Problem Solvers

Achieving More Through Accreditation

Selecting the right accreditor is part of the equation, but new specialized accreditation services are also helping providers stand out from the crowd.

• By Haley Samsel
• Apr 01, 2020

As the HME industry has rapidly expanded over the past 30 years, the CMS requirement for accreditation has largely remained the same. In order to bill to Medicare, providers must pass a review process showing that they meet regulatory requirements and standards established by a recognized accreditation organization.

While many providers have come to appreciate accreditation as a way to improve their quality of service and business practices, others still view the process as hoop to jump through. That’s the mindset that accrediting organizations are diligently working to change.

“If companies can embrace accreditation to help improve the organization and their day-to-day activity, then accreditation really does serve a purpose,” says Tim Safley, director of DMEPOS, pharmacy and sleep accreditation programs at the Accreditation Commission for Health Care (ACHC). “Many times, they can use it as the beginning template to help make their location better.”

Outside of allowing providers to either obtain or maintain billing privileges of Medicare, earning accreditation also shows private payers like Aetna and Blue Cross Blue Shield that a company is meeting high quality standards, said Sandra Canally, the founder and CEO of The Compliance Team.

“The private payers have jumped on the bandwagon about ensuring that the same level of quality applies across the board,” Canally explains. “That has definitely increased over the years. Initially, the focus was only on Medicare, and now it has broadened to the private pay system.”

Now that accreditation has become a standard even for providers that do not necessarily participate in the Medicare program, it’s time for HME companies to see how having third-party validation of their business practices and quality standards gives them an edge in the marketplace, Canally added.

“The provider needs to be of the mindset that change needs to happen and that they really want a way to differentiate themselves from the other provider down the street or the other side of town,” she says.

Finding The Right Accreditation Organization

The most crucial element in a successful accreditation experience is finding the right organization to lead the HME business through the process, Safley said. Some companies may be tempted to go with an accreditor that promises a quick “stamp of approval” process, but providers should look for organizations that offer educational elements and insight, he added.

Safley advises providers to ask: “Can they give other services outside of accreditation? Is there education? Do they do webinars? Do they keep you updated on changes in the medical equipment environment?”

Before signing up with an accreditor, company leaders should call the accreditor’s previous clients and ask if they are getting the service they need, Safley said.

In addition, providers should check to make sure that the accreditor is supporting the HME industry and conducting regular outreach with customers, usually by attending national shows and regional events. Overall, the most important factor is knowing the all-inclusive cost of the program, which should be estimated prior to starting the accreditation process, Safley said.

“Some accreditors charge monthly fees and some charge yearly fees,” Safley said. “Some pay for the surveyor visits, so you certainly need to take a look at what I call ‘intrinsic and extrinsic costs.’ What is the overall three-year cost of accreditation, including everything tied together?”

Extrinsic costs include paying an employee to keep up with the demands that the accreditor is asking for, and assigning an employee to complete annual reports and ongoing regulatory maintenance. Providers must also consider if the requirements of the accreditor fit their business size, particularly if their programs were designed for larger companies.

“Although quality standards are the same for everybody, the needs are different overall for a 100-location company, to a 10-location company, to ones that have one location that are just selling vasectomy supplies,” Safley said.

There is a preconception that accreditation has to be difficult and costly, Canally said, but her organization has focused on keeping their services cost-effective.

“We made it very cost-effective because we want the provider to succeed and we believe that if they focus on what matters most to the patient and their family — safety, honesty and caring — if they excel in those three areas, what else matters?” Canally said. “The rest is just minutiae.”

Taking Advantage of Specialized Accreditation

As providers look for new ways to differentiate themselves in a crowded HME marketplace, both ACHC and The Compliance Team are offering specialized accreditation services.

In just the past few months, ACHC introduced two new specialized programs: one focused on mail-order pharmacies, the other on home infusion therapy. These options are designed for providers that work mostly or solely in one market and want to avoid aspects of accreditation that don’t apply to them.

In addition to not having to complete requirements that do not pertain to their market, HME companies are also drawn to specialty accreditation because it shows they have gone the extra mile to ensure high-quality service in a complex field, Canally said.

“The market differentiator is when they want to raise the bar and take it to the next level,” Canally said.

In 2018, The Compliance Team began to offer a patient-centered respiratory home program to recognize advanced respiratory care providers performing at the top of their licensure. In order to expand beyond oxygen and embrace “value-based care,” these providers seek to obtain accreditation that will help them build relationships with prescribers, physicians and more.

“When providers focus on what they provide to their patient and coordinate more with the other providers and prescribers in the circle of care for their patients, that’s where there’s going to be a turn and hopefully additional payment,” Canally said. “We see it in pharmacy, and there’s no reason why advanced DME services that are meeting the patient needs on a higher level couldn’t be part of this as well.”

Safley and Canally agree that the increased focus on specialized accreditation is not going away, particularly as more companies stress the need to focus on quality over quantity of products and services. The results of Round 2021 of competitive bidding will surely have an impact on how providers weigh the costs and benefits of pursuing specialized recognition, Safley added.

“I think we’re going to see more specialized, but it depends on who is awarded these bids,” Safley said. “I think everything is coming down to how the bids are going to be awarded in the competitive bid process.”

This article originally appeared in the April 2020 issue of HME Business.