On Its Own Rehab Industry Seeks Its Own Accreditation Standards FOR TOO LONG, the rehabilitation technology market has stood in the shadow of its older sibling, the home medical equipment industry. But this year, it could finally begin to stand on its own.

That's the word from key players in the rehab technology profession who for two years have attempted to get accrediting agencies to adopt a set of guidelines called RAP 2000 - the Re/hab Accreditation Project.

RAP 2000 is a yardstick by which accrediting bodies could measure rehab company practices. But the project, which had been championed by members of the former National Association of Medical Equipment Services, was put on hold when NAMES and several other organizations merged to become the American Association for Homecare. "It got bogged down in the transition," says Gary Gilberti, president of Baltimore-based Chesapeake Rehab Equipment.

RAP 2000 might be on its way again, however. AAHomecare has established a Re/hab Technology Council with David Williams of Elyria, Ohio-based Invacare as executive director and Gilberti and Rita Hostak of Carlsbad, Calif.-based Sunrise Medical as co-chairs.

The Accreditation Commission for Health Care in Raleigh, N.C., has also written a chapter for its home care manual that recognizes the rehab segment and brought Gilberti onto its board of directors. "I would anticipate that sometime after the beginning of the year you're going to see some progress on [rehab accreditation]," says Gilberti.

That's encouraging to members of the rehab technology field, who have long been lumped with hospitals or HME providers when it comes to accreditation. Gilberti's company, for example, is accredited by the Joint Commission on Accreditation of Healthcare Organizations. "But about 70 percent of what we went through doesn't apply to the rehab industry," he says. "Some people realize there is a gap [in standards]," he adds, naming Tom Cesar, president and chief executive officer of the ACHC. "But there's still a section of the industry that's not recognized when it comes to the accreditation process."

Rehab needs separate recognition because the equipment is largely customized - sometimes very high-end - and the staff who work with it often must be specially trained, says Simon Margolis, whose Plymouth, Minn., company, National Seating and Mobility, has long been a mover and a shaker in the field.

Not willing to wait until formal rehab accreditation is available, Margolis and other rehab professionals are using RAP 2000 "as a selling point to third-party payers as to the uniqueness of rehab companies," he says. Managed care organizations want rehab companies to be accredited before they will agree to a contract, Margolis continues, but JCAHO doesn't offer rehab accreditation and currently is not planning to do so.

This is all the more reason, says Margolis, to push forward with RAP 2000. "We have to refine it and get rehab companies to buy into the concept in a more formal way," he says. "I think the next step was always planned to be voluntary compliance - because that's how you establish credibility."

According to Gilberti, RAP 2000 is No. 2 on the Re/hab Technology Council's "to-do" list, after standardizing reimbursement coding. But while all this is encouraging, he acknowledges it might be awhile before a formal accreditation program is in place. "It's going to take two or three years before you see something really happen," he predicts.

The standards proposed by RAP 2000 call for rehab technology companies to

- employ at least one certified rehab professional per location;

- employ at least one trained technician per service center;

- conduct in-person and individualized evaluations of clients/rehab technology needs;

- provide the client with appropriate equipment for trial and simulation;

- establish and implement a quality assurance program, including a standard procedure for assembly and setup of equipment; and

- implement a goal-oriented, client-centered outcome measurement system to measure point-in-time progress.