Hey, knock it off. The VA continues to discriminate against some HME providers

We ran a story last month on how some misguided VA medical centers still refuse to contract with HME providers who are not accredited by JCAHO. The bottom line here is this: The VA can contract with HMEs accredited by JCAHO or by any other accrediting body approved by CMS. That is the law.

In response to that story, Tom Cesar, president of the Accreditation Commission for Health Care (ACHC) sent me this email, which adds further insight into this issue. I found his experiences with the VA interesting and I think you will, too. — Mike Moran

Dear Mike

I read your article this morning regarding the VA and found it very interesting. I have been battling this issue for eleven years. Below is a brief history, started in 1998, of the effort and results of our endeavor to level the playing field with the VA.

There are currently a number of VA Medical Centers that have contracts with ACHC accredited companies. ACHC has been accrediting home care providers for the VA to meet their vendor contract requirements for several years.  After two years and eight ACHC customers being denied access to vendor contracts with VA Medical Centers, in June 2000, I wrote the Under Secretary for Health for the VA, Dr. John Garthwaith. The attached responses from his Chief Quality Director, Dr. Perlin, and General Council clearly state that there is no system-wide policy or requirement to only use JCAHO for vendor contracts.  Progress was made at that time and some ACHC accredited customers were then able to get VA contracts.

In 2002, I met Dr. Tom Edes, Chief of Home and Community based programs, at a conference. He asked ACHC to put together a cross-walk comparing ACHC, JCAHO and CHAP. Later that year, a crosswalk was forwarded to an Accreditation Workgroup that he set-up to compare the standards of the three companies. (See his e-mail response: crosswalk of ACHC, JCAHO and CHAP)  After the workgroup determined that all three were equal, Dr. Edes invited Terry Duncomb from CHAP and me to sit on a panel with Mary Ann Popovich from the JCAHO. All three accrediting organizations educated VA nurses and physicians about their programs at the 2003 VA National Home Care Conference in New Orleans. (See Dr. Edes thank you letter for the presentation 9-4-03)   During the same period, I again asked Dr. Edes if there was any reason that a VA Medical Center should deny ACHC or CHAP customers a vendor contract. His response was consistent with Dr. Perlin's (See VA update for his comments) So, ACHC customers have competed with JCAHO and CHAP for VA health care provider contracts for the past number of years.

However in 2006, we had a couple of ACHC customers again hear these words from VA contracting officers saying, “The VA only accepts JCAHO accredited companies for contracts”.  ACHC certainly understands that the VA system is very large and communications can break down, but we decided that we needed something definitive from the top of the VA to clear up the matter again. Under Secretary for Health, Dr. Michael Kussman was contacted by one of our consultants. He did not agree with this exclusionary practice and had Deputy Under Secretary William Feeley issue a memo (see contracting and Accreditation 4-07) In Feeley's memo he specifically mentions ACHC in the text and warns of inappropriate restriction of trade.  In addition to the memo, on 4-27-07 during a conference call to leadership at the VISN level on page 4 you will find a statement to the same effect read by Fred Downs.

We still occasionally run into some resistance from a contracting officer and use all of the above to hopefully open the way for our customers to compete for a VA contract. I thought this information might be of interest to you in light of your article.