A Practical Approach toHome Health QualityImprovementMany home health agencies develop elaborate andcomplex quality improvement plans that are often toocomplicated or time consuming to implement. Aneffective quality improvement plan should simply focuson processes that promote positive patient outcomesand business practices. The plan should be guided by the mission, vision and goals of the agency and involve all levels of staff.

ACHC standards take a practical approach to quality improvement. Agencies are given the flexibility to evaluate their ownwork processes and practices to determine any areas that may need improvement. Through this evaluation, agencies are ableto identify problem areas and develop a plan of correction to improve patient care/services. In addition to an annual programevaluation, ACHC standards require agencies to address a minimum of five areas in their quality improvement plan. Theseareas include (examples below):1) An assessment of processes that involve risks (incidents, accidents)2) At least one important aspect related to care/service (delivery of care/service, medication administration, clinical procedures)

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®

501 (C)(3) Nonprofit Organization Volume 17, No. 1 CMS Deeming Authority for:An ISO 9001:2000 Certified Company

S P R I N G 2 0 0 8

The ACHC Difference: Customer SatisfactionOne of the most important items listed in the ACHC Quality Policy is meeting customer requirements. The entire organizationis dedicated to this goal and each team member is always looking for ways to enhance customer satisfaction.

Meeting this policy requirement begins with a good product. In the home care industry, ACHC has earned a reputation forhaving accreditation standards that are clearly written, relevant to the provider market and patient-focused. While ACHC isproud to have developed accreditation programs that have been well accepted, we are especially pleased that the cultureamong staff and surveyors is to serve our customers with courtesy, professionalism and responsiveness. The managementteam ensures and actively encourages this awareness and focus on a daily basis.

INSIDE: Preparing for Accreditation IPage 2

Your Administrative Team I Page 4

ACHC Receives Inc, MagazineAward For Growth I Page 5

Spotlight on Provider:Greensboro Hospice I Page 7

Homecare Sales Strategies IPage 14

DMEPOS and Home Health

Surveyor

Continued on page 5.

(Hospice Approval Coming Soon)

Continued on page 9.

Private Duty Nursing and Private DutyAide Standards Now AvailableACHC is pleased to announce that new Scope of Service Standards for PrivateDuty Nursing (PDN) and Private Duty Aide (PDA) have been released. PrivateDuty Nursing and Private Duty Aide services are usually provided hourly andare covered by various payers, but not Medicare. Nursing Services can beadministered by either an RN or LPN.

The development of these new standards included review and recommenda-tions from a variety of providers, some of which are members of the NationalPrivate Duty Association (NPDA) and the Private Duty Home Care Association(PDHCA). Other new programs that are under development in 2008 includestaffing organizations and behavioral health. n

MAXIM Healthcare Services

One of the fastest growing providers

of home health, medical staffing and

wellness services in the industry with

over 400 locations comes to ACHC.

continued on page 11

If you have been one of those companies who has been draggingyour feet and resisting accreditation, here are some tips for a

successful survey.

TIP ONE:Get your employees involved. Have a kick-off meeting and explainto them the process of becoming accredited, the reason behind itand what their involvement will be. Employees of your organizationare the key to a successful survey. Accreditation does not happenand cannot be maintained with only a few designated peopleinvolved.

TIP TWO:Assign the overall implementation to one individual who will coordi-nate all accreditation activities. To make this process a team effort,assign tasks to other employees and monitor their progress. Examplesof tasks could include developing policies and procedures, organizingclient and employee records, organizing the warehouse and develop-ing the budget. Hold weekly meetings to assure that implementationof the policies and procedures is occurring. The accreditation coordi-nator could also serve as your Quality Improvement Coordinator.

TIP THREE:Get the owners/leaders of the organization involved. The accredita-tion coordinator should report the progress of accreditation to theowners/leaders on a regular basis. The coordinator must also communicate to the owners/leaders their part in the accreditationsurvey. Leadership will be responsible for making sure all licensureregulations are being met; establishing goals and communicatingthese to the employees of the organization; and developing, maintaining and reviewing the budget.

TIP FOUR:Assemble your client admission documents. All clients are requiredto receive specific information at the time of receiving services.These documents include: Patient Rights and Responsibilities,Medicare Suppliers Standards; the organization’s complaint process,your HIPPA privacy notice; marketing materials describing your services, hours of business and phone numbers, including after hourcontact information; and patient education materials. You must devisea way of documenting the receipt of these documents and have thisdocumentation available in the client’s chart for the surveyor.

TIP FIVE:Develop your organizational chart and then write job descriptionsfor all positions on the chart. Job descriptions should contain keyjob duties, reporting responsibilities, minimum job qualifications,experience requirements, education and training requirements forthe job, and physical and environmental requirements with or with-out accommodations. After policies and procedures have beendeveloped, training is a key factor. Any or all employees may beinterviewed during the onsite survey, so training all employees isimportant. Look through the standards and any standard that has“Employee Interview” in the evidence section should be a focus areafor conducting training sessions.

If you are unclear what documents should be present in a personnelfile, you need to refer to the Evidence section following each stan-dard. If “Personnel file” is listed, the surveyor will be looking forsome kind of written documentation.

TIP SIX:Safety and infection control standards are common downfalls fororganizations. Take proper infection control measures to protectyour staff and clients by using accepted disinfectants, and stress frequent and proper hand washing with all employees. Train allemployees on proper infection control procedures, and monitorthem for compliance. Set up your warehouse so there is adequatespace for dirty equipment. Develop policies on transporting, cleaning and bagging equipment.

All your equipment should be up to date for the manufacturersrequired maintenance. If you don’t have current service manuals con-tact the manufacturers for these manuals. You must be able to docu-ment that all rental equipment is currently maintained according to

2 Surveyor Spr ing 2008

If you haven’t started preparing for HME accreditation, the clock is ticking. CMSrecently announced that all suppliers who want to continue to bill for DMEPOSmust be accredited by September 30, 2009. Preparing for your HME survey cantake anywhere from four to 18 months. Can you afford to procrastinate and takethe risk of not receiving accreditation, therefore losing your supplier number andyour ability to serve the Medicare Beneficiary? If your answer to this question isno, then now is the time to start preparing for your survey.

TEN STEPS TO A SUCCESSFUL DMEPOS ACCREDITATION

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the manufacturers’ requirements. If you have not developed aprocess for tracking serialized equipment, start now. You should beable to track the location either manually or through your computersystem.

TIP SEVEN:At a minimum, your Quality Improvement plan must include: 1)beneficiary satisfaction with and complaints about product(s) andservices(s), timeliness of response to beneficiary’s questions, prob-lems and concerns, 2) impact of your business practices on the ade-quacy of beneficiary access to equipment,items, services and information, 3) frequen-cy of billing and coding errors and adverseevents to beneficiaries due to inadequate ormalfunctioning equipment, items or servic-es, such as injuries, accidents or hospital-ization. Establish acceptable limits orthresholds and implement a plan of correc-tion whenever the limit or threshold hasnot been achieved. Concentrate on indica-tors that make sense to your business and can improve your compa-ny. These indicators may include after hours calls, timeliness ofdeliveries, equipment breakdowns, damaged products and employeeturnover. Leadership and employee involvement are critical.Communicate QI findings to leadership and your employees andseek input from them in regard to areas that may need improvement.

TIP EIGHT:There is no specific order that client records need to be organized,but having all records following the same format makes it mucheasier for the surveyor when they are performing record reviews.When charts are not organized in similar format, it makes it difficultfor the surveyor to locate the supporting documents that they arerequired to observe during the record review process. Multiple filesare acceptable, such as Clinical Respiratory or Rehab Technology, butmake sure to provide these additional files to the surveyor.

TIP NINE:Develop Corporate Compliance policies and procedures that addressantifraud and abuse controls. All employees must be trained andhave knowledge of the organization’s policies for fraud and abuse.Designate one employee to serve as the Corporate ComplianceOfficer. This person should be responsible for training employees,

auditing and investigating any reports of fraud and abuse.Compliance guidelines issued in 1999 from HHS/OIG for DMEPOSare available on their website: http://www.oig.hhs.gov/fraud/compli-anceguidance.html You must also document that none of youremployees are on the Medicare Exclusion list. This online searchabledata base can be located at: http://www.oig.hhs.gov/fraud/exclu-sions.html

TIP TEN: Putting your Preliminary Evidence Report (PER) together is a great

way of identifying whether you are in com-pliance with all the standards and are readyfor an unannounced survey. When submit-ting supporting documents that are requiredin the PER, refer to the standard. Ask your-self if your policies, forms or other docu-ments contain everything that is mentionedin the standard. If you don’t have to submita document, can you provide evidence thatthe standard has been implemented through

employee interviews, client records, personnel records or other doc-uments? If the answer to these questions is yes, then you are readyto submit your PER. If the answer is no, take some additional timeto fine-tune your policies, do more training with your employeesand tweak any other supporting documents. Once your PER is submitted, you are saying that you are ready for your survey.

Your survey is now over. You and your employees have worked hardfor many hours to get to this point. So now what? Don’t stop now.Continued compliance is the key to a successful re-survey. Lookthrough the standards and identify what needs to be completed onan annual, semi-annual and quarterly basis. Develop a spreadsheetto assure all of these requirements are completed each year. Yourfirst survey only covers approximately four months of compliance;your next survey covers three years. Continue all the processes.You have worked hard and have seen your organization improve byimplementing the standards. Don’t get lax and find yourself back toTip One in three years. n

Cindi Hutchinson RCP/RRT is the President of CHX Consulting, Inc., a DME-POS consulting company located in Indiana specializing in consulting andaccreditation preparation. Ms. Hutchinson has over 15 years of experiencein the Home Medical Equipment industry and is a surveyor for ACHC. Ms.Hutchinson can be reached at cinhutch@msn.com or (574) 875-7330.

"Accreditation does nothappen and cannot bemaintained with only afew designated people

involved."

ACHC’S E-NEWS SIGN-UP

If you would like to receive your Surveyor Newsletter, press releases, workshop information and other important news from ACHC through email, then sign up atwww.achc.org. Simply click “E-News Sign-up.” From there you can customize what type of informa-tion you are interested in receiving. It’s quick, easy and your information stays private. Try it today!

4 Surveyor Spr ing 2008

In our ACHC accreditation world, manypieces work together to produce an effi-cient, organized, positive and comprehen-sive product. The spotlight shines brightlyon the Accreditation Account Managerswho provide assistance to our customers.It shines on our surveyors who visit ourcustomers on-site to share their best-prac-tices. And, it also shines on the standardsthat provide guidance for future accreditedorganizations.

However, there is another integral piece toour ACHC team. Someone has to greet visitors, fix the computers, run the website, count the money, keep a pulse on ourcustomer satisfaction, and ensure that thelights turn on and stay on. Our ACHCAdministration team keeps the organiza-tion buzzing with these behind-the-scenes, often overlooked duties.

• When the phone rings at receptionistMary Trybuskiewicz’s desk, she answers itwith a warm, friendly, “AccreditationCommission for Health Care, how may Ihelp you?”

• After every accreditation survey is com-pleted, Cindy Brammer contacts the cus-tomer where the survey took place, solicit-ing and compiling feedback on how wellthe ACHC staff and our surveyor(s) did inproviding the best in ACHC services.

• Jay Lucido carefully reviews andprocesses each invoice, examining it toensure that it is crystal-clear to the cus-

tomer. He anticipates customers’ questionsand answers them in advance; thus, savingtime and providing another level of cus-tomer service to the ACHC experience.

These are just a few of the many day-to-day examples of the Administrationdepartment’s responsibilities and commit-ments. Our “behind the spotlight” teamworks hard to ensure that customersalways receive world-class service and care.We go the extra step to develop a rapportand relationship with our customers.

As a service organization, we recognizethat our customers’ time is valuable. Theydon’t enjoy being transferred fromemployee to employee in order to have asimple question answered. Customers donot look forward to getting an automatedattendant when they call a company –

only to press “0” just to get a live body.The Administration team at ACHC strivesto answer questions quickly and efficient-ly; yet in a friendly manner, which reflectsconcern for our customers’ overall satisfac-tion with us.

In trying to determine the best ways inwhich to serve our customers, we’ve foundthat getting customer feedback is criticalto ensuring that we’re doing the impor-tant things that really matter to the com-panies we accredit. We’re not afraid to ask“How are we doing?” or “What can we dobetter?” Furthermore, if there are thingsthat we could do better, we proceed to

research and implement best service prac-tices. We want our customers to knowthat not only are their voices being heard,but that our policies are being shapedaround their opinions. We believe that ourcustomer satisfaction surveys give folks thechance to let us know where we need tomake adjustments and also hear from that“silent majority" of happy and satisfiedcustomers.

The TeamLeslie Knuth has been with ACHC since2002. Leslie started her career on theAccreditation team, directly working withcustomers. In 2004, Leslie became ourQuality Assurance Manager and becameresponsible for soliciting feedback fromcustomers, measuring our success, deter-mining when we need to change our poli-cy course, and responding to grievancesfiled by patients/family of our customers.As an ombudsman for the general public,Leslie’s responsibility is to investigate com-plaints and to serve as an independentand impartial arbiter in recommendingwhat can be done to satisfy the com-plainant or in explaining why no action isnecessary.

Leslie has spearheaded ACHC’S ISO9001:2000 efforts and conducts regularaudits of our internal systems to ensurethat we practically execute exactly whatwe say we will perform. Leslie tirelesslyworks to ensure that we live up to ourcommitments to our customers.

Jay Lucido has been ACHC’s StaffAccountant since 2004. Jay relentlesslyworks hard towards making sure that cus-tomers are kept in the loop from a finan-cial perspective. He works with our cus-tomers ensuring that communiqués areclear, relevant, and gives the customer theinformation they need. Jay also worksclosely with our internal staff and survey-ors in processing all of ACHC’s accountingneeds and requests- from daily purchaseorders, to expense reports and payrollassistance.

Deric Rutledge is our MarketingCoordinator who is responsible for muchof the newsletter you’re reading today. Heplans months in advance to ensure thatthe content of the newsletter is clear,timely and valuable to the thousands of

Your Administrative Team, Unsung No Moreby Paul Hetzel, Director of Information Technology and Operations

Top, from L: Jay Lucido, Mary Trybuskiewicz, Cindy Brammer, Deric Rutledge Bottom from L: Tom Cesar, Paul Hetzel, Leslie Knuth

Surveyor Spr ing 2008 5

3) At least one important administrative function (performance evaluations, in-service hours, billing audits)4) Satisfaction surveys (patients, staff, physicians, referral sources)5) Patient record reviews (sampling of open and closed records)

A key component ofan effective qualityimprovement plan isdocumentation ofactivities. Agenciesoften perform quali-ty improvementactivities each daywithout givingthemselves credit forthe improvements

that are made. Forexample, during a billing audit, the staff identifies a problem withthe timeliness of signed physician orders. After further analysisof the problem, they determine that over half of the physicianorders were from the same physician practice. The billing supervi-sor contacts the physician practice manager to address the prob-lem and to identify possible solutions. The agency decides to dropoff and pick-up signed physician orders on a weekly basis. Nextmonth the billing staff re-evaluates the timeliness of physicianorders and concludes that the problem has been corrected.

To assist agencies in documenting quality improvement activities,ACHC recommends that each of the following areas be addressed(using the above example): 1) Description of the indicator (timeliness of physician orders)2) Frequency of activities (monthly)3) Responsible person (billing supervisor)4) Methods of data collection (patient records, physician orders)5) Acceptable limits for findings (<15%)6) Reporting responsibilities (staff, QI committee, board)7) Plans to re-evaluate (re-evaluate in 30-days after implement-ing plan of correction)

Quality improvement is more than monitoring specific areas; it’sabout implementing changes that will improve patient care.ACHC standards focus on improving patient care/services byencouraging agencies to identify undesirable trends and patternsthat have been noted through data collection. In home health,we are fortunate to have access to OBQI/OBQM reports to assistus in collecting data and evaluating patient outcomes. Thesereports allow us to identify problem areas, evaluate care deliverypatterns and develop a plan to improve outcomes. Agencies alsohave access to their state home care associations and QualityImprovement Organization (QIO) for additional assistance andsupport. n

Teresa Harbour, RN, MBA, MHA, Harbour Health Services, Inc.

A Practical Approach to Home Health Quality ImprovementContinued from Page 1

Doug Martin, Board Chair, celebrates INC Magazinerecognition with the ACHC management team.

From left to right; Paul Hetzel, Leslie Knuth, Tom Cesar, Doug Martin and Sherry Hedrick

customers who regularly receive it. Arriving in 2006, Dericquickly gained the pertinent industry knowledge necessaryto speak intelligently at trade shows, workshops and pre-sentations throughout the country. Many times, he plansour trade show presence a year in advance of the actualevent. His record-keeping and attention to detail is criticalto ensuring that these events go off without a hitch.

Cindy Brammer joined ACHC in 2007 as our AdministrativeAssistant. Cindy contacts customers to solicit their feedbackon recent accreditation surveys. During these customer sat-isfaction calls, Cindy is non-threatening, engaging andprobing. She truly wants to hear when we’ve done well.But, more importantly, she is able to listen to and noteareas in which improvements can be made. Cindy logs thisinformation, compiles monthly statistics and escalatesissues to appropriate supervisory staff to ensure we doeverything within our power to provide quality customercare.

Our newest team member, Mary Trybuskiewicz is the nervecenter of ACHC. As Receptionist, Mary is responsible forfinding the appropriate staff member to answer a cus-tomer’s phone or in-person inquiry. Mary arranges travel forstaff members, ensures that the office is running efficiently,and is responsible for processing the multiple shipmentsthat get delivered to ACHC on a daily basis.

I’m extremely proud of the entire Administration Team atACHC. I’m lucky to get to work with these talented peopleevery day. Although their responsibilities vary, their level ofcommitment towards providing an excellent customer expe-rience is unparalleled. They have devoted themselves to giv-ing our customers what they need, what they want andmost importantly, what they deserve. n

Want to be an ACHC Surveyor?We are currently recruitingPharmacists who would like tobecome an ACHC surveyor. Weare also accepting resumes andletters of interest for all otherdisciplines. New surveyor trainingis scheduled on an as-neededbasis. If you would like tobecome an ACHC Surveyor pleasesend your resume and letter ofinterest to the e-mail or postaladdress below. Give us a call ifyou have any questions.

Accreditation Commission for Health Care, Inc.Attn: Director of Clinical Compliance4700 Falls of Neuse Rd. Suite 280

Raleigh, NC 27609phone: 919.785.1214

fax: 919.785.3011 employment@achc.org

6 Surveyor Spr ing 2008

Nellie Plasencia Nellie joined ACHC in the capacity of account manager in March of2007; she moved to Raleigh from New York in 2006.

Her background is in social work, working with at-risk youth andtheir families. Nellie received a BA with concentration in Sociologyfrom Brooklyn College.

She enjoys the theatre, exploring Raleigh and hiking-being close to nature for spiritualrenewal. Her goal is to make Raleigh home and convince her family to join her.

Meet Your StaffMatt HughesMatt joined ACHC in April of 2007 as the AccreditationSupervisor. Matt’s primary function is to ensure that all cus-tomers receive outstanding customer service and their accredita-tion process is smooth and successful. Matt supervises all ACHCaccount managers, who are the central point of contact for allcustomers.

During the four years prior to joining ACHC, Matt managed at a large HME, HomeHealth and Pharmacy provider where he gained the knowledge necessary for thedemanding healthcare industry. Matt received his Bachelor of Science Degree inBusiness Administration from Western Carolina University. He and his wife live inRaleigh, NC where he enjoys playing golf in the summer, snowboarding in the winterand spending time with family and friends.

Surveyor Spr ing 2008 7

Founded by a strong coalition ofvolunteers from the academic,faith and nursing communities

of Greensboro, HPCG also has enjoyedthe support of business and industry.HPCG has exhibited extraordinary sta-bility as it was led by the same CEOfor the first 22 years and welcomedits second CEO, Patricia Soenksen, inMarch 2007. The fledgling organiza-tion accepted its first patient in 1982,and by 2007, averaged a daily censusof 285 patients. Such rapid growthattests to how quickly Greensboroembraced HPCG and its philosophy ofcare.

HPCG Services Include:In-Home Hospice Care: HPCG pro-vides expert medical and emotionalcare for patients and their families,usually in the patient’s home, butalso in assisted-living residences andlong-term care facilities.

Hospice Care at Beacon Place:Located on the 8-acre HPCG campus,Beacon Place offers the finest healthcare in a beautiful 14-bed, home-likefacility.

Kids Path®: Kids Path is tailored tothe needs of seriously ill and grievingchildren. Kids Path offers a range ofservices from counseling and in-homecare, to bereavement camps and playtherapy for children and their fami-lies. Kids Path was founded inGreensboro, NC, and has licensed tenother Kids Path programs in theSoutheast. Identified in 2005 by theWall Street Journal as a leader inpediatric palliative care, Kids Path isnow expanding into neo-natal pro-grams and palliative care for infants.

The Counseling and Education Center(CEC): We offer grief counseling tofamily members served by HPCG, aswell as anyone in the GreaterGreensboro area grieving the loss of aloved one. Another CEC program,Transitions and Life Change (TLC)Consults, addresses concerns thataccompany a diagnosis of serious ill-ness, geriatric care management andadvance directives planning. Similarlyinnovative, TLC in the Workplace®acknowledges the concerns of griefand care-giving in the work world.

Palliative Care Services (PCS): PCS is amedical specialty offered to patientsfor goals-of-care discussions andrelief of symptoms of serious illness,at any stage of an illness. PCS isavailable, upon doctor’s orders, inGreensboro assisted-living and long-term-care communities. Additionally,PCS, through a collaborative initiativewith the Moses Cone Health System,is available at all Greensboro hospitals.

HPCG, accredited by ACHC throughDecember 2010, has three facilitybuildings, located on a beautifullylandscaped campus, demonstratingthe benefits of the HPCG horticulturaltherapy program. Our 200+ volunteersare critical members of the HPCGteam, serving patients in their homes,in long-term-care facilities, and inHPCG facilities. Last year our HPCGvolunteers provided approximately13,544 hours of service. n

*Kids Path and TLC in the Workplaceare registered marks of Hospice andPalliative Care of Greensboro.

Contact: Laura H. Hunt, Director ofMarketing, HPCG, Greensboro, NC (336) 621-2500

Providers Spotlight: Hospice and Palliative Care of Greensboro

Celebrating life since 1980, Hospice and Palliative Care of Greensboro (HPCG), anon-profit organization, supports people in the Greater Greensboro, NorthCarolina, area and enables them to live fully, with comfort and dignity, to theend of life. HPCG provides physical, emotional and spiritual support for peoplefaced with a life-limiting illness, as well as their caregivers and families.

8 Surveyor Spr ing 2008

The first article in this series describedhow to create and live your strategy mapand balanced scorecard. Next, there areusually four stimulating aspects of astrategy map that your leadership teamsneed to ponder and agree upon. Theseaspects are financials, customers, process-es and people/automation. In this sec-ond article, we will discuss imperativequestions to ask both yourself and yourleadership teams about your financialsand customer value proposition.

Typically, most business units have a verygood understanding andtracking of their finan-cial perspective. Thequestion to be answeredby your leadershipteams is “If we succeed,how will we look to ourshareholders?” Usually,there are two basicstrategies within thefinancial perspective.First, how can we growour business? Here weask our teams (1) howcan we develop newsources of revenue fromnew markets, new prod-ucts or new customers;and (2) how can weincrease customer valuewith existing customersto expand the relation-ship with our firm? Second, how can weimprove productivity within our firm?Here you should brainstorm how to (1)improve cost structure and lower directcosts of products and services; (2) reduceindirect costs and share commonresources with multiple units; and (3)

improve asset utilization. In other words,how can you most effectively reduce theworking and fixed capital needed to sup-port a level of business by implementinggreater utilization and more carefulacquisition, or by disposing of parts ofthe current and fixed asset base?

During my last ten years of leading busi-ness units through strategic planning ses-sions, the most stimulating disagreementamong leadership teams has been deter-mining the client’s customer value propo-sition. While it is necessary to implement

all three customer value strategies, suc-cess is determined by your firm’s abilityto excel at one of those strategies. It hasbeen shown trying to excel at all threecustomer value strategies results in failureof all three. WOW! Yes failure! Therefore,your leadership teams must decide (1)

which customer value proposition strategyis most important for your firm, and (2)how your products and services map sup-port this customer value proposition.

Let’s take a look at the three customervalue proposition statements:First is “Operational Excellence.” Theimportant product and service attributesto this strategy are price, quality, time andfunctionality/selection. Your processesand investments must support theseattributes. The key to this value proposi-tion is quality in selected categories with

unbeatable prices. Thebrand displayed to the cus-tomer is “the smart shop-per”, which places lessimportance on the relation-ship. Examples of compa-nies using this value propo-sition today are Wal-Martand McDonalds.

Second is “CustomerIntimacy”. The importantattribute here is building arelationship with the cus-tomer consistent with thebrand image of “the trustedBrand.” In this model, per-sonal service must be tai-lored to produce results andbuild long-term relation-ships with the customer.Hence, the two most impor-

tant attributes in this customer proposi-tion are service and relationships.Determining how to invest and buildstrong processes around these two attrib-utes is essential. For example, Lowe’sLumber is notorious with its customers forbuilding relationships through outstand-ing service.

By Richard M. Wetherell

STRATEGY IMPLEMENTATIONImprove your Financials and Customer Satisfaction ThroughStrategy Implementation. (2nd of a 5 part series)

Could you improve your organization’s understanding of the strategy and direc-tion of your business? Would you like to improve profits and reduce costs whiledelighting your customers? Would you like to improve employee morale andretention and involve your employees in achieving financial and customerobjectives? We have the solution.

Surveyor Spr ing 2008 9

Third is “Product Leadership”. Thisproposition offers unique products andservices that “push the envelope” result-ing in a brand of “best innovative productin the marketplace.” The target is to bringan excellent selection of new productswith greater functionality to the market-place in less time.

Most firms are excellent at creating goalsfor financial perspectives, but customervalue propositions are typically debatedtopics for leadership teams. You must per-form well on all attributes of customervalue propositions, while focusing invest-ment and improvement initiatives onattributes important to both you and thecustomer’s value propositions. Eventhough it is sometimes difficult, successfulmarket leaders routinely decline purchas-

ing and investing in items not mapped totheir strategy.

Have you determined the customer propo-sition value statement for your firm? Do all of your leadership teams agree on your customer value proposition? In answering these questions, you may besurprised to find your leadership teamshave different views and opinions on thevalue your firm offers to its customers. A common vision and customer valueproposition among leadership teams isessential to your firm’s success.

In the next newsletter, I will discuss howto develop processes and your people andautomation strategies that must map toyour financial and customer value propo-sition attributes. You will then be able todisplay your business strategy on a single

sheet of paper which will easily commu-nicate and show your alignment to all.ACHC and Q4MedSource will be conduct-ing a one-day workshop at upcomingtrade shows on this topic to improve bothyour skills and your business in theseareas. n

Richard Wetherell, Chief Financial Officerof Q4MedSource, is an educator and specialist in strategic planning, balancedscorecards, and improving quality, marketshare and customer satisfaction. He workswith businesses to develop, deploy andalign strategic plans to achieve financialand customer results. Richard can bereached at www.Q4MedSource.com or(919) 388-9559. Q4MedSource hasoffices in Cary, North Carolina; HoustonTexas; and Orlando, Florida.

ACHC’s vision of excellent customer satisfaction begins with the real-ization of knowing what our customers want, need and expect. Webelieve that our customers want to be treated as though we genuinelycare about what concerns them. They want to feel that when theycontact us, we are sensitive to their specific situation and are not justgiving a rote response. In other words, the ACHC team tries to estab-lish a personal, emotional connection which makes our customers feelboth comfortable and welcome.

Customers also need to feel that our team members are “down-to-earth” people. We do our best to provide accurate and correctanswers, establish reliabilty, and provide overall good service. Just asimportant, we are willing to acknowledge when we make a mistakeand do what we can to correct it. Customers expect us to be there forthem -- to help them in the process and when not available, return e-mails and voice messages in a timely manner. This emotional connec-tion evokes customer commitment and loyalty.

Leslie Knuth (Quality Assurance Manager) and others are constantlyassessing how well we treat our customers and meet their expecta-tions. All provider locations that are visited receive a telephone calland are asked a series of questions regarding the provider’s experi-ence. Half of these questions directly relate to the office staff and theremainder assess performance of the surveyors who make the onsitevisit. In the past three quarters, approximately 300 customer inter-views have been conducted. The overall satisfaction figure has consis-tently averaged at about 95%.

All ACHC team members receive continuous feedback on how wellthey serve our customers (who we consider as partners in deliveringquality services to patients). This feedback helps all of us learn fromeach experience and continuously improve the level of service to ourcustomers. Leslie reviews all responses and comments by our cus-tomers and utilizes constructive recommendations as part of our QI

process. As Leslie stated, “Customer comments and suggestions arecrucial for us because they’re used as discussion topics in surveyortraining classes and weekly departmental meetings, for standardsupdates, as well as annual review of ACHC’s corporate objectives, toname a few.”

We, also with a company’s permission, share testimonies in our mar-keting material and on our web page. There are dozens of testimoniesfrom satisfied providers continuously rotating on the pages of theACHC web site.

ACHC recognizes that we are on an educational journey and thatthere is always opportunity for improvement. We differentiate our-selves from competition by going beyond a good product to a higherlevel of meaning, dedication and commitment to our customers. Weare always open to learn how we are doing. Please let us know bysending an e-mail to feedback@achc.org n

By Tom Cesar, President, ACHC

The ACHC Difference: Customer Satisfaction, Continued from Page 1

10 Surveyor Spr ing 2008

I want to tell you how positive the entire experiencewas. Our surveyor was wonderful to work with.She was extremely professional and very organized.In addition, she gave us suggestions, recommenda-tions and explanations. Her manner was not adver-sarial (as has been my past experiences with statesurveyors and other accreditation bodies). I alsowant to compliment our Account Manager who hasbeen a great help as well. She responded to all myquestions and concerns with professionalism andvery quickly. My contacts with everyone at ACHChave all been very positive. I would certainly rec-ommend your company to anyone.” Interim HealthCare; Oak Lawn, IL

“Their surveyors conduct the surveys in a mannerthat helps us become a better organization. ACHCStandards have been developed from our industryand accurately reflect how we do business.”Chesapeake Rehab Equipment; Baltimore, MD

“After years of other accrediting bodies, ACHC wasa breath of fresh air. We have actually referredback to our PER a number of times and are nowusing our hospice PER for survey readiness.”Optimal Health Services; Bakersfield, CA

“We have had a very positive experience withACHC and the entire process has helped us tobecome a stronger organization.” Medical Equipment Specialists; Milwaukee, WI

“Everybody at ACHC was friendly and helpful dur-ing our accreditation process. I've been throughother accreditors in the past, so the accreditationprocess is not new to me. We felt that our Account

Manager did a good job, all of our items and docu-ments were processed in a timely manner. We feltthat ACHC has an attitude of wanting their organi-zations to succeed and do well during the entireaccreditation process. The survey experience withACHC was helpful and educational. It was definite-ly professional, but non-threatening. I’m verypleased with the entire experience.” Northampton County Home Health Agency; Jackson, NC

“You have all made the process very smooth andwere always there when I had a question. I amextremely pleased that we chose ACHC forAccreditation.” Upstate Rehabilitation Products; Albany, NY

“Our ACHC accreditation experience it wasextremely positive. Our Account Manager was sogreat! She really helped us out a lot. I reallyenjoyed working with her. We felt very preparedgoing into the experience because of the customersupport we received from our Account Manager.Our survey experience went really well. The ACHCsurveyors had really good best practice suggestionsfor us throughout the entire survey. We thought a lot of what they suggested was really very helpful for us." Mini Pharmacy; Los Angeles, CA

“We have been re-accredited by ACHC several timesand each time has been a positive experience whichhas facilitated growth for our company.”Total Home Care; Morganton, NC

What People are Saying about ACHC

Accreditation Checklist for Success

ACHC is pleased to announce that a new publication is now available to DME companies.The checklist includes practical questions about policies and procedures that will helpproviders understand and focus on what must be in the content of their policies andprocedures. Sample interview questions and observations that are typically asked andlooked at by the surveyor during the actual survey are included. It is designed as a work-book with ample space for comments and notes. The step-by-step guide helps the appli-cant walk through what is required for being accredited. This great tool can be used toconduct a company-wide mock survey. Contact ACHC to order your workbook. n

Raleigh, NC- The Accreditation Commission forHealth Care is pleased to announce that MaximHealthcare Services has received ACHC accreditation.Maxim is one of the largest privately held providersof home health and wellness services in the industry.Maxim is a full-service healthcare company that hasearned the reputation of providing innovative solu-tions that improve health and enhance the quality oflife for its patients. Their dedication to customer serv-ice and improving patient care, combined with acommitment to staffing quality healthcare profes-sionals has made Maxim one of the most dependablehealthcare companies in the country.

We would like to hear from you regarding your experienceswith ACHC. Do you have something to say about an inter-action, a process, a staff member, standards, an ACHC sur-veyor or even this publication? Please do so via e-mail atfeedback@achc.org

Good or bad, we would like tohear from you and we consideryour feedback very valuable.

How Are We Doing? Let Us Know

Surveyor Spr ing 2008 11

MAXIM HEALTHCARE Services,Continued from Page 1

Changing Public Policy on DME, ONE Congressman at a Time!

Join NAIMES and lend your voice to the association dedicated toindependent suppliers and the patients they serve.

$350 per year - $250 if you are a member of your state association.

We are the grassroots advocacy organization dedicated to preservingthe future of DME and homecare for all suppliers in all 50 states

and US Territories.

NATIONAL ASSOCIATION OF INDEPENDENT MEDICAL EQUIPMENT SUPPLIERS

5037 Halifax Road, Suite L7, P. O. Box 669, Halifax, Virginia 24558 434-572-9457 ---- FAX 434-572-3033

TOLL FREE 1-877-4DMEHELP www.dmehelp.org e-mail – yourfuture@dmehelp.org

• Nurturing Grassroots Advocacy• Raising Public Awareness• Developing Legislator Relationships• Proactive, Positive Response to Industry Issues

12 Surveyor Spr ing 2008

UPCOMINGEXHIBITIONS

AIHMES Amerisource BergenBurlington Drug Co. CAHSAH D.A.B.G. Dedicated DistributionElectronic Billing Services Essentially WomenGrove Medical HCAVHD Smith HME ProvidersKinray McKessonMed Trust MedlineMed Trust of Tampa Bay NPSCPBI Pharm. Buyers ProclaimSCMESA VGM

GROUPDISCOUNTS

ACHC offers discounts to members of the following groups:

MESAFebruary 28-29 Austin, TX

NHIAMarch 9-12 Phoenix, AZ

CAMPSMarch 9-12 Phoenix, AZ

NPDAMarch 26-28 San Diego, CA

TAHCMarch 31-April1 Franklin, TN

Essentially WomenApril 7-9

NHPCOApril 10-12 Washington, DC

SWRHCCApril 22-23 Dallas, TX

AHHC of NCApril 28-29 Raleigh/Durham, NC

MedTrade SpringMay 7-8 Long Beach, CA

CAHSAHMay 7-8 Palm Springs, CA

HCACMay 8-9 Vail, CO

PHAMay 14-16 Harrisburg, PA

IAHCJune 3-4 Coralville, IA

Heartland/ VGMJune 9-12 Waterloo, IA

AHHIFJune 18-19 Orlando, FL

ACHC’S E-NEWS SIGN-UP

If you would like to receive your SurveyorNewsletter, press releases, workshop informa-tion, and other important news from ACHCthen sign up at www.achc.org. Simply click“E-News Sign-up.” From there you can cus-tomize what type of information you areinterested in receiving. It’s quick, easy andyour information stays private. Try it today!

Surveyor Spr ing 2008 13

JANICE CLARK I Home Health and Hospice

Janice Clark’s ADN and BSN were obtained from Pace University Westchester, and she earned an MSHP from SouthwestTexas State University, majoring in Health Care Administration. In 2005, while living in Colorado Springs, she earned aGraduate Certificate in Forensic Nursing from the University of Colorado at Colorado Springs.

Her home care experience began with a position as a field nurse for a large agency in Austin, Texas. After several yearsshe started a hospital-based home health agency and then accepted a surveyor position with the Texas Department of

Health. Currently, she has fifteen years experience in survey and accreditation.

Janice has worked in acute care and spent over 20 years combined service in the active and reserve Air Force. The most memorable part ofthe Air Force experience was as a C-130 Flight Nurse stationed at Kelly AFB, Texas, with several training assignments to Korea. In addition tothe surveyor position with ACHC, Janice works as a Legal Nurse Consultant in Albany, New York, near her home in Voorheesville.

Laylee Downing, RN, BSN has over 25 years experience in home care and home infusion, including patient care management,administrative policy development and preparation for accreditation surveys.

Laylee currently works as Director of Nursing for the Chico, CA, office of Walgreen’s OptionCare. She has been their PerformanceImprovement Coordinator for 10 years and has also consulted with their corporate office to revise their performance improve-ment program, streamline their clinical documentation tools and update their nursing policies and procedures.

Laylee has been a national Director of Quality and Risk Management as well as infusion nurse, instructor and administrator. She has helped theiroffices to prepare for accreditation surveys and participated as the quality management expert in both local and corporate surveys. She has alsobeen involved in many clinical and operational training programs offered throughout the country, including PICC insertion, performance improve-ment and ACHC Standards updates.

Laylee is involved with her local Oncology Nursing Society chapter and has held offices from secretary to president. She is also an active partici-pant in the annual Relay for Life, sponsored by the American Cancer Society. These activities relate strongly to her home care oncology back-ground, the area in which she worked prior to home infusion. Laylee is a graduate of California State University in Chico, CA, where she continuesto reside with her husband.

MEET YOUR Surveyor

LAYLEE DOWNING I Infusion Nursing

ROB SUMMITT I HME, Rehab

Rob Summitt is the President/CEO of Summitt Group, Inc. a Chattanooga, TN based consulting firm that works withHealthcare clients in the areas of Rehabilitation Technology, ADA Construction, “Aging in Place” and BusinessDevelopment. For over 15 years he has worked in the fields of Healthcare, Government Administration, Finance, andManagement, and built a successful Healthcare industry practice. He is educated in Business and his credentialsinclude: Certified Rehabilitation Technology Specialist (CRTS) and a Certified Environmental Access Consultant (CEAC).He is also a member of The National Registry of Rehabilitation Technology Suppliers (NRRTS) and the Rehabilitation

Engineering and Assistive Technology Society of North America (RESNA). Rob’s work and his company have been featured in HME News andExceptional Parenting Magazine. He has been an Accreditation Surveyor for ACHC the last three years.

14 Surveyor Spr ing 2008

In today’s environment of congressional threats to our businesses,changing reimbursements, competition, and tighter margins, it’seasy to get stuck on the day to day operation of a company.

Hopefully by now you are fully into the implementation of your 2008business plan, but if not it’s never too late to improve your plan.

It is even more important today to take the time to implement agood business plan that includes a strong sales and marketing pro-gram. In most sales organizations, the reality is the company mustgrow or die. Because we continuously lose patients in all facets ofhomecare, such as HME, infusion and nursing, it’s vital to have agood, sound sales strategy to bring in even larger sources of newclients. Despite the many negatives we face each day, the opportu-nities in homecare are huge: the population is aging with justunder 8,000 people turning 65 each day and a total of 77 millionbaby boomers on the horizon; the number of patients in assisted liv-ing facilities (rather than long-term care) is growing; and the prolif-eration of new products and services, successful retail programs, andthe internet are all increasing theneed and awareness of homecareservices.

Every one of us in homecare knowsthat the home is the most cost-effective site and preferred locationfor service -- so now is the time tomake sure your sales strategy capi-talizes on that fact. Here are somesimple steps that successful salesdriven organizations must execute.

1. Access Your Current SituationIt’s hard to know where you aregoing without firmly knowing where you are. Part of this knowl-edge comes from understanding the competition, as well as yourown business. All employees, and especially your sales team, shouldhave a clear understanding of what your core focus is. In otherwords, you must determine what parts of the business you want togrow and what financial benefits to the business would result fromthat growth.

First, we need to clearly define the geographic area that the businesscan service. It’s critical to assess the competition by researchingsuch things as: who they are; how large they are; what is theirstrategy; what are their strengths and weaknesses; how manypatients do they serve; what type of patients do they serve; andwhat are their targets. Answers to these questions will help deter-mine the possibilities for increasing your own market share. Thisinformation can be obtained from different websites, local sales reps,Medicare, and potential referral sources.

A standard SWOT (strengths, weaknesses, opportunities and threats)analysis is included at the end of this article as it’s a simple butvaluable tool to help your management team brainstorm your orga-nization’s current situation and assess your competition. It’s also a

good idea to conduct a SWOT from the perspective of a key com-petitor. When the exercise is done from this standpoint, the resultmight surprise you with information on how to differentiate yourcompany.

2. Set your Goals and DirectionA good first step is to identify what is unique about your company’sposition in the market place. In other words, what differentiatesyou from your competitors. This differentiation can be defined bysuch things as the quality and service of your programs, equipmentprovided, services provided, or even a niche focus of your company.It’s this crucial difference that you must communicate to your refer-ral sources as part of you sales efforts. In addition, referral sourcesare looking for data on good patient outcomes, so make sure youprioritize ongoing communications with referral sources.

To set goals you need to look at how much you are growing todayand be realistic. If your company’s growth rate last year was 3%,

setting a goal for 30% growth next yearwould only serve to demoralize yourstaff. New growth might come fromsources such as current referral sources,new referral sources, new products orservices, or a geographic expansion. Insetting goals, you will need to identifywhat your sources for new business willbe and what the potential for each oneis in terms of new revenue or patients.On the human resource side, you shouldalso question whether you will need toadd additional staff to accomplish yourgoals and, if so, when during the yearhiring should occur. Finally, try to

ensure total staff buy-in since every member of your staff can affectperformance, and therefore they must understand the company’sgoals and objectives.

3. Gaining Market Share and ProfitabilityDedicated and targeted sales efforts are a common factor in thefastest growing providers and agencies in homecare. Your salesmanager role is to set targets for the sales or marketing team onwhere they call and how many calls per day they should make.

Another great way to develop potential referral sources is throughparticipation in in-services. Don’t forget that most manufacturerswho you partner with should be willing to go with you on these in-services, which may help defray the costs. Alternatively, you are avery valuable source of knowledge on new products for your referralsources – interestingly, most providers do not capitalize on this. Youshould be continually learning about new technologies and educat-ing your referral sources on what is available.

Manufacturer partners may be also willing to partner with you onadvertising as long as it is tied to sales. Your advertising focusshould complement your sales team with good support materials

Homecare Sales StrategiesTom Tucker, Attentus Medical

CRITERIA EXAMPLES

Advantages of Service or Product? Capabilities? Competitive advantages? USP's (unique selling points)? Resources, Assets, People? Experience, knowledge, data? Financial reserves, likely returns? Marketing - reach, distribution, awareness? Innovative aspects of your business? Location and geographical? Price, value, quality? Accreditations, qualifications, certifications? Processes, systems, IT, communications? Cultural, attitudinal? Management cover, succession?Philosophy and values?

CRITERIA EXAMPLES

Disadvantages of proposition? Gaps in capabilities? Lack of competitive strength? Reputation, presence and reach? Financials? Own known vulnerabilities?Cashflow, start-up cash-drain?Effects on core activities, distraction? Reliability of data, plan predictability? Lack of Accreditations, etc?Processes and systems, etc?

STRENGTHS WEAKNESSES

CRITERIA EXAMPLES

Market developments in reimbursement ? Competitors' vulnerabilities? Industry or lifestyle trends? Technology development and innovation? Global influences? Material costs?New markets,? Niche target markets?New USP's? Tactics: eg, surprise, major contracts? Business and product development? Information and research? Partnerships, agencies, distribution? Volumes, production, economies? Seasonal?

CRITERIA EXAMPLES

Political effects? Legislative effects? Environmental effects? IT developments? Competitor intentions - various? Market demand? New technologies, services, ideas? Vital Insurance contractsInsurmountable weaknesses? Loss of key staff? Sustainable financial backing? Seasonality?

OPPORTUNITIES THREATS

Surveyor Spr ing 2008 15

that help establish your differentiation; advertising, direct mail, andmarketing at the right special events that help attain your growthgoals.

The sales staff should have goals for new referrals or business basedon the profitability of the business. If you have goals based solelyon dollars sold, these may not reflect the company’s goals for theservices they provide. Stated differently, this could lead to referralsthat represent large dollars, but small profit. Sales pay should betied to Gross Profit Dollars minus Expenses as much as possible,even though this formula may be simplified for staff to make it eas-ier to process. Business segments that are difficult to collect ormanage must have adequate profit tied to them to reflect additionaleffort required.

4. Continuous Improvement of Your ProgramSuccessful organizations continuously benchmark themselvesagainst other companies. The first experience many organizations have with benchmarking isthrough their accreditation survey, as this is a great way to assurean organization is up to par with CMS’s quality standards. Yourorganization’s benchmarks don’t need to be just from our industrythough. In fact, you should look at other industries to see how well

your company stacks up and what strategies they employ in theirsales efforts. Knowledge and information gleaned through thisbenchmarking process is important and may be passed on to referralsources.

A fundamental goal for the organization’s continuous qualityimprovement program must be to better meet the needs of referralsources and patients. To that end, getting your employees to under-stand and embrace the company’s goals is critical to consistentlymeeting those customer needs.

Sales strategy, like other facets of your business, relies on the pas-sion and direction of you and your staff. There are many ways tobe successful, so take the time to talk to sales people at other suc-cessful companies you do business with every day. Find out howthey develop their sales plans and strategies, and maybe you’ll pickup some valuable nuggets of information.

Tom Tucker, ttucker@attentusmedical.com, 866-456-3929

SWOT Analysis Template State what you are assessing here. Please note that these criteria examples relate to assessing a new business venture or proposition.Many listed criteria can apply to other quadrants, and the examples are not exhaustive. You should identify and use any other criteria that are appropriate toyour situation. You can access this template with out some of the modification at www.businessballs.com and many other sites.

ACHC Congratulates Its Newest Accredited Locations

A and D Healthcare, LLC; TX CRCS, HME, RTSA 2 Z Home Medical Supplies, Inc.; NC Fitter, HMEA To Z Medical Equipment & Supplies, LLC; TX HMEA2Z Home Medical Supplies, Inc.; NC Fitter, HME, MSPAbility Medical Supply, Inc; FL HME, RTSACME Consultant International, Inc; PR HMEActive Therapy Supply, Inc.; NY HME, MSPAdapt Inc.; TX HMEPetersen Medical; UT (6 branches) Fitter, HME, RTSAdvanced Care Solutions; FL MSPAdvanced Medical DME; KS (2 branches) HMEAdvanced Medical Supplies of Johnston County; NC HMEAdvanced Medical Support Inc.; FL MSPAdvanced Service, Inc.; NC (2 branches) CRCS,HME, MSP, RTSAdvantage Infusion Services; TX RXAerosol Plus, Inc.; SC HMEAffinity Distribution, Inc.; TX HMEAirway Management, Inc.; FL CRCS, HMEAll Florida Medical Supplies Inc.; FL HMEAll States Medical Supplies, Inc; NC MSPAll Ways Accessible Rehab, LLC; FL RTSAmbient Healthcare of West Florida, Inc RXAmcare Plus, Corp.; TX HH, PDAA-Med Health Care; CA MSPAmerican HomePatient, Inc.; TN (Over 200 branches) HMEAmerican Life and Health; TX HME, MSP, RTSAmericare Health Services Corp; CA MSPAmMed Direct, LLC; TN MSPAM-PM Medical Supplies; MA HME, MSPAnthony Cooper; TX HMEApothecary Services; IN HMEAppalachian Medical Services, Inc.; GA HME, MSPApple Homecare Medical Supply, Inc; TX HME, MSPAshe Services for Aging, Inc.; NC PDAAssistive Technology Group, Inc.; IL (14 branches) RTSAtlantic Healthcare Products; FL HMEAtlas Respiratory Svc. Inc; KS HMEAvante Group, Inc; FL (20 branches) MSPB - Pharm Inc; MO HMEB and B Respiratory Solutions, LLC; NJ HMEBalch Springs Nursing Home, LP; TX MSPBandy's Pharmacy, Inc; IL Fitter, HME, MSPBernens Convalescent Pharmacy; OH Fitter, HME, MSPBest Care Medical, Inc.; FL HMEBilling Specialists, Inc; NC HMEBlanchard, Inc.; AZ MSPBluedot Medical, Inc; NC HMEB-Med, Inc.; NC MSP

B-Pharm, Inc.; MO HMEPacific Pulmonary Services; CA (102 branches) HMEBrotherston Homecare, Inc; PA HMECare Solutions, LLC; NC HMECarefree Health Services, Inc; FL MSPCarelinc Medical Equipment and Supply Co., LLC; MI CRCS, HME, MSPCareMax Medical Resources, LLC; MD (10 branches) CRCS, HME, RXCarolina Apothecary, Inc.; NC (2 branches) CRCS, Fitter, HMECarolina Mobility and Seating, Inc.; NC (4 branches) HME, RTSCaswell County Home Health Agency; NC HHCeres Strategies Medical Services; AR HMECharles Tabeek and Son; NJ HME, MSPChartwell Pennsylvania, LP; PA IRN, RXChartwell Rocky Mountain Region, LLP; CO HME, IRN, RXChest Diagnostic Therapeutic Services, Inc.; TX (5 branches) CRCS, Fitter, HME,

MSPCHS of Greater Detroit; MI HHCoast to Coast Home Medical, Inc.; FL MSPCoast to Coast Medical Equipment; FL HME, MSPCoastal Care Medical Supply, Inc.; FL HMEColonial Manor Nursing Center - Cleburne, LP; TX MSPComplete Medical Homecare; MO HME, MSPComplete Medical Supplies; FL MSPCoram Healthcare Corporation of Nevada (2 branches) IRN, RXCore Medical Supplies Inc; NC CRCS, HME, MSPCorner Homecare, Inc.; KY (3 branches) CRCS, Fitter, HME, RXCourierMed, Inc.; FL MSPCR IV Service, Inc; IA HH, IRN, RX, PDACraven County Health Department Home Health - Home Health Hospice; NC HH, HospCrown Care Medical Products, Inc; FL HMECustom Healthcare, Inc.; LA (9 branches) HME, RTSD&J Medical; MD MSPDanielson Pharmacy; CT Fitter, HME, MSPDavid Hudson Warren; NC Fitter, HMEDavie Medical Equipment; AR HMEDavie Medical Equipment, Inc.; NC CRCS, HMEDenman Services, Inc.; IL (4 branches) CRCS, HME, MSPDiabetes Care & Education, Inc; KY (3 branches) HMEDiabetes Professionals, Inc.; FL MSPDiabetic Supply of Suncoast; PR MSPDiagnostics Unlimited Inc.; FL MSPDJO, LLC; CA MSPEBI, LP; NJ HME

This list consists of organizations that were accredited between June 1st and November 30th 2007

16 Surveyor Spr ing 2008

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EmpiCare, Inc.; KY (10 branches) HME, MSPEquinox Healthcare, Inc.; MD IRN, RXFirst Call Pharmacy, LLC; LA RXFirst Health Home Care; NC (2 branches) HHFirstHealth Hospice and Palliative Care; NC HospFitzhugh Enterprises, Inc; TXFitter, HMEFive Oaks Manor, LLC; NC MSPFlorida Home Medical Supply, Inc.; (3 branches) Fitter, HME, MSP, RTSFounders Healthcare - Reno; NV CRCS, HMEFounders Healthcare LLC; CA CRCS, HME, RX, RTSFour Points Home Medical; NC HME, MSPFranklin County Home Health Agency; NC HHFreeport Home Medical Equipment, Inc.; IL Fitter, HME, MSPGardens Drugs, Inc.; FL Fitter, HME, MSPGIBIS Inc; NC MSPGolden Years Homecare Specialist, Inc; TX HH, IRNGreenville Nursing Center, LP; TX MSPGrove Medical, Inc.; SC MSPHealth Care Product Solutions; SC HME, RTSHealth Quest; TX HH, IRNHealth System Services; NY HME, MSPHealth Technology Resources, LLC; IL HMEHenley Medical; TN RTSHills Drug Store; CA (2 branches) Fitter, HME, MSPHMO of Indiana; IN HH, HME, RXHoffman Home Care, Inc.; CA RXHoliday Hills Rehabilitation and Care Center, LP; TX MSPHome Care Equipment, Inc.; VA (2 branches) Fitter, HME, MSPHome Delivery Incontinent Supplies; MO MSPHome Health and Hospice of Halifax; NC HH, HospHome Patient Supply Inc; FL HMEHome Respiratory, Inc; NC HMEHospice and Palliative Care Charlotte Region; NC (4 branhes) HospHospice of Gaston County, Inc.; NC HospHospice of Scotland County; NC HospHospice of Surry County, Inc.; NC(4 branches) HospHospice of Union County, Inc.; NC(2 branches) HospHospice Services of Anson County; NC HospIllini Health Services, LLC; IL (2 branches) CRCS, HME, MSPInfusion Care of South Carolina, Inc.; SC RXInfusion Technologies, Inc.; FL HH, IRN, RXIV Care, LLC; IL HME, IRN, RXJ and J Medical, Inc.; PA HMEJ D Brown and Co., Inc.; IL Fitter, HME, MSPJ S and H Orthopedic Supply; TX MSPJ.I Medical, Inc; CA (3 branches) HME, MSP, RTSJabez Home Infusion; NC RXJason C Wuest; CA HMEJIL Medical Inc.; NC HME, MSPJohnson Drug Company, Inc; NC (2 branches) CRCS, Fitter, HME

JRS Medical Supply; FL HME, MSPKelmedix, Inc; FL HMEKindStar; TX HHLink Medical, Inc.; NC (2 branches) CRCS, Fitter, HME,

MSP, RTSLivewell Medical; NC HME, RTSM. Davis Management, Inc; FL HMEM.E.D. Supplies; OH MSPMajors Mobility Inc.; MI (2 branches) HME, RTSManns Sickroom Service; PA HMEMapes Medical Supply, Inc; OH HME, RTSMark Drug Home Health; IL Fitter, HME, MSPMatrix Management Group, Inc; OH MSPMaximum Comfort, Inc.; CA (5 branches) HMEMedCare Diabetic Supply, LLC; FL HME, MSPMedela, Inc; IL HMEMedical Center Pharmacy; OK (4 branches) Fitter, HMEMedical Equipment Solutions of Southeast Florida HMEMedical Home Care, Inc.; AL CRCS, HMEMedical Nutritional Services; MI HME, MSPMedical Park Center Pharmacy; OK (2 branches) HME, MSP, RXMedical Quick Assist, Inc.; CA HMEMEDIGY, LLC; TX HMEMedi-Quip, Inc.; TN (4 branches) HME, MSPMedi-Rents and Sales, Inc.; MD HME, MSP, RTSMedline Industries, Inc.; IL (17 branches) MSPMed-Link of North Texas Systems, Inc.; TX HMEMedmark, Inc; PA IRN, RXMedox Healthcare; NC (2 branches) CRCS, HMEMedtrac Solutions, Inc.; TN MSPMesquite Tree Nursing Center, LP; TX MSPMetro Medical Equipment, Inc.; TX HMEMichael Potter; IN HMEMichael's Medical, Inc.; NE HME, RTSMid-South Medical and Mobility; TN (2 branches) CRCS, HME, RTSMini Pharmacy Enterprises, Inc; CA HME, MSP, RXMiniMed Distribution Corporation; CA HME, MSPMission Lake Convalescent Center, Inc.; MO MSPMississippi Medical Supply; MS CRCS, HME, RTSMMS Northern Detroit, Inc; MI HME, RTSMMS Southern Maine, Inc.; ME (2 branches) HME, RTSMobility First, Inc.; MO HME, RTSMountain Medical Equipment, Inc; KY Fitter, HME, MSPMullaney Medical Inc; OH (3 branches) CRCS, Fitter, HME,

MSP, RTSNational Home Respiratory Services Inc.; FL MSPNationwide Medical Equipment Inc.; TN HMENavigator Health Management Solutions; TN MSPNexion Health Medical Supplies, Inc.; MD MSPNine Lac, Inc; TX HHNorth Carolina Medical Supplies, LLC; NC HME, MSPNorth Huntington Medical, Inc.; PA MSP

18 Surveyor Spr ing 2008

Northcare Health Services; NC (2 branches) HHNortheast Medical Supplies, LLC; PA HMENutritional/Parenteral Home Care, Inc; AL (2 branches) IRNOpis Medical Supply, LLC; FL MSPOptimal Hospice Care; CA HospOption Care Enterprises, Inc.; CA RXOrange Belt Pharmacy, Inc.; FL Fitter, HME, MSPOsceola Kissimee Limited Partnership; FL (4 branches) MSPOxycare, LLC; CT HMEPal-Med, Inc.; SC HME, MSPPalms Respiratory; FL HMEPark Medical Pharmacy Inc.; CA (4 branches) Fitter, HME, MSPPark View Care Center, LP; TX MSPPenCare, Inc; TX IRN, RXPenn Med Consultants, Inc.; PA (18 branches) MSPPharmacy Corporation of America; GA (4 branches) HMEPine Island Diabetic Supply; FL MSPPinnacle Homecare; NJ HME, MSPPinnacle Medical Solutions, LLC; MS MSPPL Medical Supply, Inc.; TX Fitter, HMEPlanned Eldercare; IL HME, MSPPlus Medical LLC; FL Fitter, HME, MSP, RTSPremier Home Healthcare, Inc.; FL HMEPrism Healthcare Services, Inc; IL HMEProfessional Respiratory Services, LLC; TN HMEPro-Med Equiment and Supply, Inc.; NC Fitter, HMEPromesa Home Health, Inc.; TX HHPSG Services; IL HH, IRNRCS Management Corporation; IN (4 branches) CRCS, Fitter, HME,

MSP, RTSReach Med Care, LLC; TN HMERegal Medical Services, Ltd; VA (4 branches) Fitter, HME, MSPRehab Supply, LLC; NY HME, MSPRemke Medical; KY (2 branches) CRCS, HMERespiratory Plus Healthcare, Inc; KY HMERiver City Pharmacy, Inc.; CA HME, IRN, RXRKF, Inc.; TX HMERobeson County Home Health Agency; NC HH, IRNRockingham County Council on Aging, Inc.; NC PDASan Jose Home Health Care; TX HHSanta Barbara Healthcare; CA HME, MSPSanta Fe Health & Rehabilitation Center, LP; TX MSPScott-Wilson, Inc.; KY HH, IRN, RXSecure Care, Inc.; GA HH, HME, IRNSelect HME; OK (4 branches) CRCS, HME, MSPSerenity Medical, LLC; GA MSPShady Med, Inc.; PA MSPSkyemed Pharmacy & Infusion Services, Inc; FL HME, RXSleepcare Diagnostics, Inc; OH (4 branches) HME

SleepMed Therapy; GA ( 23 branches) HME, MSPSomniCare, Inc.; KS (3 branches) HMESource One Medical, Inc.; KS HMESouth Point Medical Supply, LLC; FL MSPSoutheast Diabetic Supply, Inc.; NC HMESouthern California Mobility; CA RTSSouthern Healthcare Services, LLC; FL (2 branches) HME, MSPSouthern Mobility and Medical, LLC; NC HMESpectrum Infusion, Inc.; NC IRN, RXStalls Medical Inc.; NC (3 branches) HMEStanly County Home Health Agency; NC HHStat- Care Pharmacy; MA RXStateline Medical Equipment; IN HMEStoll's Pharmacy, Inc; CT Fitter, HME, MSPStracon Medical Supply; TX HME, MSPSummitt Group, Inc.; TN RTSSunbelt Medical Supply & Oxygen; FL HME, MSPSV-Jupiter Properties; FL MSPTelcom Consultants, Inc.; PA HME, MSPTennessee Valley Home Medical; AL CRCS, HME, RTSTexas Medical, Inc.; TX HMEThe Care Group of Texas; TX CRCS, HMEOlathe Good Samaritan Center; KS MSPGood Samaritan Health Care Center; FL MSPDenton Good Samaritan Villiage; TX MSPLake Forest Good Samaritan Village; TX MSPThe Forms Boutique; SC FitterTheratech, Inc.; TN MSPTotal Home Care, Inc.; NC HMETriad Respiratory Solutions, Inc.; NC HMETri-County Home Medical Equipment -Montgomery, AL CRCS, HME, RTSTrinity Home Care; NY IRN, RXTrinity Home Health Care LLC; MD HH, PDA, PDRNTrusted Life Care, Inc.; MA (20 branches) HMETwin State Home Health Care Services, Inc.; NC CRCS, HMEUnified Home Care, LLC; NC HH, IRNUnimed II Inc.; KS (3 branches) HMEUnique Boutique, Inc.; NC FitterUnited Nutritional Services; GA HME, MSPUnited States Pharmaceutical Group, LLC; FL (3 branches) MSPVital Care of Southwest Virginia; VA RXWal-mart Stores Texas, LP; TX MSPWedgewood Nursing Home, LP; TX MSPWellness Life Systems; MO Fitter, MSPWest Home Health Care, Inc.; VA (2 branches) CRCS, HME, RTSWhite Settlement Nursing Center, LP; TX MSPWilmington Medical Supply, Inc.; NC HME, MSPWilson County Home Health; NC HH

Surveyor Spr ing 2008 19

August 9, 2007

Mr. Tim SafleyAccreditation Commission for Health Care, Inc.

Mr. Safley:

The purpose of this letter is to thank you for improving our small business. We received our Certificate and window sticker today, so we are now officially accredited. I wanted to write this letter several weeks ago, but I didn’t want to look like a brownnoser during theAccreditation process.

You may remember a comment I made at the introductory seminar you conducted in Atlanta this spring. The topic of the conversation was the dreaded QI plan. My comment regarding QI, as I remembered it, is as follows: “For the small business owner, what you call a QualityImprovement Plan is what we refer to as everyday decision making. All of this paperwork that you require just seems like one great big stackof documentation poo.”

Your response to this comment, in which you referenced the poo factor, was quite helpful. These are not your exact words, but as I remem-bered it. You encouraged the attendees to look for areas to monitor that have not been looked at before, especially those that impactprofitability. You also stated that the need for QI for accreditation purposes stemmed from the need to be able to evaluate businesses whichvary greatly in size and nature, on a standard scale.

When we returned from Atlanta, we soon started our QI program with a nice luncheon. We discussed possible additions to the program, andI agreed to do a spot audit on product prices from suppliers verses the actual contract price we were supposed to be paying. I even spentmore time creating a new audit form, so that it would look real nice in the middle of the poo pile.

To get it over with, we started the spot audit immediately. To my surprise, we found a mistake to our benefit of over $1,000 within twominutes. We continued for several hours and found another $7,000. Even though I am a small business owner without much QI experience, Ihad enough sense to order myself to conduct a complete audit. Several weeks later, we finished our audit and found a total of $20,773.80that was owed to us. Our supplier has agreed to refund the money, and we are expecting a check any day.

Humility often comes to those who need it the most, but it doesn’t usually have a $20,000 check attached. My comment, although sincere,was out of place. My initial perception of the QI program never looked at a possible benefit, only the work required to meet the minimumstandard.

Thank you for your help in making our company better. Please accept my apology for not only my public comment, but also the other negative comments that you didn’t hear about the QI requirement in general.

Many Thanks,Timothy Kelley, PresidentMedtrac Solutions, Inc.

A small HME provider recovered $20,773.80 using an ACHC Quality Improvement (QI) Standard

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