Testimony on House Bill 105

 

Before the

House Commerce and Labor Committee

 

May 20, 2003

 

 

Kelly Friar

Vice President of Care Continuum Businesses

Mount Carmel Health System, Columbus

 

On behalf of the

Ohio Hospital Association

155 East Broad Street 15 FL        Columbus, OH 43215

614.221.7614        614.221.4771 (fax)        www.ohanet.org

 

Chairman Young and members of the House Commerce and Labor Committee, my name is Kelly Friar and I am Vice President of Care Continuum Businesses at Mount Carmel Health System where I oversee Mount Carmel’s home medical equipment program. Mount Carmel is a three-hospital system of more than 7,500 employees, 1,200 physicians and 1,300 volunteers located here in Columbus.

 

I am testifying today as an opponent to HB 105 on behalf of the Ohio Hospital Association. OHA represents Ohio's 170 community hospitals, which employ more than 230,000 health care workers across the state of Ohio.

 

HB 105 would license the approximately 450 home medical equipment providers which operate in the state of Ohio through the Ohio Respiratory Care Board. Proponents of the legislation have stated that this legislation is necessary to protect consumers, citing a lack of quality standards in the home medical equipment industry. For some HME providers in the state, licensure may be appropriate to ensure that quality standards are in place to protect Ohio consumers.

 

But it is important for the committee to know that the majority of HME providers operating in the state of Ohio meet stringent quality standards which are continuously reviewed and improved by the medical community. That’s because nearly 275 HME providers in the state are accredited by the Joint Commission on Accreditation of Healthcare Organizations.

 

The Joint Commission was established over 50 years ago as an independent, not-for-profit organization.  It is governed by a board comprised of physicians, nurses, and consumers, and its sole purpose is to set the standards by which health care quality is measured in health care facilities around the country and around the world. 

 

The Joint Commission accredits over 17,000 health care organizations, including hospitals, HMOs, nursing homes, outpatient surgery facilities and home health service providers. 

 

The standards established by the Joint Commission for HME providers are extensive. I’ve provided you with a synopsis of the standards. As you will see, they focus on patient assessment and education; the delivery, setup, maintenance, and emergency replacement of equipment; patient rights; and other quality standards.

 

In addition, Home health care must comply with six evidence-based patient safety goals. They include: ensuring accuracy of patient identification, effectiveness of communication, safety of using high-alert medications, safety of infusion pumps, and effectiveness of alarm systems associated with equipment.

 

To ensure these standards are met, JCAHO surveys accredited organizations every three years, and conducts unannounced surveys throughout the accreditation cycle to ensure compliance. The purpose of the survey is to evaluate the organization's performance in areas that affect patient care.  Accreditation may then be awarded based on how well the organizations met JCAHO standards.

 

The surveys are intensive, taking 2 to 4 days to complete using 2 to 5 surveyors comprised teams of physicians and nurses. Surveys also include visits to patients’ homes to ensure quality service standards are met. Beginning in 2004, JCAHO is increasing time spent in the direct patient care areas to further enhance the review of quality and patient safety.

 

As you can imagine, obtaining JCAHO accreditation is time consuming, and it’s also expensive, costing roughly $15,000 for a medium-sized HME provider. Previous testimony on this legislation has suggested that accreditation is voluntary, which is true unless an HME provider wants reimbursed. Most private health insurers require JCAHO accreditation before they will contract with an HME provider. Also, Medicare recognizes the extensiveness of the Joint Commission and will forgo requiring HME providers to meet Medicare’s standards if they show proof of Joint Commission accreditation.

 

Over the past few years, the Joint Commission has improved its outreach efforts so that the public can compare accredited providers and know where to turn if they have any concerns about quality or patient safety.  After the Joint Commission completes its survey process, results of the survey are posted on the Joint Commission’s website so that patients can compare which provider has best met the quality standards and choose the provider that’s best for them.

 

Patients who have concerns about the quality of care or services they received can call, fax or e-mail their concerns to the Joint Commission. Depending on the severity of the complaint, the Joint Commission could immediately conduct an unannounced, on-site inspection of the organization. If the organization was in violation of JCAHO standards, the Commission could reduce or remove the organization’s accreditation status. This would result in the loss of all private insurance and government reimbursement, essentially bringing immediate closure to the facility.

 

HME providers take very seriously their responsibility to continually adhere to Joint Commission standards. It is important to recognize that several other government entities also have regulatory jurisdiction over HME providers, including the Food and Drug Administration, the Occupational Safety and Health Administration, the Office of the Inspector General, the Centers for Medicare and Medicaid Services, the state fire marshal, the departments of Commerce and Transportation, and the state Pharmacy Board.  Furthermore, there are other aspects of the provision of home medical equipment that would not fall under the scope of Respiratory Care Board.

 

OHA feels additional regulation of HME providers which are JCAHO accredited is unnecessary. Quality standards required by the Joint Commission and other requirements of various state and federal regulatory agencies ensure that home-care patients have access to high quality equipment and services. For this reason, OHA requests that the committee consider amending HB 105 to fully exempt HME providers which obtain and maintain JCAHO accreditation from licensure.

 

Thank you for the opportunity to testify today and I would be happy to answer any questions you may have.