In February of 2004, I wrote an article for HomeCare informing home medical equipment providers that they should consider starting the accreditation process, since accreditation was mandated as part of the Medicare Modernization Act. More than a year-and-a-half later, many of the details about mandatory accreditation are still outstanding.
It is expected, however, that the supplier quality standards developed by the government should be published by the time you read this article. (They were scheduled to be discussed at a Sept. 26 meeting of the Program Advisory and Oversight Committee.) Once those standards have been released, providers will be on the fast track to become accredited if they want to take part in national competitive bidding — and continue to participate in the Medicare program.
Again, it is stressed that providers should begin the accreditation process as soon as possible, notwithstanding the lack of details. By some estimates, fewer than 25 percent of eligible providers are currently accredited, so if there's a big rush, the existing accreditors may be unable to accredit all the providers who apply in time to participate in NCB.
Keep in mind that the accreditation process does take time. In some cases, it can be more than a year from the time you decide to become accredited until you receive the actual certificate.
Besides, you may want to consider accreditation anyway since its ultimate goal is to improve business operations and assure that quality care is provided to patients.
Presently, there are several potential accreditors that may be recognized by CMS, which has yet to name the accrediting bodies it will choose to apply the supplier quality standards.
For this article, we look at four not-for-profit organizations: the Accreditation Commission for Healthcare (ACHC); the Community Health Accreditation Program (CHAP); the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); and a newly formed organization, the Healthcare Quality Association on Accreditation (HQAA). There may be others that will accredit other segments of the industry, but these four specifically have standards for HME.
The purpose of the accompanying grid is simply to show differences and similarities among the accreditors and, hopefully, to help providers as they determine which program best suits their business and which accreditor to choose.
Remember, at present there is no approved accreditor for maintaining Medicare HME supplier numbers. But it is anticipated that these accreditors will all be considered, and that those providers already accredited by them will be grandfathered in initially — so long, of course, as the accreditor's standards meet the final CMS standards. This is definitely not a guarantee, but it is a logical expectation.
The information in this grid was compiled from the accrediting organizations' Web sites, with additional information provided by these accreditors. But any provider wishing to become accredited should contact each of these organizations — or any others being considered — to ask specific questions. Only the accrediting organization will be able to address such questions as exact cost and length of survey, for example.
Remember, accreditation is not necessarily a process where one size fits all.
| Accreditor | Accreditation Commission for Healthcare (ACHC) | Community Health Accreditation Program (CHAP) | Joint Commission on Accreditation of Healthcare Organizations (JCAHO) | Healthcare Quality Association on Accreditation (HQAA) |
|---|---|---|---|---|
| Date Organization Began | 1986 | 1965 | 1951 | 2005 |
| Services Accredited | • Home Health • Home Infusion • Home Care Aide Programs • Home Medical Equipment • Specialty Pharmacy • Hospice • Fitter Provider Services (companies that specialize in services and products for women's health/ post-mastectomy) • Rehabilitation Technology Supplier • Medical Supply Provider (mail order) |
• Home Health • Hospice • Home Medical Equipment • Home Pharmacy • Infusion Therapy Nursing • Private Duty Services (includes professional and paraprofessional services) • Home Care Aide Services (for paraprofessional-only businesses) • Public Health • Supplemental Staffing Services • Community nursing centers |
• Ambulatory care organizations • Assisted living facilities • Behavioral health care organizations • Critical access hospitals • Clinical laboratories • Health care networks • Home care organizations • Hospitals • Long term care facilities • Office-based surgery practices |
• Home Medical Equipment |
| Accredited Organizations (HME locations) | 335 | 850 | 4,300 | In testing phase |
| Deeming Authority | Has applied for Home Health (site visit scheduled December 2005) | • Home Health • Hospice |
• Home Health • Hospice • Other institutional services |
|
| Process | • Application • Preliminary Evidence Report • Site Survey • Scoring • Determination |
• Application • Self Study • Site Visit • Board of Review • Determination |
• Application • Agency does internal preparation • Site Visit • Preliminary Determination on Site • Final Determination |
• Application • Web-based Study • Coached Review and Consultation • Site Survey • Determination |
| Fees | • Based on size and scope of organization • Additional fees for extra branches • Fee covers 3 years |
• Application Fee • Annual Fee • Site Visit Fee • Contract period is for 3 years |
• $3,565 to $12,125 based on size and scope • Additional branch fees based on distance from main office • All-inclusive fee assessed in year of the survey; surveys conducted every 3 years • In 2006, fees will be assessed annually |
To be determined December 2005 |
| Accreditation Decisions | • Accreditation • Deferral • Denial |
• Accreditation • Accreditation with required actions • Accreditation with required actions and a progress report due • Accreditation with required actions, a progress report due, and a follow-up focus visit • Defer accreditation (initial accreditation only) • Formal warning (continued accreditation only) • Deny accreditation (initial accreditation only) • Withdrawal of accreditation (continued accreditation only) |
• Accreditation • Provisional accreditation • Conditional accreditation • Preliminary denial of accreditation • Denial of accreditation • Preliminary accreditation (early survey option) |
• Accreditation • Accreditation with follow-up • Accreditation denied |
| Usual Time to Complete Process | 6 months | 6 months | 6 months | 3-6 months |
| Revisions to Standards | No set time frame | No set time frame | Annual | Annual |
| Electronic or Paper Process | Paper (accepts PERs electronically) | Paper | Electronic | Paperless |
| Self-Study (company's own evaluation) | Preliminary Evidence Report | Self-Study | Periodic Performance Review (completed mid-cycle) | Interactive during process |
| Survey Length | 1 day for very small; usually 2 or more based on size | Usually 3 or more days | 1 day for very small; usually 2 or more based on size and complexity | 1 day for very small; can be more based on size |
| Location Web Site Phone Number | Raleigh, N.C. www.achc.org 919/785-1214 |
Washington, D.C. www.chapinc.org 800/656-9656 |
Oakbrook Terrace, Ill. www.jcaho.org 630/792-5000 |
Waterloo, Iowa www.hqaa.org 866/909-4722 |
| Profit Status | Not for Profit | Not for Profit | Not for Profit | Not for Profit |
| Management | Tom Cesar, President | Terry Duncombe, President & CEO | Maryanne Popovich, Executive Director, Home Care | Mary Nicholas, Executive Director |
| Status | Independent | Independent | Independent | Start-up support through VGM & Assoc. |
| Announced Visits | Announced (for single location) | Announced | Announced (current); unannounced beginning in 2006 | Announced |
Jerold S. Cohen is president of Caesar Cohen, Ltd., a consulting firm specializing in compliance training, outsourcing and operations management for the home health care industry. He has previously served as president/CEO of CHAP, and has experience in surveying for several accrediting organizations in HME. He may be reached at jcohen287@aol.com or by phone at 609/364-1983.
Stop by Accreditation Central on the exhibit floor at Medtrade, Oct. 18-20 in Atlanta, for more information about supplier accreditation.
