Agency forecast: This spring, accreditation will blossom

The proverbial "other shoe" still hasn't dropped with regard to mandated industry-wide HME accreditation, but agencies expect to hear the rumble of scrambling feet some time this spring. "I thought the past year was intense, but the tempest is still ahead of us," said Mary Nicholas, executive director of the Healthcare Quality Association on Accreditation (HQAA) about the impending rush of HME provider applications. At last check in August, accrediting groups were busily gearing up for the onslaught: The Accreditation Commission for Health Care (ACHC) had just moved to spacious new quarters, HQAA and the Compliance Team were solidifying their programs, the Community Health Accreditation Program (CHAP) saw its HME component fielding a steadily growing number of inquiries and the Joint Commission for the Accreditation of Health Care Organizations (JCAHCO) was advising potential clients to get a jump on the crowd. The situation hasn't progressed much in the ensuing months, but accreditors anticipate drastically heavier workloads during the second quarter of 2006, following CMS's release of final quality standards. "We haven't seen a huge increase in the number of applications yet--an awful lot of providers are still waiting," said Sandra Canally, president of the Ambler, Pa.-based Compliance Team. "We believe it will all hit going into Medtrade Spring (March 21-23 in Las Vegas)." The Compliance Team is still scurrying around in preparation for the expected stampede, including finding a larger office, finalizing procedures and interviewing job candidates, but the waiting game has reached a point of frustration for Canally. "We had a sensational level of interest at Medtrade (in Atlanta in October), but there is still a lack of action--everyone is still thinking about it," she said. "Even if these people made the decision to go with us, they haven't necessarily started. It's driving us nuts because we're trying to help them. The longer you wait, the more difficult it's going to be." The stagnation is due to the absence of definitive accreditation quality standards from CMS, which at press time in early January were due to be published this spring. Once the standards become official, the application lines are expected to, figuratively, stretch out the door, around the corner and down the block, accreditors say. "The draft copy drew some 5,600 comments, which I thought was really impressive," Canally said. "I thought there might be a couple hundred, but apparently a lot of people have some serious things to say with regard to those standards." Maryanne Popovich, executive director of Oakbrook Terrace, Ill.-based JCAHO's homecare accredition program, said her organization is getting between five and 10 inquiries a day and that so far about 40 HMEs have translated their interest into applications. Even so, that rate is running a little behind her expectations. "We initially thought we'd get more interest in the fourth quarter, but we understand that CMS has not released its standards yet and that the 10 [Metropolitan Statistical Areas] affected have not yet been named," she said. "We're still waiting for the real frenzy to begin." Even though the "real frenzy" is yet to occur, there are signs that providers do realize the gravity of the situation. The number of procedural manuals sent out by Raleigh, N.C.-based ACHC rose 300% in 2005, dramatically exceeding President Tom Cesar's expectations. "Manuals are going out right and left," he said. "Even in December, which is usually a slow month, we were sending out an average of one manual a day." At HQAA, Waterloo, Iowa-based VGM's accreditation arm, Nicholas said she is constantly on the phone with inquiring providers. "We've heard from people in 48 states, including Juneau, Alaska, just the other day," she said. "It has been enjoyable talking to people--I'm willing to help anyone who calls and has questions about accreditation." CHAP was in the process of moving its headquarters from New York to Washington, D.C., in early January and couldn't be reached for comment. Unannounced visits set Unlike those already enrolled in accreditation programs, providers who wait until after the CMS final standards to apply for accreditation will not be notified in advance of their surveys. As of Jan. 1, JCAHO and CHAP were conducting surprise visits and ACHC planned on adopting the new policy after Feb. 24. The procedural change comes from CMS, which mandates that unannounced surveys be done by agencies with "deeming authority." Cesar says the approach is "a huge step" for his agency, but that it is necessary for the program's credibility. While he sympathizes with company managers who may see the move as escalating an already high-anxiety process, Cesar said the nature of HME demands they be ready for an inspection at all times. "HME is a 24/7 business and theoretically, providers should be able to rise to the occasion at any given moment," he said. Prior to making it official policy, the Joint Commission conducted unannounced surveys on a voluntary basis for two years, Popovich said. "People really didn't have a problem with it," she said. The impending bulge Canally met with CMS recently to discuss the accreditation timetable and determine the best way to keep the process moving once the bulge of applications starts growing. "We told them that we saw an awful lot of hesitation because they haven't even developed criteria for us to meet yet," she said. "The standards are supposed to be done by spring and they said they would try and get applications out for the accrediting bodies by summer 2006. If the rules are ready for us in the summer, what's going to have to happen to get people through is grandfather them or look at the masses of providers who are accredited and have them pushed through the first time around. That's my gut feeling about it." Nicholas concedes that the CMS timeline "is what it is" and that she has to focus on what she can control. "It's true that people are discouraged by being left in a fog as to what the final standards will be," she said. "We're doing what we can. Though I'm anxious to hear what CMS is looking for, it makes sense for me as a new company to open my doors when the standards become final. That way I can offer the most up-to-date standards available."