Using the Accreditation Multi-Tool
The role accreditation plays in HME has expanded beyond a simple Medicare requirement. How can providers maximize its value?
- By David Kopf
- May 01, 2019
Ever since providers had to become accredited in order to bill Medicare, the importance of accreditation has continued to grow. Where accreditation once was something providers sought out as mainly a requirement they needed to fulfill, they quickly realized that accreditation can help them better respond to immediate industry changes and market opportunities.
Moreover, accrediting organizations now offer specialized accreditation programs to help providers distinguish themselves as expert providers in certain types of care, which helps them differentiate from their competitors.
A STRATEGIC ASSET
While providers continue to need accreditation to bill Medicare, how providers are using accreditation has changed over the years, according to Timothy Safley, MBA, RRT, program director of DMEPOS Pharmacy and Slate for Accreditation Commission for Health Care (ACHC).
“We’re seeing more and more people get accredited but are not necessarily playing in the Medicare market,” he says. “In other words, they’re getting accredited for payers, but CMS may or may not be one of them.”
For example, sometimes a state Medicaid program or a private payer will require providers to be Medicare accredited. Or, the provider might not even need Medicare accreditation, but continue to seek it out because they feel it brings value, Safley says.
“I think providers are using it strategically because even if they’re not playing in the overall Medicare market, they’re using it to be a differentiator between themselves, say, for a national contract,” he explains. “To give you an example, we have many companies that decided they’re not going to play with Medicare, so they’re not mandated to be accredited. However, they chose to be accredited, because they see it as a differentiator between them and other people when they put out their bids.”
Earning accreditation is a way for providers to affirm their business model, and inherently reflects the use of solid, verified best practices, says Matthew Gruskin, MBA, BOCO, BOCPD, credentialing director for Board of Certification/Accreditation (BOC).
“Accreditation sends a message to patients and the competitive community that a facility is committed to meeting and exceeding national standards for competence, professionalism and safety,” he notes.
ACCREDITATION AND THE BIDDING GAP
When it comes to market and changes and opportunities, once such trend immediately facing providers is the competitive bidding gap. Per CMS’s final ESRD/DMEPOS rule issued in November 2018, competitive bidding went dormant for a period lasting 18 to 24 months starting Jan. 1. Moreover, per CMS Final Rule any Medicare accredited DMEPOS provider can offer items for which they didn’t have a contract.
For providers that were unable to successfully bid a contract for a competitive bidding area or a product category they might have previously served, this could represent a tremendous opportunity. That said, they might have let their Medicare accreditation for a particular category lapse and would need to get accredited again.
“It’s an opportunity for them to not only rise to the occasion for their own businesses, but to serve their patients in their community in additional ways, but they’ve got to be mindful and strategic about it,” says Sandra Canally, RN, the founder and CEO of The Compliance Team, a CMS-approved accreditation organization that is celebrating its 25th anniversary.
First, it’s all about market assessment. Canally says providers must first assess the number of patients in their area that would likely use these additional products. Then they must identify what referral sources are going to actually give them orders over, and how they can help those physicians and other healthcare professionals better meet the needs of their patients.
Once providers have done that, then they can approach accreditation, and there are several things they must do in that regard, she says.
“We have a variety of things that we tell the providers to do,” she says. “Number one is, they really need to identify the state licensure database through the Supplier Clearinghouse and look at what licenses may be needed to do these additional products, whether it’s license and certification of personnel, or whether it’s they’ve decided that, okay, they’re in Illinois, and they also want to get into Ohio, and Iowa, and so forth. Well, then they need to check whether or not licensed personnel or even state license is required to do that.
Also, providers pursuing accreditation for new lines opened up by the bid gap need to understand the varying state requirements related to the categories they want to serve.
“They need to review the HCPCS codes and for what they’re considering and what is categorized as capped rentals and so forth — what’s off the shelf, what is prefab — all of the things for which the different states have different requirements,” she explains. “The other thing that is relevant is the local coverage determination. They must have a good understanding of what the key elements are for coverage.”
And there are additional requirements, such as training, that are part of the accreditation process, according to Canally.
“We ask for the additional license,” she explains. “We ask for proof of training, proof of policies and procedures that relate to these additional products where they haven’t really done them before, and we want to make sure that they’re capable with doing the right instruction of the patient.
“Last but not least, The Compliance Team or any AO’s quality standards and how they can ensure that they’re meeting the evidence of compliance to meet those quality standards, whoever they’re accredited by,” Canally adds.
At this point, it should be clear that over the years accreditation has morphed into a strategic asset for providers. Accreditation is not just a list of tasks that a provider must fulfill in order to meet billing requirements on a state or a federal level. Rather, it is a competitive edge that shows how they can provide solid product category knowledge so that their referral partners and their patients are going to feel that they are working with an expert resource.
And, to that end, accrediting organizations are starting to offer special designations to help them do that.
“We’re looking at elevating the standard so that these providers are raising the bar so that they do have that market differentiation,” Canally says. “… It goes back to the value-based care models across the country.
Bearing that in mind, The Compliance Team introduced a special accreditation program called Patient-Centered Medical Home into the pharmacy arena that helped pharmacists communicate to prescribers that they offered additional service levels and would help act as a “hub” for medication care management. This has led to other specialized accreditation services, Canally says.
“It was a very successful model, and now, we’ve taken it a step further into respiratory with Patient-Centered Respiratory Home,” she explains, adding that this latest specialized accreditation program helps respiratory providers show referrals that they focus on “the higher level of clinical expertise and quality being delivered to these patients; that care coordination; taking that respiratory DME and having them partner with the pulmonologist and the various physicians that are managing their patients for COPD.”
The respiratory service sets higher quality thresholds so that providers holding the distinction can further differentiate the respiratory services and quality standards they offer to referral partners’ patients. The program, which won HME Business’s 2018 New Product Award for Business Services, is the first accreditation program designed to help advanced respiratory care providers perform at the top of their license to better serve patients. The program uses concise measures to help the provider prove it functions to a higher standard, Canally says.
“There’s a real opportunity there for the providers, for their patients, to get this additional care and service,” she adds.
In addition to the business, there are ways that providers can work with accrediting organizations to also ramp up their staff’s skills, as well, BOC’s Gruskin adds.
“Many HME providers now pursue staff certification as an additional opportunity to gain a competitive edge. Unique certifications like BOC’s Certified Durable Medical Equipment (CDME) Specialist allow businesses to prove HME proficiency to patients, referral sources, payers and any additional stakeholders,” he explains.
Ultimately, what these special designations help providers show how they can contribute to value-based care, Canally adds.
“It’s differentiating yourself and that validation of quality by a third party,” she says.
“Sometimes, I say, “Forget the word ‘accreditation.’ Call it something else. Call it your blueprint to quality and your quality initiative, and this is how you can show payers that you’re helping patients stay out of the hospital, stay out of the emergency department. This is what we’re focused on now.”
PICKING AN ACCREDITING ORGANIZATION
So, if accreditation can offer multiple ways to help providers sharpen strategic edge — a multi-tool to help HME providers run their businesses, so to speak — how do they find they right accreditor?
ACHC’s Safley advises them to shop around, and a primary selection criterion is communication; providers want an accrediting organization that provides useful and regular communication.
“It can’t be about you paying money and then you walk away and you don’t hear from an accreditor for three years,” he says, adding that this is particularly important for smaller providers. “Being a small provider, it’s so hard to have the resources to reach out for regulations that change or to ideas that change.
“The accreditation needs to be a resource for you to understand ongoing compliance and regulatory issues pertaining to whether it’s government or whether it’s private payers, or whether it’s even acceptances of an accreditor or acceptance of your program,” he continues. “That’s the most value that any accreditation can give today.”
Ultimately, what providers need is a partner, Safely says.
“Accreditation can be used as a blueprint or a guide to make sure you’re not only meeting the regulatory statues in either federal or state levels, but also to give you a blueprint to help run your own business,” he explains. “It’s not about getting accreditation just so you can check a box. It’s about choosing an accreditor that can help you help yourself succeed.”
This article originally appeared in the May 2019 issue of HME Business.