Home Health Care: The Politics of Certification

Jon Springer

Gaining accreditation from the Centers for Medicare and Medicaid Services to sell prescription durable medical equipment billing through Medicare Part B is difficult, costly and ultimately unfair and unnecessary, retailers say. But there's one benefit.

“It means never having to say ‘no’,” according to Rebecca Lichucki, pharmacy manager of Topco Associates, the Skokie, Ill.-based private-label cooperative. Lichucki in September completed a year-long effort to provide member supermarket retailers with a “turnkey” program toward accreditation. Around 1,000 stores, primarily small chains, participated in the program.

“When you have a diabetic patient — which is the biggest market for this — you don't want to have to tell them to take their business elsewhere,” Lichucki explained.

“But if you're not accredited and you can't bill Medicare for the strips, you're at risk not only for losing the prescriptions for their diabetic testing strips, but likely, other prescriptions they take and their family takes. This program lets you say ‘yes’ to every person who walks through the door.”

To grant accreditation, CME requires a lengthy list of procedures and facility requirements.

“The most difficult part about being in the home health business was preparing for it — and, as the saying goes, you can't overprepare,” said John Acosta, vice president of pharmacy for Stater Bros. Markets, San Bernardino, Calif. Stater, he said, was the first retailer to gain accreditation under Topco's accreditation program.

“It was a lot of work for us to make sure the stores and people were ready. Most of it was making sure our pharmacists knew what was covered and the policies and procedures — even though the guidelines were changing until the last minute. We also had to incur the cost of surety bonds.

“We could have opted out of it and it wouldn't have hurt our business that much,” Acosta noted, “but if a shopper comes to you needing an item and you can't bill it because you're not accredited, they're going to go to CVS. We did it to compete.”

Trade groups including Food Marketing Institute have argued against the certification requirements for pharmacies, noting that CMS has the discretion to exempt certain providers from those requirements.

“Pharmacies are licensed and highly regulated, subject to stringent state laws and regulations that inspect and control the scope of pharmacy practices,” Cathy Polley, vice president of pharmacy services for FMI, told SN. “Requiring accreditation for state-licensed, retail pharmacies is duplicative and unnecessary.”