The Three Little Pigs Get Accredited

Dedicated consulting will ensure your efforts to get CMS accreditation don’t become a fractured fairy tale.

The CMS mandate requiring all DMEPOS providers to become accredited is a saga that mimics my children’s favorite bedtime story, “The Three little Pigs.”

As I was reading the story last night, I couldn’t help but imagine CMS as Mother Pig with her three little DMEPOS providers, the accrediting bodies as the wolf, and the consultants who supply their knowledge and materials to each pig as the houses of straw, wood, and bricks.

One day CMS told her little providers, “You are too out of compliance to live here any longer. You must go and get accredited.” The three little pigs set off. “We will take care that the wolf does not catch us,” they said.

The First Little Pig

Soon they met a consultant who was offering a manual on CD ROM. “Please, will you give me a copy of your manual?” asked the first little pig. “I want to get myself accredited.”
“Yes,” said the consultant and he gave the first little pig a manual for $2,000.

The first little pig took his CD ROM and built himself a house by spending many long hours inserting his company name and other important information into all the pages of the manual and the forms he would need to use. Not understanding where to begin, every day he found himself trying to piece together policies, forms, procedures, standards and training, causing him great frustration.

The first little pig had many questions but little help in finding the answers. He soon lost sight of the other important work of running his company. Finally, after many months of toiling until the wee hours of the morning, the first little pig believed he was prepared for accreditation.

The Second Little Pig

“I shall build a stronger house than yours,” said the second little pig. So he met with a consultant who was selling a package for $3,000 that included a manual on CD ROM and a promise to provide a consultant by telephone for support if the little pig had any questions.

“Please, will you give me your manual and phone number?” asked the first little pig. “I want to get myself accredited.”
“Yes,” said the man and he gave the second little pig a CD ROM and a phone number.
The second little pig went to work. Like his brother, he spent much effort customizing the forms and manuals he was given. However, he too had many questions and soon found himself on the phone every day looking for answers, causing him great frustration. Finally, after many months of toiling the second little pig believed he was prepared for accreditation.

The Third Little Pig

“I shall build a stronger house than yours,” said the third little pig.
The third little pig walked on along the road by himself. Soon he met a consulting firm offering a solution which included all his policies and procedures fully customized, an on-site consultant to work alongside him to build his house, and a trainer to teach him how to maintain the house once it was complete.

“Please will you give me your solution?” asked the third little pig. “I want to build a house for myself with your help.”
“Yes,” said the consultant. He pledged to help the third little pig build his house for $4,000. Soon the third little pig’s consultant set out to build his house. He customized the third little pig’s manuals and forms, trained his staff, hung his signs, and began implementing the customized policies and procedures.

While the consultant worked to build his house, the third little pig spent the next few months developing his business, managing his accounts/receivables, and providing quality patient care. He was pleased to see that the changes the consultant had implemented to make him compliant also improved his cash flow. Because he chose to work with a partner to build his house, he was not frustrated. The third little pig was able to focus on running his business and found he could spend time with his family at night. He did not lose sight of his other important work.

Soon, the wolf came knocking at each of the little pig’ houses. The wolf blew down the first little pig’s house with one puff; his patient files were not complete. Then the wolf blew down the second little pig’s house with two puffs; he did not have the correct signs posted and his employee files were incomplete. Then the wolf came to the third little pig’s house. He inspected and he inspected and he inspected and he inspected, but the house did not fall down.

The wolf thought, “This is a clever little pig. If I want to catch him I must pretend to be his friend.” So the wolf said, “Little pig, let me talk to your staff and patients.” So he did, but could find nothing the matter. He was surprised by how compliant the third little pig was. There was nothing to fix. The wolf gave the third little pig full accreditation status and he kept his provider number.

Lesson Learned
The moral to this story is: If you don’t have a living breathing consultant touring your facility, teaching your staff and holding your hand, your house may fall under the pressure of an accreditation inspection.

How do you know if the consultant you are using, or intending to use, is going to build your house with straw or brick?
I suggest that you use four criteria when evaluating what your consultant offers:
1.    How much of your time will be required?
Time is Money: How many hours will YOU be spending building your house? Translate that into real numbers and add it to the consulting fee. Also add the cost of lost revenues due to you and your staff taking time away from marketing, billing, and selling. The Consultant’s Fee + Cost of Your Time + Opportunity Cost = Your TRUE COST of getting ready for the wolf to come knocking.
2.    How much on-site time will the consultant provide for staff training?
One hurdle is for you to understand the accreditation requirements. Another is to ensure that every member of your team be well-versed in these standards, from the front office to your delivery technicians. Can your consultant ensure that all staff will stand up to the surveyor’s huffing and puffing?
3.    Will your consultant be around in the long run to help you stay accredited?
Getting accredited requires several months of compliance. Staying accredited requires three YEARS of compliance. Can you count on your consultant to keep you abreast of changes in rules and regulations? Do they offer quarterly reviews? Can they train new staff?
4.    How will your consultant’s solution integrate and improve your business?
The most effective solution for remaining compliant is one that makes business sense and is easy to use. An implementation that improves your bottom line is likely to remain in place and keep you in compliance. Does your consultant have the experience and knowledge necessary to make you a more efficient and effective company while bringing you into compliance?
With the proposed cuts and competitive bidding looming, every little pig should focus on not only becoming accredited but also taking their business to the next level. A house built of bricks can hold up to a great deal of huffing and puffing.

This article originally appeared in the May 2008 issue of HME Business.

About the Author

Ted L. Jones, Jr., is President and Owner of The Intelligent Business Network Inc. (TheIBNetwork), Los Angeles, Calif., a health care consulting firm providing turnkey solutions for NABP and Joint Commission accreditation, management consulting, and continuous process improvement for healthcare organizations. Ted can be reached via e-mail: or online at


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