month compliance history and it has to be moved along quickly," she said. "We then do a 60-day follow-up where they might have to make some corrections. This is an exemplary program, so they must meet 90% of the criteria." Debunking myths Ahead of CMS's announcing the top 10 MSAs, accreditors reported that their phone banks were lighting up constantly, some even to the point of being "insane." Still, agency representatives contend that the activity so far is just the tip of the iceberg and that many providers continue to balk at undergoing the process. One reason for the hesitation is a proliferation of "myths and untruths out there," Popovich said. "I am continually dismayed by the fact that some believe small providers won't have to be accredited," she said. "It's clear that every provider must meet quality standards--no exceptions. You have got to get and understand factual information. You don't want to be wasting any time or resources doing something you might not have to do or do something in a way that won't get you accredited." To combat misinformation, the Joint Commission refers providers to a Web site, www.hmeaccreditation.org, that contains factual information about accreditation, as well as a downloadable version of the CMS quality standards. Unfamiliarity with the accreditation process is another obstacle, so Hedrick and her team are putting an emphasis on communications. "We are helping our clients understand what it means to go through accreditation," she said. "It's so new to many of them and they often sound nervous. We want to give them knowledge; we want to adequately communicate the answers they need." Status question Ready or not, the HME industry is entering an era where accreditation will be the rule rather than the exception. But many of those providers who have already secured accreditation are using it as a way to distinguish themselves from their competitors. It raises a marketing issue: If everyone must now be accredited, should there be an elite level that designates the cream of the crop? The Joint Commission, which used to offer an "Accreditation with Commendation" status, has considered resurrecting the designation, Popovich said, but decided against it at this stage. ACHC is looking at issuing a special citation of excellence, but, Hedrick says, it would be developed down the line after things have settled. "We will consider it, but for the first go-round there are so many new companies that we wouldn't want to segregate them yet," she said. "We first want to know how many of them can meet the minimum standards. After that, we'll evaluate it and see how it goes."