'It gets complicated'

YARMOUTH, Maine - It's not the first time HME providers have felt like they landed on the short end of the stick when it comes to accreditation.

Several years ago, the Department of Veterans Affairs (VA) came close to limiting providers to being accredited by one accreditation agency. The VA ultimately decided providers could be accredited by any agency, but that the agency's standards had to at least meet the Joint Commission's standards.

What's been the impact of that requirement?

"We still lost the potential business of a very large customer based on their fear that the VA wouldn't accept their accreditation," said Mary Nicholas, executive director of HQAA. "But we're making some headway with some of the regional centers."

Industry stakeholders suspect that WellPoint and the VA have requirements like these as a way to limit the number of providers they have to work with and to reduce the amount of administrative work they have to do.

That desire's not going to go away anytime soon. So in many ways, it's up to the accreditation agencies to be aggressive advocates for their standards and their providers, says Tim Safley, clinical manager for HME, sleep and pharmacy, for ACHC, which is one of three agencies approved by WellPoint.

"We've fought this battle since 1993," he said. "We were around before accreditation was cool and it was only the Joint Commission and CHAP. We've had to prove our worth through countless memos and emails, and through a comparison of standards. It gets complicated."

There's another reason for the requirements: Not all accreditation agencies are created equal, even among the 10 agencies approved by Medicare, says Margherita Labson, executive director of the homecare program for the Joint Commission.

"That's increasingly become a challenge for payers," she said. "Are they going to recognize all 10 as equivalent or do they look underneath that and see what's involved in the process? I think it makes really good sense to do that."