Quality standards: Believe me, the sky may be falling

Wednesday, November 30, 2005

Fraud, system abuse, and unscrupulous providers--these are all things honest providers abhor and would like to see stopped. CMS's new quality standards for suppliers will do just that but not in a way any of us will like. If adopted as proposed, or with only minimal "cosmetic" changes and enforced in the same style that Benefit Integrity or Program Integrity have tried to enforce "guidelines" in the past, it will, in all likelihood, put more than 90% of DMEPOS suppliers out of business in short order.
Do I sound like Chicken Little? Believe me, the sky might be falling.
What will adversely affect small- to mid-sized providers the most? Consider this provision: "Suppliers shall have staff available for telephone customer service during posted business hours and after-hours emergency service." This standard is more than understandable for oxygen or ventilator suppliers because their patients depend on those items for their survival. But what about prosthetic or orthotic providers? Why should 24-hour "emergency" service be required for products not required to sustain life? What kind of expense can the small provider or supplier face to comply with this standard?
The same argument applies to this provision: Suppliers will be required to "provide(s) the beneficiary with a toll-free telephone number or other national access numbers for all applicable equipment to assist the beneficiary in accessing support from the supplier or manufacturer when needed."
Now let's look at the financial management requirements. Besides requiring all suppliers to provide a long laundry list of financial documents, this section requires all suppliers to notify CMS of any "potential adverse financial operations." This is including, but not limited to, "an adverse financial condition which could potentially result in delayed payments to its manufacturers/suppliers." This section also requires all suppliers "to maintain adequate financial resources to ensure that the supplier can meet its financial obligations for each quarter." Given the sometimes erratic manner in which the DMERCs process and reimburse claims and the constant Sword of Damocles of alleged overpayments hanging over suppliers, how can any supplier accurately forecast cash flow or ever meet this standard? Failure will, in all likelihood, result in the National Supplier Clearinghouse suspending the supplier number, further exacerbating these negative and adverse financial conditions.
Overall, this standard violates the basic premise of a supplier's right to privacy. The vast majority of DMEPOS suppliers are small non-public entities that deserve a right to privacy.
The apparent intent behind these standards is well meaning, and no one can fault CMS for desiring that its beneficiaries get the very best products and services for each and every dollar expended. CMS needs to understand that to make such standards workable, they need to be realistic in the "real world." Wording and requirements need to be adjusted so that the small to mid-sized DME supplier is not expected to meet all of the same requirements that a multimillion dollar multinational supplier would be expected to meet.
All suppliers--small, medium and large--are strongly urged to comment on how these proposed standards will impact their businesses. If you don't take the time to do it now, we will all regret it later.


Michael Watson is vice president of government affairs for American Medical Technologies. Reach him at michaelwatson207@sbcglobal.net or (707) 542-0330.