Mandatory Accreditation is Here:Now What?

AARC 52nd International Respiratory Congress

Bob Floro, RRTSenior Associate Director Joint Commission December 13, 2006

Topics for Today

MMA and Mandatory Accreditation

Value of Accreditation

Two MMA Requirements for Accreditation

1. All DMEPOS Suppliers Must meet CMS Quality Standards - Unsure of Implementation Date

2. To Participate in Competitive Bidding – Implementation to Begin in 2007

CMS Recognition of Accreditors

Must Meet Quality Standards Through Accreditation Process

Final CMS Quality Standards released August 2006

Accreditor Must Be Recognized by CMS– Eleven chosen by CMS– Some accreditors have limited scope

8/1/06 CMS Fact SheetRequirements of Accreditors

Plan for small business – Plan to reduce accreditation fees for small/specialty suppliers and suppliers that have multiple locations.

Application of streamlined quality standards – Processes will not to expand on streamlined quality standards.

Streamlined processes – Their role is to ensure compliance with the quality standards.

Exclude certain services - Accreditation should not be contingent on using consultation services or purchasing manuals.

Unannounced survey process – Utilizing an unannounced survey process reduces “ramp-up” costs and survey preparation time.

Same Process as Today

Value of accreditation should not change CMS Quality Standards woven into the fabric

of accreditation Elements of survey process examines patient

services Accreditation assures patient safety and

quality of services

What’s known today:

Competitive Bidding

• Must be accredited to receive a contract award

• CMS to begin paying Q4 2007

• CMS determines payment amount based on bids

• Awards cannot exceed current fee schedule

Implementation Schedule and MSA’s 2007 – 10 MSA’s 2009 – 80 MSA’s

Chicago, New York and Los Angeles excluded from 2007 competitive bidding

Specific equipment categories will be bid

Eleven Accreditors Recognized by CMS

What’s known today:

Competitive Bidding (cont.)

HR 3559 - Hobson-Tanner Bill (7/28/05)

Proposes Changes in Competitive Bidding Supports Quality Standards and Accreditation 150+ co-sponsors Exempts rural areas (MSA’s under 500,000) Allows all qualified suppliers to participate in CB Adds judicial review for providers Exempts items and services if 10% savings cannot be

achieved Companion Senate Bill:

– Introduced 9/21/06 - S 3920 Hatch – Conrad Bill

The Eleven

All Services: Joint Commission CHAP ACHC CARF HQAA BOC – Board for Orthotist/Prosthetist Certification ABC – Am. Bd. For certification in O & P National Board For Accreditation for Orthotic Suppliers National Association for Boards of Pharmacy Board of Certification in Pedorthics Compliance Team

Values of A Quality Accreditor

Standards are Relevant and Address Quality and Patient Safety

Processes are Developed Using Resources From The Industries It Serves

A Patient Focused Survey Process Accreditation Decisions Are Consistent Effective Surveyor Training, Education and

Qualifications Survey Includes Education And Consultation Continuous Process – 100%/100% Experience, Resources and Ability to Sustain

What We Don’t Know Today

Equipment Categories to Be Bid – Some Suspects: Oxygen, Diabetic

Equipment and Supplies, Wheelchairs and Orthotics/Prosthetics

10 MSA’s – Some suspects: Houston, Riverside CA,

VA Beach, St. Louis, Kansas City, San Juan, Atlanta, Charlotte, Miami and Pittsburgh

Rules for Competitive Bidding (MSA’s and Equipment - to be announced before end of 2006

What We Don’t Know Today (cont.)

CMS Quality Standards

Business Standards – Administration, Financial Management, Human Resource Management, Customer Services, Performance Management, Product Safety, and Information Management

General Product-Specific Service Standards – Preparation, Delivery and Setup, Training/Instruction to Beneficiary and Caregiver, and Follow-up

Appendix A – Respiratory Equipment and Supplies– AARC CPG’s – Delivery/Setup and Patient/Caregiver Instruction

Appendix B – Standard and Custom Mobility– Factory Trained Technician and RTS for Custom Mobility

Appendix C – Custom O & P– Proscriptive Assessment Requirements– Plans of Care

Value of Accreditation

The Value of Accreditation

Improves Quality Of Care Improves Patient Safety Raises Awareness Of Compliance Issues Raises Awareness Of Liability Issues Represents HME Company To The Public As A

Quality Organization Improved Access To Referral Sources Meets Some State License Requirements Access To Third Party Payors Access to CMS Beneficiaries

Improves the Quality of Care and Services

Meeting Standards and Requirements

Survey Process – External Validation

Through Commitment to Quality and Organizational Culture

Improves Patient Safety

Improve Processes

Standards Compliance

Performance Improvement

Culture

Compliance and Liability

Standards Address Regulatory Agency Requirements Standards Address Law and Regulation Examples of Standards that Address Liability

– Patient Rights and Responsibilities– Organizational Ethics and Billing Practices– Leadership – Responsibility and Accountability– Environment of Care - Operable Equipment, Safe Vehicles,

Effective PM/Maintenance, Backup Services and Equipment, etc. – Management of Information and Documentation

Potential Decrease In Liability Costs

State and Federal Recognition

State Recognition of Accreditation– DME Licensure Requirements– Growth Post MMA

CMS– Validation of Patient Safety and Quality Services– Validation of Ethical Practices

Access to Third Party Payors

Private Carriers – Traditional and MCO

State Medicaid Programs– Current Trend– Growth Post MMA

CMS– Payment for Quality, Patient Safety, Beneficiary

Access and Ethical Practices

Elements of Accreditation

ApplicationPreparationOn-Site SurveyAccreditation DecisionPost-Survey Activities Interim Activities

Elements of the On-Site Survey

Unannounced! Opening conference Patient Visits Documentation Review Review of Environments

– Warehouse, trucks, patient environment, emergency preparedness, etc.

Employee Competency Review Leadership Review Summary Conference

Value

Accreditation must bring value to:– Individual organizations– Patient Safety– Quality of Patient Services– The Industry

Raise the Bar!

Contacts

Joint Commission:– Home Care

630-792-5771– Bob Floro

630-792-5741 rfloro@jointcommission.org

CMS – DMEPOS Center:

http://www.cms.hhs.gov/center/dme.asp– Accreditor List: