Until recently, the word on the street was that competitive bidding would officially begin in October 2007. With the new rule just finalized, that date has been pushed to April 2008. What does that mean for providers who have yet to seek accreditation? Can they linger even longer?

The experts say don't delay. The accreditation process takes time. But equally important, you should be seeking accreditation for reasons beyond access to competitive bidding. You might say that accreditation is a little bit like the Good Housekeeping Seal of Approval. It can only enhance your business for the future. And with competitive bidding under way, the future is now.

According to the new competitive bidding rule, HME providers will need to submit bids this year. But the good news, says industry consultant Mary Ellen Conway, president of Capital Healthcare Group LLC in the District of Columbia, is that you don't necessarily have to be accredited just yet. "I am relieved that companies just have to be ‘in the process' of accreditation rather than actually accredited to bid," says Conway.

However, that does not mean providers should drag their heels, either. "It takes a good 3 to 4 months at minimum to gain accreditation," says Conway. "Providers need to get going!" What's more, Conway cautions providers against bluffing. You can't pretend that you are "in the process." "Providers should be made aware that the accreditation agencies are required to tell CMS every month who is accredited, who is in the process, and who is scheduled for a survey that month," says Conway. "In other words, you can't fake it."

OPPORTUNITY TO IMPROVE BUSINESS PRACTICES

Compliance with new regulations is never a welcome experience for any business, but the transformation to a competitive bidding environment and the accreditation process that goes along with it gives providers some surprising advantages. Companies large and small are discovering that the accreditation process is not only easier than expected, but once installed, it can help guide your business into a more efficient and profitable direction.

For example, Blackburn's Medical in Pennsylvania has been accredited for 10 years. Blackburn's specializes in clinical respiratory, basic HME, high-end rehab, and dispensing pharmacy. "You have to buy into the accreditation process as a way to make your company better, not just because it has to be done for competitive bidding," says Dawn Cetti, CFO of Blackburn's. "With accreditation, we've brought more consistency to our company; we've raised the bar for standards and customer service, and ultimately provided better patient care."

Cetti has no doubts about the advantages of accreditation. "It forces you to look at processes and procedures and find ways to operate more efficiently," says Cetti. "It also forces you to look at budgeting and financials, and identify performance improvements and new trends in the industry."

Mary Ellen Conway

Alan Derr

Alan Derr, president of Derr Medical Equipment Inc, Manheim, Pa, agrees. With more than 20 years in the industry, he just recently got accredited after he and his wife started their own business 3 years ago. "We didn't see it as an option," says Derr. "Accreditation was at the top of our business plan long before we heard about competitive bidding." Derr claims accreditation gives him a clear competitive advantage and more credibility in the marketplace. "Without accreditation, you put yourself in a position of inferiority," says Derr. "With it, we have risen to the highest standards."

WHICH AGENCY IS RIGHT FOR YOU?

There are currently 11 CMS-approved accreditation organizations responsible for the task of qualifying HME providers. Each has certain strengths and weaknesses in relation to your business, so selecting which agency is right for you will take a little research on your part. Much of the process, which often takes 6 to 10 months to complete, depends on how you are currently doing business.

If you already do activity-based costing and activity-based management, you may be well on your way. However, if your company has picked up some bad habits or substandard practices, accreditation could take as long as a year. Either way, there is no getting around the fact that accreditation will give you new responsibilities and change the way you do business—many think for the better.

It was just this past December when Derr Medical Equipment received accreditation. Derr provides first-time accreditation seekers with some insight into choosing an agency. "Examine all of your options," says Derr. "Find an accreditation body that works for your company, not necessarily the most widely known one in the business."

Indeed, Derr recommends contacting all of them by phone. He says you can quickly tell by speaking with a representative just how helpful they are likely to be. The next step is to narrow down your list to those you think can identify your company's specific strengths and weaknesses. Of course, price also enters the decision-making process. Cetti concurs. "You should look at the fees because they can be very expensive," says Cetti, whose company was accredited a decade ago. "It used to be they all charged about the same, but now pricing is more competitive."

After you have narrowed your choices, contact other providers with businesses similar to yours, Derr suggests. "But make sure you compare apples to apples. If you're a general HME provider, don't ask a provider who specializes in respiratory," says Derr. He also cautions new applicants not to be afraid of the process. "Don't let it intimidate you," adds Derr. "It can be a lot of work if you're not doing business properly, but that's the purpose of accreditation—to raise the standards of the industry."

Derr encourages providers to set realistic time frames for themselves, too. He urges new applicants to be honest about their policies, procedures, and practices and call the surveyor in only when you know you are truly ready.

In retrospect, Derr found the accreditation process to be a pleasant experience, although he points out that for the most part he was already conducting business properly. This is probably why he qualified in a mere 4 months. He was particularly impressed by the personal service he received through his agency. "They assigned a contact person—an accreditation adviser—who helped keep us on track and prepared us for the initial accreditation survey in countless ways," says Derr. "In fact, they knew when we were ready for the survey. We didn't have to guess."

Cetti recommends attending educational seminars on the topic. She points out that it is a good way to meet other providers and get their advice on how they are interpreting and meeting various standards.

WHAT TO EXPECT

Getting through the accreditation process smoothly requires managing your own expectations and understanding the expectations of the accreditation body.

Derr advises providers not to put all the pressure of gaining accreditation on one individual in your organization. It is better to delegate duties and work as a team. Accreditation should be a company-wide project. He urges providers to consider the opinions of nonmanagement staff as well. "Some of the most informed people are employees who handle day-to-day operations."

Cetti says good communication is key to a successful process. "It's not who you choose. But once you get their standards, the challenge is understanding what the standards actually mean and determining how to meet them," says Cetti. "You need to communicate well with the agency to understand just how far you should take the standards."

She warns to expect the unexpected when it comes to meeting certain standards for home health care. For example, drivers may be required to perform the time-consuming task of checking electrical outlets, smoke detectors, and even slippery area rugs. This requirement may be appropriate when oxygen equipment is being used, but, according to Cetti, it is "a bit much" when the driver is merely delivering a hospital bed. Nonetheless, the standards put a high premium on patient in-home safety, so they must be met. And it is up to you as a provider to determine just how far you are expected to go based on your accreditation agency's guidelines.

The accreditation process applies to how you work with employees, too—not just patients. The standards may require that you provide employee training on hazardous materials, lifting, safety issues, and numerous other areas of competency. They must be evaluated on a regular basis, but once you adopt the standards of quality care every day, you will find excellence from everyone in your company. As Cetti points out, "Although the first survey is the hardest and most time-consuming, once in place it becomes an everyday custom of how you do business."

Nevertheless, the process sometimes requires that you write detailed job descriptions, assess competencies, and conduct yearly reviews for your staff. The upside, Cetti maintains, is that these procedures have a positive effect on employee morale and job satisfaction. "Employees are less frustrated because they know how to do their jobs correctly. That improves company performance and contributes to profitability, too," says Cetti.

AN ONGOING PROCESS

Earning the accreditation seal of approval is just step one. As providers know, CMS accreditation is a continuing process that requires yearly maintenance surveys. This periodic self-assessment process is done online. That means you will need to be organized and dedicated to running your business according to specific standards.

To stay prepared for the annual survey, Blackburn's has formed committees comprised of management employees who meet each month to assess trends and address new issues as they arise. New standards are added to a spreadsheet to keep current. "It takes commitment, time, and, therefore, money," Cetti admits, "but it's money well spent." Blackburn's continued vigilance also keeps them well prepared for occasional "surprise visits" by accreditation agencies, which use this tactic every 3 years or so.

For more articles on this topic, search for accreditation in our free online archives.

All in all, both HME providers we interviewed agreed that the accreditation process has had a favorable impact on their businesses. "It makes you an exemplary provider," Derr asserts, "The kind that sets an example in the industry." It also can provide access to additional revenue sources. "It has opened doors to other pay sources for us," says Derr. "Certain private insurance companies will work only with accredited providers."

Perhaps the larger message is that, after a considerable delay that may have given some providers a false sense of security, the competitive bidding program is finally going forward. Legislative remedies may be on the way, but they might not. Regardless of what happens, there is no time like the present to gain accreditation—especially since the future is now.

Marianne Matthews is a contributing writer for  HME Today.