Bring it on, but...

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Monday, June 30, 2003

The Senate Finance Committee is calling for HME providers who bill Medicare to become accredited by a recognized, independent national accreditation organization. The HME industry is evenly split on this subject, according to a June 16 HME NewsPoll. Fifty-one percent of 115 respondents are in favor of mandatory accreditation; 49% are not.

The issue’s critics don’t want the added costs associated with accreditation, especially if the government imposes additional cuts in the form of a CPI freeze or competitive bidding. They believe state licensure is enough. They don’t want more regulation. They don’t believe it will ensure higher quality service for Medicare beneficiaries. They believe it will limit competition. They believe accreditation is good for large HME companies but bad for small companies.

The issue’s boosters say mandatory accreditation will weed out companies that practice fraud and abuse, principally by raising barriers to entry. They point out that the HME industry is the only significant sector of health care that does not require some form of rigorous standards. Accreditation, they say, will ensure a more professional class of suppliers and provide more credibility to the industry.

It’s difficult to argue with those who say accreditation will weed out the bad apples in this industry. Companies that systematically file false claims and pay cash money for referrals do not take their vocation so seriously that they’ve gone to the trouble of achieving accreditation. Accreditation may not be a guarantor of high quality service, but it will certainly deter the riff-raff.

It’s the riff-raff who’ve brought this industry to the brink of competitive bidding. In the House competitive bidding proposal released last month, competitive bidding is laid out as a measure to combat fraud, abuse and waste in the Medicare program. The riff-raff is why the largest undercover healthcare fraud investigation in the FBI’s history was aimed at the DME industry. Remember Durascam? As a general rule of thumb, the all too prevalent point of view is that it’s wiser not to trust an HME company.

The HME industry has been laboring under an uncertain future for too long. A climate of mistrust among legislators and administrators will only prolong that uncertainty. How else does this industry shake its bad rap?

Many of accreditation’s critics liken a new mandate to undue government regulation. And if you were a mop maker who never billed the government for anything, I’d agree. But it is due. The industry hasn’t been able to do anything about reducing the number of crooks that use DME as a front.

It’s hypocritical to say no to accreditation, and then dip your hand in the Medicare pot - not when you’re the only kind of Medicare provider that doesn’t meet a professional class of standards and when the government is acting in the interests of America’s seniors.

If accreditation does come, then two things should come along with it. One, the government must regulate the accreditation standards to ensure that accreditation companies don’t just implement an Oryx-like initiative whenever it seems reasonable to them. And two, the government must also recognize that it will be dealing with a higher caliber of providers. Yes, there’s fraud and abuse at large today, but there’s also no doubt that government auditors have applied an unduly heavy-hand to their investigations.

If you want a better class of HME providers, you got to treat them better. HME

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