Mandatory Accreditation:Can We Afford It?

AARC 51st International Respiratory Congress

Bob Floro, RRT, Associate Director Joint Commission December 3, 2005

Topics for Today

Value of Accreditation Value of Joint Commission Accreditation MMA and Mandatory Accreditation Can We Afford It?

Value of Accreditation

Improves the Quality of Care

Meeting Requirements– Accreditation Participation Requirements– National Patient Safety Goals– Standards– Performance Improvement

Survey Process and PPR– External Validation

Through Commitment to Quality Quality and Corporate Culture

Improves Patient Safety

Public Notice to Patients and Employees Standards Compliance Performance Improvement Culture

Compliance and Liability

Regulatory Agencies Law and Regulation Standards

– Rights, Ethics and Responsibilities – All Stds– Provision of Care – Care Planning– Leadership – Responsibility and Accountability– Environment of Care

Operable Equipment PM/Maintenance Records

– Management of Information – Documentation Decrease In Liability Costs

State and Federal Recognition

State Recognition of Accreditation– HME Licensure

CMS– Recognition of Quality

Growth Post MMA

Access to Third Party Payors

Private Carriers – Traditional and MCO State Medicaid Programs CMS!

– Payment for Quality

Deemed Status

Definition Equivalent Standards

Joint Commission Accreditation

Leader In Health Care Accreditation

56 Years Private – Not For Profit 15,000 Health Care Organizations 4,000 Home Care Organizations 1,500 HME Organizations (4,745 locations)

– All Accreditors – Approx. 27% Market Penetration

Standards And Survey Process Development

Internal Resources– Program– Standards– Research

External Resources– Advisory Councils– PTAC– SSP

Patient Focused Survey Process

Patient Tracer Methodology Systems Tracer Methodology Value

– Third Party View– Standards of Practice– Education and Consultation

Consistent Accreditation Decisions

Decisions Based on Consistent Scoring Preliminary Decisions Revealed on Survey Clarification During and Post-Survey Appeals Process Review and Scan

– 100% for Deemed Status

Surveyor Qualifications

Bachelors/Masters 5 Years in HME Professional - HME Specialist, RCP, & Rehab Tech Training

– Initial– Conference– Distance Learning

Accountability– Certified– Supervised Observation– Scans

Improved Access to Referrals

Recognition of Joint Commission Accreditation

Similar Processes Public Awareness

– Speak Up

Representation to Public As A Quality HME Organization

• Public Notice to Patients and Employees• Accreditation Status and Quality Check• Random Unannounced Surveys• Unannounced Surveys• Organizational Responsibility to Promote• Gold Seal

Professional Recognition in HME

Since 1988 Clinical Respiratory Services Rehabilitation Technology

Culture of Quality

Continuous Process – 100% - 100% Elimination of Survey Prep PPR Accountability to Public

The MMA andMandatory Accreditation

The MMA, Competitive Bidding & Mandatory Accreditation

Elements– Competitive Bidding– Equipment Categories– Implementation Schedule and MSA’s– CMS Quality Standards– Approved National Accrediting Bodies– Mandatory Accreditation

Competitive Bidding

Specific Equipment Categories Implementation Schedule and MSA’sCMS Quality StandardsConcern for Small BusinessesBidding MechanismsPAOC (www.cms.hhs.gov)

Equipment Categories

Categories vs. Single Items High Dollar Categories High Volume Categories Some Suspects:

– Oxygen– Diabetic Equipment and Supplies– Wheelchairs– Orthotics/Prosthetics

Implementation Schedule And MSA’s

Definition – MSA January 2007 – 10 MSA’s January 2009 – 80 MSA’s January 2010 – All Participants

CMS Quality Standards

Proposed Standards– Supplier Business Quality Standards (11 pages)

Administration Financial Management Human Resource Management Beneficiary Services Performance Management Equipment and Safety Beneficiary Rights and Ethics Information Management

– Appendices for Supplier Product Specific Service Requirements – Appendices A – O (89 pages)

– Unannounced and 100% Sample

Approved National Accrediting Bodies & Mandatory Accreditation

National Accrediting Bodies to Implement CMS Quality Standards

Equivalency in Standards Joint Commission and CMS

Formal Process for CMS Approval of Accreditor

Volumes and Access to Accreditors

Accreditation Fees

Accreditation Fees

Fees Based on 3 Factors

• Services

• Size

• Number of Locations

2006 HME Fee Calculation – 3 Years

Classification: Size: Fee:Very Small 1 – 50 $3565

Small 51 – 300 $5185

Medium 301 – 999 $6900

Large 1000+ $9790

Miles from Main Site: Fee Per Site:

Less than 59 $395

60 - 119 $730

120 – 199 $1070

Over 200 $1380

2006 Fee Calculation - Locations

Can We Afford It?

Cost of Preparation Cost of Maintenance Cost of Survey Value vs. Cost Cost of Culture Change

“The success of Joint Commission accreditation will be measured by our ability to assist HME organizations in embracing quality patient services and safe provision of care as an integral element of their corporate and organizational culture.”

Philosophy

Joint Commission Home Care Accreditation Program

Central Office – 630-792-5000 (www.jcaho.org)

Program office – 630-792-7441

Bob Floro – 630-792-5741 (rfloro@jcaho.org)

Account Representative – 630-792-3004

Standards Interpretation – 630-792-5900