Does It Help?

A vast majority of providers clearly recognize the benefits of being accredited. Overall, 81 percent of providers who are accredited agree that accreditation helps their operation. (Yet, 54 percent said they feel CMS' quality standards are too tough/too prescriptive.)

Currently accredited providers had the following comments about how accreditation has helped:

• “Allows payers to have confidence that company provides quality service.”

• “Encourages organization of processes and observation of outcomes.”

• “Got us into several networks.”

• “Helps ensure quality processes and consistency between branches.”

• “Helps us provide better service to our customers.”

• “It keeps the standards of care high by universal policies and procedures.”

• “It keeps us doing the right things consistently and keeps us looking for ways to become better at what we do.”

• “Makes us a more professional company.”

• “Referrals equate accreditation with quality standards.”

• “We are very good at what we do, and we enjoy it. [Accreditation] just reminded us that we are that good.”

Some providers, however, believe accreditation “hinders” a company's operations. In addition to adding costs and creating “mountains of paperwork,” as many commented, they had this to say about accreditation:

• “Does nothing to improve quality of care.”

• “Increased administrative and time commitment.”

• “More and more layers of paperwork that do nothing to improve service to our customers or limit/prohibit fraud.”

• “More overhead that is mostly overkill.”

• “More time with policies, etc., less time with patients.”

• “Sure there will be some improvements … but I think the yield will be less than the fertilizer applied.”

• “Will force smaller providers out of business.”

Opinions vary on whether mandatory accreditation will prevent fraudulent providers from entering the business: 34 percent think it will, 35 percent do not think it will and 30 percent are unsure.

One provider with a cynical view said he feels accreditation “will just require the fraudulent provider to be a little more sophisticated.” But many respondents noted it is difficult to fake your way through accreditation, and another wrote in that it is more difficult to fool those accreditors that utilize tracer methodology. Some said the sheer number of standards would be too much trouble for thieves to bother with.

If You Haven't Already, Start!

With CMS' accreditation deadlines rapidly approaching, there are a significant number of providers struggling with the decision of which accrediting body to embrace. No matter which is ultimately chosen, most providers feel accreditation will be a positive step for the industry as a whole.

Those HME company owners and managers who do their homework, understand their options and come to terms with the real costs of accreditation will be ahead of the game for Medicare and beyond. There is little doubt that accreditation is here to stay.

One provider's comment adequately sums up what lies ahead for providers now starting the quest for accreditation: “To quote Karen Carpenter, we've only just begun.”

Survey Fast Stats

• Respondents are likely to operate in one or more competitive bidding areas, as 27% operate in one or more of the 10 MSAs in round one of competitive bidding, and an additional 29% operate in one or more of the 70 MSAs designated for round two of competitive bidding. 43% do not operate in a competitive bidding area. Among respondents with 10 or more locations, 83% operate in one or more current or future competitive bidding areas.

• The majority of respondents (61%) indicate their company is currently accredited.

• One in five respondents (21%) whose company is currently accredited indicate they have been accredited by a different organization in the past.

• Among respondents who are not yet accredited, 86% plan to apply. In fact, 35% have already begun the accreditation process.

• Respondents who are not currently and do not plan to become accredited are most likely to indicate they don't need it for their HME operation (38%), it is too expensive (33%) and/or they plan to stop accepting Medicare (25%).

• To prepare for accreditation, 64% expect to get help only from their accrediting organization; 49% expect to buy materials from an accreditation preparation service; 18% plan to hire a consultant; and 20% expect to work through the process entirely on their own.

• Overall, respondents believe that accreditation helps their company's operations (81%).

• Opinions vary on whether mandatory accreditation will prevent fraudulent HME providers from entering the business: 34% believe it will, 35% do not believe it will and 30% are unsure.

• More than four in five respondents (83%) have a compliance officer.

• Among respondents who are currently accredited, 70% indicate that their other payers accept accreditation from their Medicare-approved accrediting body, while 2% said they need accreditation from another organization as well.

• Overall, 38% of respondents indicate their company is required to participate in state licensing surveys that are similar to CMS accreditation.

• Providers that are not currently accredited are basing their selection of an accreditation organization on a variety of factors, including: service provided by accreditor, 71%; price, 56%; time it takes to complete the process, 49%; and type of process, 47%.

Do you think mandatory accreditation will prevent fraudulent HME providers from entering the business?

Yes

• “Accreditation is a step, but not a cure-all.”

• “Accreditation makes you prove you are following the rules.”

• “You can't fake your way through accreditation.”

• “Criminals usually look for an easy way to make money. Accreditation is difficult to achieve and must be continually updated.”

• “I don't think they will go through all the hassle.”

• “There will be too much red tape for the fraudulent supplier to jump through to get into this business. Conversely, it makes it harder for anyone to get into this business unless they have a large sum of capital to start the business with.”

• “They will no longer be able to run their business out of a garage and claim to have an ethical business.”

• “Tracer methodology through unannounced visits cannot be faked where policy is concerned.”

• “Way too much work for the bad guys to put up with.”

No

• “A dishonest person will always find a way to try and beat the system.”

• “CMS does a lousy job of enforcement.”

• “Crooked suppliers will find ways to become accredited or buy an accredited company.”

• “Fraud cannot be stopped by a survey.”

• “It will just require the fraudulent provider to be a little more sophisticated.”

• “Surveyors are looking at quality and patient standards. While there are financial standards involved as well, fraudulent providers can certainly get their activities past an auditor.”

• “There are plenty that practice now and they are accredited.”

• “They will look better and steal more.”

• “You cannot regulate criminal activity. It hasn't worked in other government-regulated fields. Why would it work in this one?”

On what did/will you base your selection of an accreditation organization?

	Currently Accredited	Plan to Become Accredited
Service provided by accreditor	53.0%	71.2%
Price	22.8%	56.2%
Time it takes to complete the process	14.6%	49.0%
Type of process	31.0%	47.1%
Other	22.1%	9.2%

To prepare for accreditation, will your company:

	Currently Unaccredited
Get help only from your accrediting organization	64.1%
Buy materials from an accreditation preparation service	49.0%
Work through the process entirely on your own	20.3%
Hire an outside consultant	18.3%
No answer	1.3%
Base = unaccredited respondents

What is your total cost per location for one completed accreditation cycle (including all survey costs and any add-on fees)?

	Currently Accredited
Less than $1,500	2.8%
$1,500 to $4,999	27.4%
$5,000 to $9,999	26.7%
$10,000 or more	12.1%
Unsure	30.2%
No answer	0.8%
Base = accredited respondents

Mean = $6,173

For providers with one location, cost averaged $7,110. For providers with 10 or more locations, cost averaged $5,190.

About This Survey: Data were collected Feb. 19-March 11, 2008. Of 459 qualified responses, 74 percent came from HME providers, 9 percent from pharmacies/chain drugstores with HME and 7 percent from specialty HMEs. Nearly half (46 percent) of these companies operate one location, while 41 percent operate between two and nine locations, and 13 percent operate 10 or more locations. One-quarter (24 percent) of responding providers report revenue of less than $1 million, while 11 percent have revenue of $25 million or more. Nine in 10 respondents indicate their company is privately owned. Not all respondents answered every question, and some totals may add to more than 100 percent due to multiple responses. Survey methodology conforms to accepted marketing research methods, practices and procedures.