When it comes to DME accreditation, surveyors receive multiple inquiries on an ongoing basis regarding how to monitor quality continuously and improve the performance of their organization.
One of the first questions we suggest you ask yourself is how you select the areas you would like to improve. We find that most responses center on the Medicare Quality Standards and their guidelines. Often we find that companies look further and deeper into their organization to determine “why” that specific area, concept or process is important to their company and “what” they are expecting to achieve by managing and collecting data on those areas determined to need improvement. This is the “why” behind the “what.”
The concept of monitoring quality continuously is to locate, identify and correct any company weaknesses you expect to improve. Medicare requires certain areas be reviewed, but within those areas choose what makes the most sense, and what can be the most beneficial to your operation.
You can better evaluate the importance of each area if you take the five areas Medicare requires you to review and break them down into smaller bites:
- Beneficiary satisfaction with and complaints about products and services. Complaint forms/logs seem to be the choice when recording information for this requirement. When documenting information, especially for a Medicare beneficiary, there are certain items (e.g., Medicare HIC number, written notification to the Medicare beneficiary of the results of its investigation and response within 14 days) that need to be recorded on these forms/logs.
Record all information such as: the date and time of the complaint, name/address/contact information of complaint, detailed description of the complaint, investigation of and the resolution to the complaint. By documenting this information, there may be indications of deficiencies within your organization’s structure. By reviewing these quarterly, you have a better opportunity of correcting issues before your competition corrects them for you.
- Timeliness of response to beneficiary questions, problems and concerns. Many organizations categorize this area as ‘incident reports.’ It is important to remember that these are your customers and they have choices as to where they receive their equipment and supplies. Addressing issues and concerns timely can create goodwill and hopefully satisfy your customers. Remember to log the information you receive including the date and who contacted you, the reason for the concern, your follow-up actions, dates and resolution for that concern.
- Impact of the supplier’s business practices on the adequacy of beneficiary access to equipment, items, services and information. There are a wide variety of indicators within this area. Some monitor "after-hour” calls to ensure the patient’s concerns are satisfactorily provided in a timely manner. Other organizations may monitor a business activity such as hours of operation. They may question their own hours to ensure they are meeting the goal of the organization. It may be decided to monitor “after 5PM” set-ups.
Within this review, you may choose to adjust the Service Tech/Delivery Personnel’s work hours. This may help you reduce the overtime dollars spent on late set-ups. Again, remember to record your results. When an indicator becomes a non-issue, select another business activity to monitor.
- Frequency of billing and coding errors (e.g., number of Medicare claims denied, errors the supplier finds in its own records after it has been notified of a claims denial). This review is based on billing, coding and other financial areas. Many organizations evaluate their billing process, how their billing errors can be better managed, which staff needs to receive additional training due to errors found within their scope of billing and collecting, what percentage of collections are received and what can be done to improve these results. These are all good indicators to improve your business model, increase cash flow and ensure your staff is properly trained. Once you identify an issue and correct it, select another indicator to continually increase the quality within your organization.
- Adverse events to beneficiaries due to inadequate services or malfunctioning equipment and/or items (e.g., injuries, accidents, signs and symptoms of infection, hospitalizations). This may be identified through follow-up with the prescribing physician, other healthcare team members, or the beneficiary and/or caregivers. Most companies never experience an adverse event. Your policy and procedures should define what you deem an adverse event. Example verbiage might be: “An adverse event is when a patient is hospitalized or passes away due to or caused by the organization’s equipment or service to the patient.”
There are definite timeframes for researching and reporting an adverse event. You need to have a process regarding the timeframes and who is contacted. There may be a variety of persons contacted, such as the manufacturer, your insurance agency, the referral source, your attorney, etc. Maintain a complete record of all pertinent information, timeframes and what information was reported to whom; keeping in mind any adverse event must be reported to your accrediting body.
It is also noted in the CMS Quality Standards that the supplier shall seek input from employees, customers and referral sources when assessing the quality of its operations and services.
Summarize and document your results and your findings on a quarterly basis. Define your intentions on improving the results of your quality program. Annually, at a minimum, bring your results to the organization’s leadership for further review and definition of how to proceed. Use this structured format to help your organization move forward. This program only benefits you when you use it.