1. Mandatory Accreditation: Can We Afford It? AARC 51 st International Respiratory Congress Bob Floro, RRT, Associate Director Joint Commission December 3, 2005

2. Topics for Today Value of Accreditation Value of Joint Commission Accreditation MMA and Mandatory Accreditation Can We Afford It?

3. Value of Accreditation

4. 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

5. Improves Patient Safety Public Notice to Patients and Employees Standards Compliance Performance Improvement Culture

6. 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

7. State and Federal Recognition State Recognition of Accreditation – HME Licensure CMS – Recognition of Quality Growth Post MMA

8. Access to Third Party Payors Private Carriers – Traditional and MCO State Medicaid Programs CMS! – Payment for Quality

9. Deemed Status Definition Equivalent Standards

10. Joint Commission Accreditation

11. 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

12. Standards And Survey Process Development Internal Resources – Program – Standards – Research External Resources – Advisory Councils – PTAC – SSP

13. Patient Focused Survey Process Patient Tracer Methodology Systems Tracer Methodology Value – Third Party View – Standards of Practice – Education and Consultation

14. 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

15. Surveyor Qualifications Bachelors/Masters 5 Years in HME Professional - HME Specialist, RCP, & Rehab Tech Training – Initial – Conference – Distance Learning Accountability – Certified – Supervised Observation – Scans

16. Improved Access to Referrals Recognition of Joint Commission Accreditation Similar Processes Public Awareness – Speak Up

17. 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

18. Professional Recognition in HME Since 1988 Clinical Respiratory Services Rehabilitation Technology

19. Culture of Quality Continuous Process – 100% - 100% Elimination of Survey Prep PPR Accountability to Public

20. The MMA and Mandatory Accreditation

21. 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

22. Competitive Bidding Specific Equipment Categories Implementation Schedule and MSA’s CMS Quality Standards Concern for Small Businesses Bidding Mechanisms PAOC (www.cms.hhs.gov)www.cms.hhs.gov

23. Equipment Categories Categories vs. Single Items High Dollar Categories High Volume Categories Some Suspects: – Oxygen – Diabetic Equipment and Supplies – Wheelchairs – Orthotics/Prosthetics

24. Implementation Schedule And MSA’s Definition – MSA January 2007 – 10 MSA’s January 2009 – 80 MSA’s January 2010 – All Participants

25. 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

26. 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

27. Accreditation Fees

28. Fees Based on 3 Factors Services Size Number of Locations

29. 2006 HME Fee Calculation – 3 Years Classification:Size:Fee: Very Small1 – 50$3565 Small51 – 300$5185 Medium301 – 999$6900 Large1000+$9790

30. Miles from Main Site:Fee Per Site: Less than 59 $395 60 - 119$730 120 – 199$1070 Over 200$1380 2006 Fee Calculation - Locations

31. Can We Afford It? Cost of Preparation Cost of Maintenance Cost of Survey Value vs. Cost Cost of Culture Change

32. “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

33. Joint Commission Home Care Accreditation Program Central Office – 630-792-5000 (www.jcaho.org)www.jcaho.org Program office – 630-792-7441 Bob Floro – 630-792-5741 (rfloro@jcaho.org)rfloro@jcaho.org Account Representative – 630-792-3004 Standards Interpretation – 630-792-5900