Tuesday, August 29, 2006
Business of dealer accreditation seen creating its own competitive spark - home care equipment accreditation
Business of dealer accreditation seen creating its own competitive spark
Just as home care equipment dealers are seeking a competitive edge through formal accreditation, the organizations offering those sales of approval now find themselves sparring over whose industry standards are most meaningful.
Perhaps the best known option for dealers is the program offered by the Joint Commission on Accreditation of Healthcare Organizations. Since June of 1988, JCAHO has accredited more than 600 home care organizations under a program which now employs 18 durable medical equipment surveyors. Heavy hitters which have either gained accreditation or indicated they will seek it include Abbey Foster, Caremark, Glasrock, Homedco and New England Critical Care.
The program has come under fire from some dealers who say its cost are prohibitive for many smaller companies. JCAHO's 1989 survey fees started from a base of $3,700 plus incremental amounts for branches. However, the group is now looking at a sliding scale based on some variable yet to be determined, according to Anne Rooney, associate director of the JCAHO home care accreditation program.
Meanwhile, the National League of Nursing's Community Health Accreditation Program (CHAP) recently published separate standards for home medical equipment, infusion therapy and pharmacy. CHAP has been accrediting other home care providers since 1965.
The group has now positioned itself as the only independent evaluating body for home care and community health driven solely by considerations of management, quality and patient outcomes. Officials claim the biggest difference from JCAHO is that their standards are consistently more stringent than minimum safety standards. They also assert that CHAP looks at the broader elements of a company's management and financial condition, and places more emphasis on patient outcmes than structure and process.
Applying outcomes research to home care represents a unique challenge in that so many of the patients have either chronic or deteriorating conditions. However, CHAP's cause got a big boost last fall with the award of a $1.2 million research grant from the W.K. Kellogg Foundation.
The three-year project will be conducted in two phases. In the first, researchers will survey consumers on their attitudes about the quality of care they have received. Analysts will draw on diagnostic, functional-status, demographic and other data from more than 700 patients. A goal is to determine what can reasonably be expected as an outcome for a given condition, what resources are required and how long improvements should take. In the second project phase, the findings will be implemented as outcome measures and incorporated into CHAP accreditation standards.
According to Carolyn Davis, former head of the Health Care Financing Administration and currently a member of the CHAP board of governors, the accent on outcomes will help channel resources toward the most productive service areas.
"Home care providers often invest time and dollars in expensive cures and sophisticated technology without any measure of the net benefit to patients. In fact many believe we've gotten further and further away from considering what's important to the patient. The quality of care from the patient's perspective has been an elusive thing; providers and consumers alike want to direct their energy--and money--toward really helping the patient," says Davis.
On another competitive angle, CHAP has firmly aligned itself with payers. The Health Insurance Association of America (HIAA) participates in the CHAP governing structure, and officials believe the outcomes study will help insurers make choices over how to reimburse for rapidly expanding home health services.
The stringency of various accreditation standards may emerge as a key issue in coming months, although the problem areas confronting dealer operations do not appear widespread. Since the inception of the JCAHO program, only eight companies have failed to make the grade. JCAHO does, however, identify certain "contingencies," or deficiencies dealers must correct in a given time period in order to gain full approval.
Among the most common problems, Rooney cites an "inconsistent understanding" among personnel on infection control policies. Some handlers, she explains, are not always up to speed on equipment cleaning and maintenance procedures are recommended by manufacturers. Other problems include compliance with OSHA and Transportation Department guidelines on the safe handling of oxygen.
Dealers' choices of accrediting bodies will likely be influenced by perceived value in the marketplace. And toward that end, sponsoring organizations probably scramble to document benefits companies have realized. For example, Rooney suggested JCAHO may soon attempt to identify dealer sales increases realized after gaining accreditation as a partial impact measure.
In its own marketing efforts, JCAHO recently published "Key to Quality: Guide to Home Care Survey and Accreditation." The $75 manual provides an overview of the JCAHO accreditation process and instructions on survey preparation. Also, the group will this year sponsor a series of educational seminars on the process.
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