Quality standards appear to 'stun' providers

Sunday, October 2, 2005

PIKESVILLE, Md. - Given the enormity of the change at hand, last Monday's special open door forum on supplier quality standards was surprisingly quiet.

"It was horrible," said healthcare attorney Ann Berriman the day after the forum. "Maybe everyone was stunned."

More than 400 callers and 60 attendees took part in the forum, but with the exception of a handful of questions about financial management requirements and the definition of "qualified staff," the industry failed to rabble-rouse.

It's also possible that the industry didn't have time to fully take in the 104-page draft, which was released the preceding Friday, or that many stakeholders already had a chance to voice concerns during the Program Advisory and Oversight Committee's meeting with CMS earlier that day.

But there's too much at stake not to beat the industry's drums at every opportunity, industry sources said after the forum. If CMS has its way, all providers will have to meet the standards eventually, starting off with the providers in the 10 metropolitan areas where CMS will kick off NCB in 2007.

The standards are divvied into two groups, representing business quality standards and product specific service requirements for 14 categories, including oxygen and power wheelchairs. Though it's still early, adjectives used to describe them included "prescriptive."

A top concern for providers are the highly specific financial management requirements. One provider asked officials why they want to require providers to notify CMS and the accrediting organization of "potential adverse financial operations" that would result in delayed payments or bankruptcy.

"All providers have financial issues like this," said Tim Pedersen, CEO of WestMed Rehab. "Does this mean we'll be sanctioned, which would only exacerbate the situation? I don't think there's a provider in this room that isn't behind in payments to one manufacturer or another."

CMS's response: "By the time the suppliers notify CMS, usually they're in real trouble and almost out of the program. If a supplier communicates this earlier, that will facilitate more communication. It's not meant to be punitive."

Per the financial management requirements, providers must also "maintain adequate financial resources to ensure that the supplier can meet its financial obligations for each quarter."

Another top concern is the need for "qualified staff," which the standards require providers to have on hand to address beneficiary concerns and needs. For instance, for rehab providers, does that mean employees with certifications from the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA)?

Providers also told officials they worry that the timeline for the final release of the standards, scheduled for March or April, would leave them little time to get accredited before NCB begins.

Details revealed at the forum include:
- Companies accredited by existing accrediting organizations will be grandfathered, as long as the standards of those organizations meet the standards that CMS publishes.
- CMS and its contractor, Abt Associates, will develop product specific service requirements for an additional 18 categories in the next phase of the project.
- Only when the final standards are published in April will CMS determine what accrediting organizations will enforce the standards.

Comments on the draft quality standards can be e-mailed to dmepos_quality_standards_public_comments@cms.hhs.gov until Nov. 28.