Guest post by Mary Nicholas
Hospitals and other health providers contract with thousands of home medical and durable medical equipment suppliers. However, the recent gatekeeper practices of insurance companies may be complicating their decision-making process and potentially driving up costs.
I am talking about a practice known as "accreditation by choice." That is a process whereby insurers reject coverage for a particular device or service if the supplier is not accredited by a specific organization they mandate. Such policies may have little to do with the overall quality of the product.
There have been some very disappointed suppliers as of late who have contacted me due to their facing a potential substantial loss of their business with a third party insurance contract, all based on who has accredited them. If one really thinks about this situation, potentially great suppliers are being excluded because they may have solely received accreditation to contract with public healthcare systems from the Centers for Medicare & Medicaid Services. Believe it or not, this accreditation is often not acceptable to insurers these days.
Certainly, the vast majority of hospitals are accredited, but usually through a single agency: The Joint Commission. Were a hospital system told that in order to take a certain private insurance company's beneficiaries they had to be accredited by additional agencies, you can bet their costs for that accreditation would increase.
Accreditation by choice is an exclusionary tactic that, frankly, is unfair and illogical. I know I am hedging a bit close to discomfort when I say that this practice seems not so far away from denying someone a membership because of their religious or educational affiliation. It's a stretch, I know. But I am mad. Mad on behalf of the thousands of customers/providers/suppliers that in good faith made a choice that was 100 percent acceptable in the eyes of the public healthcare system, only to find out that the same choice creates exclusion in the private healthcare sector. What sense does that make? Does private healthcare do a better job? Does private healthcare guarantee higher quality? I think it would be tough to prove.
If suppliers can prove that on their own merits, they should be considered for contract opportunities. They should dare the insurance companies to look past whose name is in the "Accredited By" line, and look inside the organization at its quality of service, commitment, and equipment.
And I dare the insurance companies that use accreditation as their sole determinant for approvals to develop criteria to ensure the suppliers are of the quality and distinction that is required, and to quit using accreditation organizations as the bargaining chip.
Otherwise, hospitals and other provider organizations may not know what kind of quality and cost opportunities they are missing and, ultimately, patients and the bottom line may lose out.
Mary Nicholas is the executive director of the Healthcare Quality Association on Accreditation, which provides accreditations for home medical and durable medical equipment suppliers.