CMS releases quality standards to mixed reviews

Sunday, August 20, 2006

WASHINGTON - When CMS released its final quality standards last week, the industry was relieved to see that the agency had scaled back its requirements. But some accrediting organizations wondered whether CMS went too far.

"It's true--the draft was overkill," said Tom Cesar, president of ACHC. "But, now, we feel like CMS hasn't reached the level of accreditation that's normal, in terms of helping businesses improve their operations. They might have devalued the true value of accreditation."

CMS outlined its final standards in 14 pages--a huge departure from the 104-page draft it released last year. The draft standards, which the industry criticized as too prescriptive, elicited more than 5,500 comments.

The bones of the draft standards are still intact. For example, the final standards include financial management and product-specific requirements. But the final standards aren't as specific, industry sources said.

"They set benchmarks, but they allow providers to maintain their individuality," said Mary Nicholas, executive director of HQAA.

That's good news, especially for smaller providers who wondered whether CMS's accreditation requirement would make it logistically and financially impossible for them to participate in national competitive bidding, industry sources said.

"Providers have been calling us, and they're elated," Nicholas said. "These standards are not only realistic--they're achievable."

Unlike the draft standards, for example, the final standards don't require providers to contract an independent party to conduct financial audits. They also don't include 14 product categories--they include three.

If CMS's reason for implementing accreditation is to improve service to beneficiaries and curb fraud and abuse, however, some accrediting organizations wonder whether the final standards do the job. They pointed out that there's a large divide between the final standards and the existing standards of many of the accrediting organizations.

But even though requirements like establishing a compliance program appear to be missing from the final standards, "they've been addressed in other ways," said Bob Floro, the senior associate director for JCAHO's homecare program. He pointed to a performance management standard that requires providers to measure beneficiary satisfaction and billing practices.

Also last month, CMS published in the Federal Register the application process for becoming a "deeming authority" for accreditation. One section of the application concerns accrediting organizations: To become a deeming authority, the organization must agree to use a streamlined process that considers compliance only with CMS's final standards.

"Do they want us to become just an agent to validate providers, like a clearinghouse?" Cesar asked. "We're wrestling with that a little bit."