Mandatory Accreditation Legislation Gains Support
If the US Senate has its way, the president will soon sign into law a bill that would require all HME dealerships doing business with Medicare to be accredited—and so far, the American Association for Homecare (AAHomecare) and several accrediting organizations favor the idea.

The legislation, which was included in Section 430 of the Senate’s Medicare reform bill (S.1), was, at press time, under consideration by the joint Senate and House committee charged with resolving the differences between their respective Medicare bills. If it makes it into the final Medicare bill, which the president has pledged to sign into law, the US Secretary of Health and Human Services would select independent accrediting organizations after consulting with an expert panel of physicians, practitioners, suppliers, and manufacturers.

This expert panel also would review the standards developed by the accrediting bodies. HME providers then would have 3 years to obtain accreditation.

AAHomecare said in a position paper released in mid July that it supports the proposed legislation, but would like to see a few revisions, including

• Providing DME companies with 5 years to adapt to the regulatory requirements;

• Permitting DME companies currently accredited by approved national accreditation organizations to be “deemed” to have met the federal standards if the accrediting organizations’ standards meet or exceed what the federal government requires; and

• Including DME industry experts and specialty groups on the expert panel.

The 2003 Medicare Payment Advisory Commission report released in June accounted for approximately 50,000 Medicare providers, but the accredited number is only a fraction of that figure. Currently, the Accreditation Commission for Health Care Inc (ACHC) accredits 150 to 170 DME dealerships, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredits 1,800 DME suppliers. However, JCAHO’s number could include hospice or home care.

ACHC and JCAHO say they too support mandatory accreditation and are ready for the influx of providers that would inevitably result.

“The DME world has often been criticized by Congress for not performing the way they would like them to perform, and so they are always up for cuts, which is a shame because it is the reputation of the few that seems to be impugning the multitude,” says Margaret VanAmringe, vice president for external relations at JCAHO. “I believe that to the extent that [the DME industry] can show that [it is] meeting state-of-the-art, professionally based standards, then I think that will take ammunition away from some policy makers who like to attack the DME industry.”

VanAmringe says that since the legislation would weed out organizations that could not meet accreditation requirements, providers that could make the cut would have access to the market they deserve.

Even if the legislation does not pass, Thomas E. Cesar, ACHC president/CEO, suggested dealers start thinking about accreditation. The fact that legislation exists at all shows that lawmakers are more conscious of the need for industrywide standards, he said.

“My thought is that if it doesn’t come now, it’s going to come eventually,” Cesar said.

Both Cesar and VanAmringe said providers can spread accreditation costs—ranging from $3,300 to more than $9,000, depending on the size of the business—over a series of years.

“There is a significant cost to poor quality,” VanAmringe says. “So, it’s a modest accreditation cost, but the huge benefit you get from accreditation is well worth the dollar.”

Hammering “Home” the Industry’s Message
While it became clear in July that it would take well into the fall to resolve the vast differences between the House’s Medicare legislation (HR.1) and the Senate’s (S.1), the American Association for Homecare (AAHomecare) kept up its lobbying pressure.

Much was at risk, as there was a strong possibility the joint Senate and House committee charged with formulating a compromise bill could decide many of the provisions affecting the home health care industry before the entire legislation was finished. (See “HME Issues in the Medicare Bills” chart.)

Besides urging members to contact their legislators and ask their customers and local chambers of commerce to do the same, AAHomecare pushed the industry’s agenda at a July 15 meeting with White House staffers and at a July 17 breakfast with Senator Charles Grassley (R-Iowa), chairman of the Finance Committee and one of the sponsors of the Senate bill.

“With so much at stake for our home care patients and providers, we are pursuing every avenue and every resource available to communicate our message,” said AAHomecare President and CEO Kay Cox. “We are firing on all cannons at all times.”

To help get the message out and make it easier for everyone to contact their legislators, the Association also temporarily opened up areas of its Web site normally reserved for members-only to all Internet visitors. To take advantage of these lobbying resources, visit www.aahomecare.org/medicare-campaign.htm.

“This is an unusual time, and we have to respond with the tools that are appropriate for this time period,” Cox explained. “Right now business is not as usual, and we have to react to this with a sense of urgency.”