Observation Deck

Gaining the Quality Edge

How can providers measure their quality to attract patients and referral partners?

While in California recently I took part in a conference that focused on healthcare provider quality issues. During one session, the classic 1992 movie “A Few Good Men” was mentioned.

Being a courtroom drama buff as well as having a daughter and son-in-law in the military who have been in harms way more times than I’ll ever know, the film has become one of my all time favorites to the point that I’ve memorized much of the dialogue. Since quality claims were the topic of discussion, I’ve paraphrased a line that Tom Cruse’s character, (Lt. Daniel Kaffee, USN) came to mind: “It doesn’t matter what you believe, only what you can prove!”

Admittedly, a fictional military courtroom drama is a far cry from today’s hypercompetitive DME marketplace. However, one can readily see how Lt. Kaffee’s declaration takes on a certain relevance when you consider how HME providers tout the greatness of their products and service while aiming their marketing messages at payors, referral sources and potential customers and patients. There’s no doubt that they fervently believe what they are saying, but can they prove it? As the President of a “deemed” DMEPOS accreditation organization (AO), it should not come as a surprise to anyone when I say that meeting a Medicare AO’s quality standards will go a long way in substantiating the veracity of your quality claims. However, just stating that you are accredited may not be enough “proof” in this day and age of heightened scrutiny from the government, managed care, journalists, and ever more skeptical patient advocate groups.

So how does a DME provider go about substantiating their quality claims? As I see it, in addition to embracing the benefits of accreditation as a helpful quality improvement process, it’s equally important that HME providers tout the operational strengths and uniqueness of their business model, and back it up with evidence that can be used to differentiate themselves. Your day-to-day operations can supply you with powerful information that can and should be shared with payers, referrals and customers.

Referral Source

As a business owner you know your strengths and weaknesses better then anyone. First, you need to identify the features and benefits of your products and services so you can tailor your approach to meet the expectations of specific referral sources. Given the diversity of providers, here is a snap shot of how a couple common providers types can market their businesses through quality measurement: Complex rehab. Take a complex rehab business, for instance. It’s likely that your referral sources would be interested in your staff’s credentials and whether they are qualified in assessment, measurement and fitting. Note that these are also mandatory accreditation requirements. It would also be very helpful if you show how you track delivery response times. Here are some specific ways to do that:

  • Time from order to initial assessment.
  • Delivery time for custom and non-custom products.
  • Quality control data that supports initial measurements matched to product.
  • Patient data supporting comfort and fit of the product received and outcome.
  • Follow-up policy (e.g., The time frame you contact patient after delivery).
  • Share how you document via a sample patient packet that includes a plan of care, measurement forms for product, product specs and a follow-up form.
  • How a patient is to contact you in case of malfunction.

Respiratory. In the respiratory sector of DME, it is vitally important to communicate to your referral sources that they will have 24-hour/ seven-day access to your services. Response time in delivering oxygen to a patient is often a deciding factor in getting a hospital discharge planner to choose one oxygen provider over another; providing of course you have either won the competitive bid in your area or your are outside bidding area.

Payors

The Affordable Care Act (ACA) mandates that as of January 1, 2015, managed care and third party payers need to base provider fee schedules on value, not volume. A provision in the Act ties physician and provider payments to the quality of care rendered; not just that a service was performed. Physicians and other provider organizations will see their payments modified so that those who demonstrate better care will receive higher payments.

In terms of Medicare Advantage plans, the Centers for Medicare and Medicaid Services (CMS) strengthened the ACA “five-star” plan bonus system with a demonstration that accelerates and increases the incentives for improvement in the quality of care provided to nearly 13 million beneficiaries. True, DME’s are only an ancillary provider to Medicare Advantage Networks, but all DME businesses are driven by a doctor’s orders. So if physicians are being held accountable, so will all of their ancillary providers (that’s you) in terms of products or services offered, area served, quality, and price. Physician will choose the best option for their patient.

Equipment and Patients

Demonstrate your products’ superiority and ability to serve specialized needs. Also, present data on the percentage of breakdowns, because fewer breakdowns translate to fewer repairs and less inconvenience to patients. Show how long it takes to fix or replace a product when repairs are needed, and whether or not you repair on-site for quick turn around? (Those are selling points.)

For patients, documentation is your most powerful tool. When giving patient and caregiver instruction, track data on patient/caregiver understanding; data on re-visit after instruction: and low to no patient incident on equipment. Survey patient satisfaction, and track data on patient outcomes.

Proving Quality

Communicate your benefit by displaying your Certificate of Accreditation. Share satisfaction survey results with your customers and patients. Post all in places where they will see it (e.g., website, office, retail space). Communicate to your client how you are going to meet their needs, such as evaluating their needs personally; instruction by competent caring staff; instructions via website and brochures.

Also, ask your current customers why they chose you to be their provider. What do they like about your business? Ask them how you can improve. Its all about continuous improvement.

Now I admit that the above evidence gathering tips may not be as sexy as a Hollywood courtroom drama, but they will undoubtedly help you present the proof that will help you win your case.

This article originally appeared in the August 2014 issue of HME Business.

About the Author

Sandra C. Canally is founder and CEO of The Compliance Team, Inc., which was approved by CMS in 2006 to accredit all types of DMEPOS businesses. For more information, visit www.exemplaryprovider.com or e-mail info1@tctinc.us.

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