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TomCe s a rha s be e nPr e s i de nt oft heAc c r e di t a t i onCommi s s i onf or He a l t hCa r e , I nc . ( ACHC) s i nc e1991. Tomhol dsa Ba c he l orof Sc i e n c ed e g r e ef r o mCa l i f or ni aSt a t e Un i v e r s i t ya tLo sAn g e l e sa ndr e c e i v e dh i sMa s t e ro fAr t sde gr e ei n Pub l i cMa n a g e me n tf r omt heUni ve r s i t yo fMa s s a c h u s e t t si nBos t on. Heh a s3 0y e a r so fe x pe r i e nc ewor ki ng i nh e a l t h c a r ea dmi ni s t r a t i on. Pr i o rt oACHC,h ewa saUni tMa na ge ra t Mt . Au b u r nHo s pi t a l , i nCa mbr i d g e ,MA a n dEx e c ut i veDi r e c t or ofRe h a b i l i t a t i o nSe r vi c e sofWa ke Co u n t yi nRa l e i g h ,NC.

IThi nkIcan Thehi s t or yofACHCha sbe e nt het e s t i monyof t he“ Li t t l eEngi net ha tc oul d” . St a r t e dbyaf e w homec a r epr ovi de r sdi s s a t i s f i e dwi t ht he a c c r e di t a t i onopt i onsa tt het i me , t he y de c i de dt oc r e a t eapr ogr a m j us tf orNor t hCa r ol i na . I ni t i a t i ngs t r a t e gi e sf orqua l i t ypr ogr a msa nd pr oduc t st hr oughus eofours t a nda r dst ohe l p pr ovi de r sde ve l opa ndi mpr ovet he i rown ke ypr oc e s s e sa ndpa t i e nts e r vi c e swa s t hepr i ma r ygoa lf r omt hebe gi nni ng. Thee a r l yye a r swe r ee xha us t i vei nt hec l i mb uphi l lt os ur vi vea nde s t a bl i s ht hebus i ne s s whi l ebe c omi ngavi a bl eopt i on f orhomec a r epr ovi de r s .


celebrati ng 25years ofexcellence

Re a c hi ngt het opoft hehi l lbe c a memor ee vi de nt i n2, 000whe nt hef i r s twe l l knownna t i ona l c ompa nyc hos eACHC. By2007, wewe r e na me da soneofAme r i c a ’ sf a s t e s tgr owi ng c ompa ni e sont hef i r s te ve rI nc . 500l i s t .

Tomi sa na d v o c a t ef o rqua l i t yhe a l t h c a r es e r v i c e sb yme a nsofpr ovi de r e du c a t i o na n dp e e rr e vi e wt hr ough a c c r e d i t a t i o na n d ma ke s pr e s e nt a t i on sa ts t a t ea n dn a t i ona lc onve nt i on s .Heh a sp u b l i s h e dava r i e t yof a r t i c l e so na c c r e d i t a t i o ni nt r a dej our na l s .

Ove rt heye a r s ,weha vea l s ohe l dour s e l ve st ot he s a mehi ghs t a nda r dofout s i depe e rr e vi e w t hr ougha nnua lI SO9001: 2008a udi t s , Ma l c ol mBa l dr i gee xa mi ne rvi s i t s a ndCMSons i t er e vi e ws .

Her e s i d e si nRa l e i g h , Nor t hCa r ol i na wi t hh i swi f eAmb e r .Al s ol i vi ngi n t heRa l e i g ha r e aa r et h e i rs ons -Todd wi t hh i swi f eKa t h y ,a ndgr a nds on Mi c h a e l ;a swe l la st he i rot he rs on Er i c .

Ther e l a t i ons hi pwi t hourc us t ome r sa sa l wa ys be e nt ha tofa“ pa r t ne r s hi p” . Thi si swhy, whe n l a unc hi ngourpr ogr a mna t i ona l l yi n1996, we us e dt hemot t o,“ bypr ovi de r sf orpr ovi de r s ” . Toda y,wes oundoutt heme s s a ge , “ e xpe r i e nc et heACHCdi f f e r e nc e ” .

Tom Cesar

Wha tPe o pl eAr eSa y i ng Abo utACHC “ Th eo v e r a l le x p e r i e n c ewa sg r e a t .I d i dt h ed u ed i l i g e n c eo no t h e r a c c r e d i t a t i o ns e r v i c e sb u tACHC i s b yf a rt h eb e s t .I t ’ sb e e n at e a m a p p r o a c hi nh e l p i n g Da r tMe d i c a l a c h i e v eAc c r e d i t a t i o ns t a t u sb u tmo s t i mp o r t a n t , t h e mu t u a l wo r k i n g t o g e t h e r . ACHC i s s e t t i n g t h e s t a n d a r db y wh i c ho t h e r swi l lb e j u d g e d . ”Da r tMe d i c a l ,I n c . “ To m,h e a r t f e l tc o n g r a t u l a t i o n so n ma n yy e a r so fh a r dwo r kt h a t h a sp a i d o f fi ni mp r o v i n gt h eq u a l i t yo fs o ma n yp a t i e n t ’ sl i v e s .Yo u rc o mp a n y h a sp u r s u e de x c e l l e n c ei n af a i r , e q u i t a b l e ,a n dp r o f e s s i o n a lma n n e r t h a ts p e a k s we l lo fy o u rg o o d l e a d e r s h i p ,a n dy o u rf i n es t a f f .Yo u d e f i n i t e l yma d eu sab e t t e rc o mp a n y a n dh a v ep r o t e c t e du si nma n ywa y s . Onb e h a l fo fmy s e l f ,s t a f fa n dt h e c h i l d r e n wea r eh o n o r e dt os e r v e t h a n ky o u .Wewi s hy o uma n ymo r e y e a r so fs e r v i c e . ”He n l e yMe d i c a l . “ Th a n ky o uf o rwo r k i n g wi t hu s c o l l a b o r a t i v e l yi no r d e rt oa c h i e v et h e h i g h e s tq u a l i t yo r g a n i z a t i o np o s s i b l e . Wev a l u et h ei n f o r ma t i o ny o u rt e a m o fe x p e r t sh a st os h a r ewi t hu sa n d a l t h o u g hi tt a k e sal o to fp a i ns t a k i n g t i me t o a c h i e v et h i s , we h o l d o u r s e l v e s a tt h i s s t a n d a r d a n d a p p r e c i a t et h ei n f o r ma t i o n .I ti sn i c e t ob ea b l et owo r kt o g e t h e ra n dn o tb e a f r a i dt oa s kq u e s t i o n st h a tweh a v e a b o u tc e r t a i ns t a n d a r d s .Th a n ky o u ! ” Ad v a n c e dMe d i c a lCo n c e p t s ,I n c .

The Next Chapter- Celebrating 25 Years of Excellence The Accreditation Commission for Health Care, Inc. Tom Cesar, President Raleigh, NC 2011

The Next Chapter

C e l e b ratin g 2 5 year s o f e xce l l ence

T om C e s ar P re s i d ent 1 9 9 1 - pre s ent

The Ac c r edi tat ion c om m is s ion f or Health Care , I nc .

Acknowledgments I would like to thank Bill Mallon for editing this book, Tracy Hinman for her artistic talents in the design of the book, and Deric Rutledge, Paul Hetzel, Barb Sylvester, and Leslie Knuth for their valuable feedback and suggestions.

Contents Introduction

What Is Accreditation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Who is ACHC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Chapter 1 Initial Services in North Carolina: 1985-1990 . . . . . . . . . . . . . . . . . . . . . 7

Chapter 2

Statewide Advancements and New Ventures: 1991-1995 . . . . . . . . . . . 15

Chapter 3

Nationwide Expansion and Survival Pains: 1996-2000 . . . . . . . . . . . . . 27

Chapter 4

National Breakthroughs: 2001-2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Chapter 5

National Recognition Success Benchmarks: 2006-2011 . . . . . . . . . . . . 55

Chapter 6

Looking to the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Looking Back- Benchmarks of Achievement . . . . . . . . . . . . . . . . . . . . . 70

The Next Chapter

A Few Comments from the President . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Appendix A- The ACHC Team

The Board Chairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 The Board 2011-2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 The Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 The Surveyors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Appendix B

What People Are Saying about ACHC . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 Index of Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

The Next Chapter

Introduction What Is Accreditation? The quality of home care can differ significantly from one organization to another. There are several thousand public and private organizations nationwide, with new ones opening up every day. As a protection for consumers, many states have established licensure laws governing these types of companies. Licensure rules will typically establish minimum requirements for doing business. Not all states have licensure requirements for home care companies. Another form of consumer protection is that of voluntary accreditation. Standards of care are based upon the consensus of professionals of those elements that should exist in organizations that have “gone the extra mile” to assure quality. Accreditation is professional peer review administered by a private nonprofit organization that establishes higher standards than state or federal requirements.

Why Is Accreditation important? Accreditation is regarded as one of the key benchmarks for measuring the quality of an organization. In the U.S., setting standards by industry leaders with peer review is widely accepted. Preparing for accreditation will disclose the company’s strengths and weaknesses. This stage of the process provides information for management to make decisions regarding operations, whether they are business or patient-care related, in order to improve the effectiveness and efficiency of business’s performance. In other words, organizational self-examination should result in better planning and implementation of best practices. Accreditation standards provide the catalyst for organizations’ management strategy. The on-site survey validates the compliance with those strategies and determines if the company is actually performing according to the goals and objectives.


Who Is ACHC? ACHC is a not-for-profit accreditation organization that has stood as a symbol of quality and excellence since 1986. They are ISO 9001:2008 certified and have CMS Deeming Authority for Home Health, Hospice and DMEPOS. ACHC is the provider’s choice for accreditation because of personal account managers, relevant and realistic standards, competitive pricing, and a friendly, consultative approach to accreditation. Accreditation by ACHC reflects an organization’s dedication and commitment to meeting standards that facilitate a higher level of performance and patient care.

ACHC’s Principles and Goals Vision

The Accreditation Commission for Health Care will be the accreditation organization of choice that inspires excellence in healthcare. Mission To educate healthcare providers through relevant, industry/program -specific standards and surveys that lead to successful business practices and improved patient services. Core Values Integrity, Relevance, Innovation, Enhancing Outcomes, Excellence in All Things, Flexibility without Compromising Quality, Concern for the Entire Healthcare Continuum. ISO Quality Policy Statement The Accreditation Commission for Health Care is committed to developing and improving healthcare accreditation programs and services, meet2

The Next Chapter ing customer and regulatory requirements, enhancing employee skills and efficiencies, continually improving our quality management systems and processes, sustaining fiscal growth, and improving market presence. BHAGs (Big Hairy Audacious Goals) 2001- To become the recognized accreditation service of choice by all types of healthcare organizations and providers and be the standard by which all others are measured by 2007. 2008 - To become the number one community-based accreditation organization for Home Health, Hospice, Home Medical Equipment, and Pharmacy services by the year 2012. Be awarded the Malcolm Baldrige Quality Award in 2015. Develop and implement a process management-based Hospital Accreditation program by the year 2018 (previously known as the Hybrid Project).

List of ACHC Programs and Services ACHC is excited to offer accreditation programs and services tailored specifically to our customers. Our accreditation standards result from ACHC staff and volunteer industry leaders combining their talents to develop industry-leading standards and criteria. Our standards are written for ease of understanding with realistic expectations in daily operations. Home Health ACHC’s Home Health program accredits skilled services that are provided on an intermittent basis by skilled professionals, including nurses; physical, occupational, and speech therapists; medical social workers; and home health aides. • Skilled Nursing • Home Health Aide • Physical Therapy • Occupational Therapy 3

• Speech Therapy • Medical Social Services • Behavioral Health Home Care (BHHC)— BHHC integrates behavioral health interventions into home care services for patients whose mental illness, substance abuse or intellectual/developmental disabilities make it difficult or otherwise prevent them from receiving care outside their home. Services are provided by a psychiatric nurse and other home care personnel, as ordered by a physician. Hospice Hospice is the care of patients with life-limiting illnesses in the patient’s place of residence, providing a multidisciplinary approach to medical care, pain management, and emotional/spiritual care. This team approach is used in the survey process. ACHC surveys are conducted by a hospice nurse and a clinical support surveyor, such as a medical social worker. An agency that provides inpatient services must adhere to the inpatient standards as well as the primary hospice standards. • Hospice Residential Care • Hospice Inpatient Care DMEPOS DMEPOS is Durable Medical Equipment-Prosthetics, Orthotics and Supplies. It is usually classified under Medicare Part B. Services can include the delivery, set-up, and maintenance of medical equipment. Examples that fit in this category are beds, wheelchairs, CPAP, oxygen, and any items that are considered by Medicare to be rental items. DMEPOS also includes the storage and delivery of supplies (usually disposable or semi-durable) used for medical management and/or self-care in the home, such as diabetic supplies. • Home Medical Equipment 4

The Next Chapter • Complex Rehabilitation and Assistive Technology • Fitter • Clinical Respiratory Care Services • Medical Supply Provider Pharmacy ACHC’s Pharmacy program accredits many different aspects of the Pharmacy Industry. Our Pharmacy program accredits for things such as pharmacies that provide parenteral medications for patients in alternative settings, infusion therapy, or medications delivered to a client’s home, physician’s office, or clinics specializing in chronic disease states. Retail Pharmacies that distribute medical supplies to patients without any ongoing rentals fall under Medical Supply Provider (DMEPOS accreditation). • Infusion Pharmacy • Ambulatory Infusion Center • Infusion Nursing • Specialty Pharmacy Private Duty This program accredits for skilled and non-skilled care in the home for adults and children that is not reimbursed by Medicare. • Private Duty Aide • Private Duty Nursing Sleep Sleep Lab is a facility that provides testing for sleep disorders either in an Independent Diagnostic Testing Facility (IDTF), as defined by CMS, or in hospital-based testing facilities. Sleep testing can also be conducted in the home. • Sleep Lab/Center


Behavioral Health: Behavioral Health provides inclusive standards covering services to children, adolescents, adults, and seniors challenged with mental health, intellectual/developmental disabilities, and substance abuse issues. • Integrated Care Services (ICS) • Supervised Group Living Services (SGL) • Assertive Community Treatment Team Services (ACTT) • Assessment & Referral Services (ARS) • Case Management Services (CMGT) • Community Support Services (CS) • Crisis Response Services (CRS) • Day Treatment Services (DTX) • Foster Care Services (FCS) • Intensive In Home Services (IIH) • Intensive Outpatient Treatment Services (IOTX) • Partial Hospitalization Services (PHS) • Prevention Services (PVS) • Psychosocial Rehabilitation Services (PSR) • Residential Treatment Services (RTX) • Respite Care Services (RCS) • Supported Employment Services (SES) • Personal Support Services (PSS) • Outpatient Treatment Services (OTX)


The Next Chapter

Chapter 1 “Never doubt that a small group of thoughtful, committed citizens can change the world. In fact, it is the only thing that ever has� Margaret Mead, Anthropologist

Initial Services in North Carolina: 1985-1990 The Year 1985: In 1985, several leaders in the home care aide industry saw the need for an accreditation program in the State of North Carolina. A few companies were already accredited by either the Community Health Accreditation Program (CHAP) or the National Home Care Council (NHCC). However, these leaders wanted a local program to focus more on the sensitive needs of those organizations that serve patients in North Carolina.

The Year 1986: In April, a combined group of providers and state government advisors developed the program, through the leadership of Gary Bowers, Judy Adams, and other members of the North Carolina Association for Home Care (now known as the Association for Home and Hospice Care of North Carolina). In April, these originators applied for a business development grant from the Kate B. Reynolds Foundation. The proposal was later approved for grants of $9,000 in 1987 and $10,000 in 1988, but disbursement was contingent upon the incorporation of the new organization with the State of North Carolina. Additionally, a few volunteers took assignments for developing a business structure, a work plan, a set of bylaws, and a budget. They defined the purpose as follows: 7

“To assure the provision of high quality in-home aide services throughout North Carolina, the North Carolina Association for Home Care proposed the establishment of a functionally autonomous Commission on Accreditation for In-Home Aide Services. The commission will be charged with the sole function of administering a voluntary accreditation program for in-home aide services.” In June, Jack Pleasant, Robert Parker, and Elizabeth Enloe submitted incorporation documents to the Secretary of State. On August 25, the North Carolina Accreditation Commission for In-Home Aide Services (NCACIAS) was officially incorporated by the State. The first volunteer Board consisted of representatives from local Aging programs, Social Services programs, Home Health agencies, and privately owned companies: • Judy Jay, Medical Personnel Pool of Raleigh; • Bill Mashburn, Iredell Home Health; • Jackie Pully, Nash County Health Department; • Walter Brown, Duplin County Services for the Aged; • Jane Hare, Coordinating Council for Senior Citizens in Durham; • Helen Starr, Person County Council on Aging; • Ann Faircloth, Cumberland County DSS; • Gael Hallenbeck, Durham County DSS; • Tom Harmelink, Health Force of Wake and Durham Counties; and • Amy Moore, Apple Nursing Services. In addition, ex-officio members included: • Ann DeMaine, North Carolina Division of Social Services; • Susan Harmuth, Division on Aging; • Ron Goodson, Division of Health Services; and • Judy Adams, North Carolina Association for Home Care (the first Executive Director of NCACIAS). 8

The Next Chapter According to the writer’s understanding, four states had created home care accreditation companies during this period of time. In the ensuing years, only the programs for North First Board of Commissioners: 1986.

Carolina and New Jersey survived. The New Jersey

program was established in 1986 and continues to serve providers in that state. The programs provided include accreditation for homemaker-home health aide services and in-home skilled nursing services. The current offices are located in New Providence, New Jersey. In October 1986, the North Carolina Accreditation Commission for In-Home Aide Services (NCACIAS)—the new state-incorporated organization—had it first election of officers. Those elected were members of the first volunteer Board in August 1986: Judy Jay, President; Tom Harmelink, Vice President; and Ann Faircloth, Secretary/Treasurer. During this meeting, committees were established, draft standards were approved, and workshops were planned. A press release dated November 12, 1986, announcing the newly founded accrediting organization, was publicly circulated throughout the state. Thus, the organization was launched as the North Carolina Accreditation Commission for In-Home Aide Services (NCACIAS). Immediately, four educational workshops from December 8 through 12 were conducted to introduce the new accreditation program. The four educational sessions were held in the following cities—Asheville, Greenville, Fayetteville, and Winston-Salem—with a total of one hundred twelve participants. The first surveyors were trained in February 1987. 9

ACHC’s first press release announcing creation of the new organization.

These surveyors were Catherine Gutmann, Henry Pleasant, Donna Nixon, Juliana Cooper-Goldenberg, Dr. Sterling Whitener, Dr. Betty Reynolds, Gay Twisdale, Jane Holt, and Nancy Sumner. 10

The Next Chapter The Board meeting in November was very busy. Firstly, the Board established accreditation fees for small, medium, and large agencies. Then the first annual budget of $15,255.00 was set. Moreover, the Board drafted a written lease agreement between the NCACIAS and the NC Association for Home Care for office space located at 1037 Dresser Court in Raleigh. Finally, the Board composed a surveyor contract and developed an outline for a surveyor training program. Trifold for ACHC’s first education workshops.

The Year 1987: In January, the NCACIAS accredited its first organization, the Ashe County Council on Aging, a rural program in Jefferson. The Executive Director was Mannon Eldreth, who later became a member of the Board. Other organizations sought accreditation, several of which were already accredited by the National Home Care Council (NHCC) or the Community Health Accreditation Program (CHAP). 11

Award certificate sent to the first company accredited by ACHC.

Applicants paid a $5.00 application fee, which included a copy of the accreditation standards. Accreditation fees ranged from $250.00 a year for small providers to $750.00 per year for larger providers. Also in January, the NCACIAS received correspondence from Barbara Matula, Director of the NC Medical Assistance program, explaining that accreditation from either the North Carolina Commission or National Home Caring Council was required for participation in the Personal Care Services program under Medicaid. Loretta Allen-Adams was appointed in November as the second parttime Executive Director, and Gale Hallenbeck was appointed President of the Board. The new Executive Director stayed with the company for a few months and then resigned. The company was growing very slowly throughout the state. 12

The Next Chapter The NCACIAS continued to operate primarily with volunteer labor, provided mostly by the members of the Board and the staff of the North Carolina Association for Home Care.

The Year 1988: The Board decided to terminate the position of Executive Director because of financial concerns. In addition, a new logo, designed by the Education and Promotions Committee, was presented to the Board.

The Year 1989: In July, Karen Duke was hired as a part-time secretary for the NCACIAS. The 1989-90 budget of $28,865.00 was approved. After the NCACIAS had operated for three years, a directory was printed, which listed twenty-six accredited organizations serving citizens in fifty-two counties of North Carolina. This indicated that growth was slower than expected.

The Year 1990: In April, the Strategic Planning Committee reported to the Board that the original objectives of the NCACIAS continued to be valid, but that the number of agencies receiving accreditation was significantly less than what was desired, given the length of time the Commission had been in operation. The potential continued, it was stated, even though the number currently would appear to be stagnating or even decreasing. The Planning Committee, however, believed it was possible for the Commission to survive, but felt that the elements of this program required a full-time Executive Director, a clerical staff, and a Board more focused on policy issues and less on details of the operation. Moreover, it was the opinion of the Committee that the operations of the Commission functioning at current levels were not feasible in the future, both in terms of accredited agencies and funding. 13

The stark reality was that the Commission might not survive in the long term. At the July meeting, a decision was made to submit a grant proposal to the Kate B. Reynolds Foundation for $160,000. The grant was approved by the end of the year. Also in April, Gary Bowers announced in a report that a new licensure bill had been approved by the State Legislators, effective as of July 1, 1992. The language included deeming status for agencies already accredited by a recognized quality assurance entity, and the NCACIAS was included in the record.


The Next Chapter

Chapter 2 “We need leaders of inspired idealism, leaders to whom are granted great visions, who dream greatly and strive to make their dreams come true; and can kindle the people with the fire from their own burning souls� Theodore Roosevelt, President

Statewide Advancements and New Ventures 1991-1995 The Year 1991: On June 3, Tom Cesar was hired as the first full-time Executive Director of the NCACIAS. And Karen Duke, the part-time Office Manager, became full-time. During the orientation phase, Tom was required to accompany a surveyor on a home visit. The patient was a man paralyzed by a double stroke and confined to bed for ten years. During the visit, the wife of the patient began to weep. Tom withdrew into the living room, fearing that his presence had upset the lady. However, she explained that the home care aide had been caring for her husband for a few years and had become like family to her. She told Tom how helpful the aide had been in many ways to both her and her husband. The emotional connection and the sensitive value of the healthcare service greatly impacted him. This experience left a deep impression upon him that it kindled a burning passion in his life for the work of promoting quality healthcare services in North Carolina. Since the need for growth was pressing, marketing and educational workshops were top priorities. During the fall, Board members scheduled and conducted eight workshops from the Eastern seacoast to the Smoky 15

Mountains. As a result, a few new applications were received, and growth picked up in the months that followed. A few months after Tom Cesar’s orientation, Gary Bowers, Executive Director of the North Carolina Home Care Association (NCHCA), announced his resignaTom Cesar at his first Board meeting.

tion and his relocation to Asheville, NC. Just prior

to his departure, Tom invited Gary to lunch. During their conversations, Tom asked Gary for suggestions on how to promote the advancement of the NCACIAS. He recommended exploring the possibilities for accrediting skilled nursing services in home care companies. Hence, a marketing survey was designed to measure the level of interest in an expanded program to include nursing standards. It was targeted to one hundred twenty companies in the state, which generated a 42 percent response rate. The response indicated that 60 percent would consider utilizing a new program should it become available. This information was brought to the attention of the Board, which quickly motioned for the immediate development of new standards. A grant proposal to the Kate B. Reynolds Health Trust for $17,000 was submitted and approved. Meanwhile, a Task Force was established with representatives from the North Carolina Nurses Association, the North Carolina Board of Nursing, the North Carolina Home Care Association, and the NCACIAS Board. As a result, new nursing standards became available in early 1992.

The Year 1992: In January, news articles on accreditation were written by Tom for 16

The Next Chapter the North Carolina Public Health Association and for the Aging Services Association newsletters, and the NCACIAS began attending and exhibiting at a variety of local conferences. This increased the visibility of the Commission. Since the NCACIAS had been named in the “deemed status� sector of the state home care licensure rules for in-home aide services, it was appropriate to submit the new nursing standards to the North Carolina Medical Care Commission. Board Chair Donna Steele and Tom Cesar made that presentation to the Commission, and the standards were approved. A few weeks later, Donna Steele arranged for a meeting with Blue Cross Blue Shield of North Carolina (BCBSNC), and they, too, were complimentary regarding the standards. At the close of both meetings, it was recommended that the NCACIAS consider expanding its program to add all skilled services under home health. During the fall and winter seasons, the provider fees collected for the fiscal year 1991-1992 totaled $28,850. The total revenue for the year, including grant funds and miscellaneous income, was $92,040. In the October Board meeting, the decision was made to change the name of the organization from the North Carolina Accreditation Commission for In-home Aide Services (NCACIAS) to the Accreditation Commission for Home Care (ACHC). In the winter of 1992, the first ACHC newsletter was published, and approximately two hundred were distributed throughout North Carolina.

The Year 1993: By October, ACHC had accredited thirty-nine companies. Community Care, Inc. in Greensboro became the first organization accredited under the new nursing standards. During the October 1993 Board meeting, it was decided that ACHC would pursue development of standards for home health agencies. While new applications were received, renewals 17


were lacking. In N o v e m b e r, t o increase visibility, a meeting was arranged with Program Director Walti Rasulala of W R A L - T V, t o seek production of a Public Service Announcement (PSA) featuring home care accreditation by ACHC WRAL-TV agreed to fund the feature and a PSA was produced and dis-

ACHC’s first newsletter.

tributed to TV sta-

tions throughout the state for viewing during National Home Care Month.

The Year 1994: In January, Blue Cross Blue Shield announced that all contract providers had one year to become accredited. The letter named the ACHC as one of the options for home health and home infusion. However, months had slipped by since the Board approved moving forward with home health standards. Nothing had been done. The Board quickly put together two Task Force groups, charging them with the responsibility to produce draft standards within six months. The deadline was met. The second phase was the independent review by several state profes18

The Next Chapter sional healthcare related boards and associations. Then the final step: the standards were submitted to the State Medical Care Commission, and met with approval. Awareness of the ACHC began to reach home care trade associations in other states. Prior to the 1994 Board Strategic Planning Retreat, telephone calls were received from Executive Directors of the Michigan and Texas state home care associations. The question was: “ Wi l l


make the program available outside the State of North Carolina?” Ironically, during the

Quarterly Board meeting, 1993.

same period of

time, ten customers were lost. ACHC’s problem was due to the disapproval of third-party payer contracts and hospitals—all of which insisted upon the accreditation of home care providers by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO). In January, the Health Care Financing Administration (HCFA, later renamed the Centers for Medicare and Medicaid Services, or CMS) issued a transmittal alert, stating that it would no longer recognize only JCAHO and CHAP for home health deeming authority, but would welcome applications from other accrediting organizations. During the 1994 Board Retreat, it was decided that ACHC had to position itself nationally in order to make its services more available. It must find the means of gaining acceptance on two fronts: 1. With private third-party payers who recognized only JCAHO and 2. With securing HCFA deeming authority 19

for Medicare home health agencies. The Board was confident that these challenges could be met while continuing to prepare for the future. In spite of some successes by the end of the year, ACHC faced another significant financial crisis. Consequently, benefits were suspended, the full-time office manager was reduced to parttime employment, and the President took some income reductions for a Cindy Freburg showing ACHC’s accredited locations.

few months. For a period of months he used two of his personal credit cards

to pay company bills until sufficient revenue was received for him to be reimbursed.

The Year 1995: In January, Suzanne Lafollette-Cameron, Board Chair, gained Board approval to develop standards that would best fit the needs of the Division of Social Services (DSS). Geoffrey Santoliquido, an ex-officio Board member representing DSS, had requested ACHC develop home management criteria. These new standards would be required for local county Social Services, which would help them in raising the level of quality of their services. A committee was formed to work on this project. ACHC was already recruiting an additional employee and had located new office space on Executive Drive to accommodate the need for more space. In March, the third employee, Kim Sessoms, RN, became the first Vice President of ACHC’s Accreditation Services, and was assigned to work with the committee to develop those standards. Unfortunately, 20

The Next Chapter months later, just prior to completion, the Division of Social Services (DSS) decided to administer its own program, and ACHC was relieved of its obligation to DSS. In May, ACHC accredited its first home health agency, operated by the Yadkin County Public Health Department. The Health Director, Gail Brown, was a Board member. The same year saw other home health agencies moving over to ACHC, which increased the confidence of the organization. Since the Board was serious about offering services nationally, preparation for national expansion was initiated by pursuing recognition by the National Committee for Quality Assurance (NCQA). After several months of firm, active efforts, a letter was finally received. A managed care organization’s acceptance of ACHC accreditation would meet the intent of NCQA’s credentialing standard. This was a major breakthrough for ACHC. Meanwhile, during the same period, Blue Cross Blue Shield of North Carolina (BCBSNC) was the first third-party payer to give equal status to ACHC along with JCAHO and CHAP. The struggle to gain approval from payers across the country continued for more than a decade. The first opportunity for ACHC to speak at a national convention was at Medtrade in Atlanta. The conference boasted of having more than then thousand attendees. Tom Cesar and Elliott Osowit (an ACHC surveyor) presented two seminars on home medical equipment standards. Only three people attended the first session, and four people the second session in auditoriums that could seat one hundred! Louis Feuer, Dynamic Seminars and Consulting, was responsible for the education and exhibiting venue and generously provided the room and exhibiting space at no cost to ACHC. That was the beginning of getting national visibility in the home medical equipment industry! During a Board strategy meeting earlier in the year, discussions were 21

focused on either expanding in the region or going national. Eventually, the consensus was that ACHC would take the risk of becoming a national accrediting body. The attitude of the President (formerly titled Executive Director) was that the JCAHO had Board retreat for strategic planning, 1995.

standards written by industry experts, had

qualified and trained surveyors, and had support staff for operations—as ACHC also did. Even though the JCAHO had more than six hundred employees and ACHC had only three, the company model was the same. Therefore, there was no reason why we should not try to compete. The Board agreed! Cassie Wasko, Board Chair, summarized the Board discussion with the emphasis that ACHC should not compromise its two-fold philosophy: 1. Ensure a voice for the providers; 2. Endeavor to maintain high patient-focused standards, even if it meant that the company would have to dissolve. It was a very risky move to go national with three employees and with less than $30,000 in the bank. When one former Board member learned of this decision, she was appalled. She immediately contacted the office, warning us that it was impossible to compete with the JCAHO and that the business would shut down within a year. At the end of the year, the North Carolina Medical Care Commission sent a letter of commendation thanking ACHC for helping to improve healthcare services in the state, and wishing the organization well in its 22

The Next Chapter

A letter from the NC Medical Care Commission congratulating ACHC for nine years of service in North Carolina and enhancing the quality of care.

endeavor for national expansion. The endorsement along with the NCQA letter proved later to be valuable for gaining third-party payer recognition. Although ACHC had clearly developed a viable, credible accrediting program with interested parties inside and outside the state, had to face and overcome three major obstacles in order to be a viable option: 23

The first hindrance was our inability to serve providers outside North Carolina. The second obstruction was the impact of the monopolistic practices of the JCAHO that would prevent providers from choosing ACHC. And the third deterrent was the lack of knowledge and approval of the state regulatory bodies and third-party payers. Although the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) was the dominant player, dislike of the JCAHO in the industry was apparent. The Community Health Accreditation Program (CHAP) was also available to community-based programs, but it was clearly a small program struggling to compete with the JCAHO. Tom Cesar researched the strengths and weaknesses of the JCAHO and developed a marketing strategy for moving forward. His initial move was to highlight ACHC’s strengths in contrast with the Joint Commission’s weaknesses. The following types of comparisons were explained to prospects for many years to come: • The JCAHO was known for not listening to customers’ recommendations or complaints. However, ACHC advanced the philosophy of “Ensuring a voice for Providers,” which encapsulated the principle of its operations. The first conference exhibit displayed the following slogan, which was the first tag line given to conference participants: “ACHC - the Provider’s Choice.” • The JCAHO had an inferior approach for their written home care standards by using hospital standards as the template. Eventually, the JCAHO produced standards that were not the best fit for home care providers. ACHC had utilized the expertise in the North Carolina industry to develop strong, healthy standards that best fit the home care clinical working environment and became known for relevant and reasonable standards. • The JCAHO had integrated multiple home care services grouped 24

The Next Chapter into one publication, making it difficult for providers to identify what applied to them. ACHC had partitioned home care services into separate, individual publications designed for easy understanding and simple preparation of the applicants. • The JCAHO used as their model a procedure of arriving at a customer’s location the night before the on-site survey with inspection of the company policies the evening before the review. ACHC, however, requires applicants to submit a Preliminary Evidence Report a few weeks before the on-site survey in order to give the surveyor sufficient time for reviewing and scoring the company, thus providing helpful feedback prior to the visit as an assistance to benefit the company. • The JCAHO was known for an approach that conducts adversarial on-site surveys. However, ACHC promotes an attitude of respect and courtesy from the visiting surveyor, not a “gonna-get-you” policing stance, but one of being a good, beneficial partner to help improve patient services and business operations. Customer services are an integral part of the small company culture, and it is believed that this approach would eventually catch the attention of prospective customers. • The JCAHO was known for charging expensive fees for its accreditation services. However, ACHC was efficient, small, and capable of offering services that were considerably less expensive. Six months after ACHC went national, the JCAHO dropped their prices. And approximately nine months later, CHAP lowered their fees. Furthermore, during the same period, Sherry Thomas, RN, of North Carolina Home Care Association (NCHCA) saw a potential opportunity for ACHC to consider a hospice program. She had read in a newsletter published by the National Hospice Organization that their organiza25

tion had openly rejected the new JCAHO hospice program. Out of this evolved a partnership with the Hospice for the Carolinas (now the Carolinas Center for Hospice and End of Life Care). Judy Lund-Person, Executive Director of Hospice for the Carolinas, was very supportive in the creation of hospice standards. A Task Force group, chaired by Cathy Swanson (Simmons) from Caldwell County Hospice, was created with participants from both North and South Carolina. By the summer of 1996, the first hospice standards were released. The total number of companies accredited during the ACHC organization’s first ten years of business was seventy-nine organizations, including branch offices in one hundred and eight locations displaying the ACHC Certificate of Approval.


The Next Chapter

Chapter 3 “To do something serious and new means overcoming frustration, confusion, opposition and indifference. It means being a leader” Real Change, by Newt Gingrich

Nationwide Expansion and Survival Pains: 1996-2000 The Year 1996: A press release in February was faxed to national and state associations and publishers, declaring that ACHC would begin offering nationwide accreditation. Marketing efforts, including mail delivery of ACHC’s Surveyor newsletter, were now reaching companies outside the state of North Carolina for the first time. Tom Cesar and Elliott Osowit made two road trips to the Southeast to meet with State Association Directors to impart news and information about the standards and services of ACHC. The first trip in the summer lasted three days, with visits made to the South Carolina Home Health Association, Georgia Home Health Association, and Florida Home Medical Equipment Association. Since funds were low, Tom packed sandwiches, chips, and drinks in an ice chest for meals. He also explained to Elliott that nights would be spent in low-cost motels. The trip was beneficial since meetings in each state were held to inform leaders of trade associations about ACHC’s programs, philosophy, and procedures. The second trip in the fall included appointments scheduled with the Home Medical Equipment Associations in Tennessee and West Virginia. These trips trumpeted the news that ACHC was expanding nationally and competing with two other national accrediting bodies—JCAHO and CHAP. 27

During the same period of time, Healthcare Equipment in Durham, NC, became the first home medical equipment company to be accredited by ACHC. According to Larry Lankford, President and part owner of Healthcare Equipment, the company began its preparation in March of 1995. Final approval was granted on May 1, 1996. The attraction was not only the price but also how ACHC focused on the patient and were provider oriented according to Lankford. The ACHC surveyor was Floyd Boyer. In the ensuing years, Floyd became a significant supporter of and contributor to the growth of ACHC particularly with editing and developing accreditation standards. ACHC employed different strategies to foster growth, mostly by capitalizing on the organization’s ten-year learning and successes in North Carolina. Prospects were informed that the success of the previous ten years served as a beta test in the field to develop and perfect its programs. By the time ACHC went national, approximately 20 percent of the home care providers in North Carolina were accredited by ACHC. Consequently, the goal was to reproduce that number state by state, since the competitive landscape was ready for a new, progressive, and responsive program to meet the needs of the industry. A variety of innovative approaches were implemented, and different methods of attack were used throughout the ensuing years. ACHC used “quality differentiation” as the means to capture the attention of prospects. The company outlined the distinctive differences between the JCAHO and ACHC. ACHC set up exhibitions and marketing literature at conferences, informed prospects of the organzation’s originality by not following their competitors, and articulated their endeavor to become a leader in accreditation. ACHC utilized testimonies from satisfied customers. They were highly valuable, because ACHC was able to create an excellent reputa28

The Next Chapter tion from the small number of ACHC-accredited providers. This strategy provided leverage over time, because satisfied customers were, beyond question, credible. Eventually, these companies began to refer their business friends to ACHC. These personal referrals fueled the growth totally for the next ten years, until the company had sufficient funds to consistently advertise in publications. Meanwhile, new referrals continued to deliver more companies to ACHC. Another strategy used for many years was to react reciprocally and take responsible action on what the providers value with accreditation. This was done largely by creating different accreditation programs not offered by the competitors. ACHC designed targeted methods to gain penetration into untouched market places. For example, ACHC was the first in 1996 to offer accreditation for post-mastectomy prosthetic fitter services. Years later, ACHC became the first to develop programs for Specialty Pharmacy, Rehabilitation Technology Supplier Services, and Medical Supply Provider Services. Staying below the radar screen was another tactic used. The JCAHO and CHAP had an obvious rivalry going on between them at the time and were at the forefront of the news on a regular basis. These two companies, while contending with each other, paid no attention to a little unknown company from North Carolina, which allowed ACHC a temporary reprieve to gain gradual recognition and to cultivate muchneeded supporters. Penetrating the path of least resistance also proved an effective strategy over the years. If Trigon Blue Cross Blue Shield in Virginia refused to recognize ACHC, the organization would minimize efforts in that state and aim at states where third-party recognition was more promising. During the springtime, in response to a Request for Proposal (RFP) issued by the Accreditation Council for Home Medical Services, ACHC 29

was invited to give a presentation to the Council in Chicago. The Council was determined to bring to the industry an alternative accrediting organization within one year. The member groups included the National Association for Medical Equipment Suppliers, National Association of Infusion Therapy, The MedGroup, and Van G. Miller & Associates (VGM)—all prominent national home care organizations. ACHC was eager to partner with the Accreditation Council, but could not agree on the number of seats the Council wanted on the ACHC Board. Because of that, along with other requirements of the RFP, the Accreditation Council chose a private company in New England to spearhead the project and to form a new accrediting body that could compete with JCAHO. However, the project failed in just over a year. Also in the spring, the Women’s Health Care Educational Network (WHEN) submitted a proposal for ACHC to develop an accreditation program designed specifically to women’s health. The prosthetic fitter services targeted mainly postmastectomy fitting practitioners. The ACHC Board ACHC partners with WHEN to promote quality of healthcare for women.

agreed to the proposal, which was accompanied by a $50,000 developmen-

tal grant. The program standards were reviewed by the American Cancer 30

The Next Chapter Society, the Susan B. Komen Foundation, the National Alliance of Breast Cancer Organizations, and the Y-ME organization. By the end of the year, new manuals were shipped to more than thirty women’s healthcare boutiques around the country. It was the first accrediting program of its kind available nationally. Other accreditation organizations later followed ACHC with similar programs. The end-of-the-year fiscal figures in December were again low in spite of aggressive efforts to increase business. The grant from the Women’s Health Care Educational Network, Inc. (WHEN), along with some charitable donations, was instrumental in sustaining the business.

The Year 1997: In January, Adult Home Care, the first company accredited by ACHC outside North Carolina, was surveyed in Delta, Colorado. Moreover, ten new applications were submitted for the year. Boost in Sales of the Accreditation Manuals also picked up. Adverse


against an assisted living facility in Cary, NC, prompted the North Carolina Assisted Living Association to approach ACHC to create standards Adult Home Care, the first home-care aide organization accredited outside of North Carolina.

for assisted living facilities. The national affiliate, the Assisted Living Fed-

eration of America (ALFA), had been discussing accreditation without initiating any action. An affiliate in the State of Washington was also interested in working with ACHC. Preliminary efforts in the developmental stage started, and discussions continued until mid-1998. 31

A chart made in 1996 depicting ACHC’s ten-year growth.

After learning that the two state associations of North Carolina and Washington were collaborating with ACHC, ALFA decided to go forward in their decision-making process on behalf of its national membership. The recommendation was for the Commission for Accreditation of Rehabilitation Facilities (CARF) to pilot an accrediting program on 32

The Next Chapter behalf of ALFA. This announcement curtailed any need for additional collaboration since ALFA designated funds for CARF to go forward. Hence, ACHC discontinued its efforts from developing a program for assisted living. ACHC was approached during the spring by Bill Popamaronis, President of the Epic Pharmacy Network, to pioneer a new network accreditation program with the Utilization Review Accreditation Commission (URAC). The year before, Tom Cesar had cultivated a business relationship with Garry Carneal, CEO of URAC. Epic Pharmacy Network provided services for more than one-hundred retail pharmacies. The plan was for URAC to review the Epic Network’s operations and for ACHC to execute on-site surveys at Epic’s pharmacies. This partnership approach to accreditation was the first of its kind, bringing a new network/provider accreditation model to the market. But the plan was stopped when Trigon Blue Cross Blue Shield of Virginia refused to recognize ACHC. Because Epic had too many branches in Virginia to risk loss of revenue, the project was dropped. In the fall, ACHC exhibited at a national convention with accredited companies in only two states. The exhibition was located at the National Association for Home Care (NAHC) convention in Nashville, TN. The marketing tag line on all distribution materials read, “ACHC—Providers’ Choice.” And the exhibit display read, “Ensuring a Voice for Providers.” Jack Evans, President/owner of Global Media Marketing, designed and published ACHC’s first conference program advertisement for the event. With few exceptions, Tom Cesar was the sole person exhibiting for ACHC for the next number of years. He was asked frequently, “Are you a representing consultant company that makes preparations for providers with JCAHO accreditation?” To their surprise, he responded, “No, we compete with them”! 33

In December, ACHC was faced with its third major financial crisis in its history. The CEO met with Donna Steele, Board Chair, to discuss immediate strategies to keep the business open and afloat. One strategy was to eliminate staff members, including the CEO. In order to ensure continued operations, Tom expressed his willingness to refinance his home in order to pay back fees paid to ACHC by accredited companies should ACHC have to close its doors. Donna scheduled an emergency Executive Committee meeting to address the issue. Several strategies were adopted, which included suspending health benefits, limiting staff travel, making more appeals for grant proposals to foundations, obtaining cash contributions from Board members, and procuring some in-kind contributions from Board members who could conduct site surveys. After a few months, the cash flow recovered.

The Year 1998: During the fiscal year of 1998, national growth began to pick-up slightly. ACHC received applications from companies in 17 states. Moreover, a new opportunity arose with the North Carolina Public Health Sector in late 1998. A preliminary steering committee was established with Ann Scott, local Health Director; Dennis Harrington, Chief of the State Department of Local Health Services; Bill Smith, President of the Association of Local Health Directors; and the ACHC staff. Letters of support were received from several state officials, including Dennis McBride, MD, State Health Director. Meetings continued for approximately fourteen months. A joint grant proposal was made to the Kate B. Reynolds Charitable Trust to develop an accrediting program for public health departments. After the Trust turned down the proposal, funds were explored within the State budget. Initial funds of $60,000 were set aside by the state for the project. An additional $200,000 was proposed to be appropriated for 34

The Next Chapter the project in the fall of 1999. However, Hurricane Floyd struck the state and severely damaged the eastern part of the State. All State funds went into the recovery and restoration of damaged areas. Thus, the project had to be postponed indefinitely. The plan was assigned years later to the UNC, Chapel Hill Public Health Education Department. In March, ACHC submitted an application to the Health Care Financing Administration (HCFA) for Medicare Home Health Deeming Authority. ACHC was denied. Appeals were sent by Senator Helms, Senator Faircloth, and Congressman Melvin Watt. HCFA responded indicating that, while ACHC met the criteria as an accrediting body, it was not considered a national company. Another new project was initiated at the recommendation of Rod Okamoto, RPH, and Thomas Diamantidis, Pharm.D, the owners of Nutrishare, a specialty company for Total Parenteral Nutrition (TPN) located in Elk Grove, CA. Their proposal was to develop an advanced accreditation for specialty organizations that focused on a particular disease or therapy. A developmental grant was provided to craft the program. The program was called “Centers of Excellence.” However, the market did not respond, and the Board decided to drop the program. Nevertheless, it was a significant stepping stone leading to other business developments.

The Year 1999: In January, the increased number of accredited companies reported to the Board had grown to ninety-five in twenty states. These figures were a compelling encouragement to the staff and Board, despite the company’s financial struggles and restrictive payer acceptance due to JCAHO business practices. The Board chair, Cathy Chapman, arranged for the Board to have a special luncheon in Burlington, NC, to celebrate the small but productive advancements that the company was building. 35

A letter of support from Senator Helms to help ACHC in becoming recognized by the Health Care Financing Administration (now CMS).

After learning about ACHC, Melissa McIntire of Priority Healthcare Corporation made contact with ACHC in the spring. Priority Healthcare was interested in being accredited by a competitor, but determined that their standards did not fit the model of a specialty pharmacy. Melissa 36

The Next Chapter arranged for a visit to ACHC to discuss the development of standards specific to specialty pharmacies. Priority Healthcare was a $500 million a year company and one of the nation’s leaders in specialty pharmacy for Hepatitis C. They had just been named by Fortune magazine as one of the top companies to watch. After Tom Cesar’s visit to their offices in Lake Mary, FL, Priority Healthcare agreed to fund a developmental grant for their proposal. ACHC became the first accrediting body to develop this type of program. A year later, Priority Healthcare became the first specialty pharmacy accredited by ACHC. This was a major accomplishment for ACHC. The Specialty Pharmacy program was the first of its kind in the country, and it made news, which traveled throughout the industry. This breakthrough achievement became the primary attraction to capture the attention of other large companies to ACHC. In May, a national convention hosted by Homecare Providers Co-op (HPC), owned and operated by Shelly Prial, invited ACHC to participate in a panel discussion forum with JCAHO and CHAP. It was an opportunity to inform the providers about the distinctions of all three programs. In the succeeding five years, ACHC participated nine times in similar panel discussions. Participation in these panel group meetings steadily strengthened ACHC’s recognition as a national accrediting organization. National buyer groups began to show interest in ACHC. By the end of the year, ACHC had signed preferred provider contracts with Home Care Providers Group (HPC), the Van G. Miller and Associates Group (VGM), and Pharmacy Buyers Inc. (PBI). Another obstacle to business growth surfaced in June 1999. ACHC learned from potential customers in Illinois and North Carolina that local Veterans Affairs Medical Centers would contract only with companies that were JCAHO accredited. For two years, efforts were made with VA officials at the local and national levels to change its policies and 37

accept ACHC, but the efforts were met without any positive responses. Tom Cesar decided it was time to write to Dr. Garthwaith, the head of VA healthcare. As a result, in April 2001, ACHC received confirmation that Dr. Perlin, Chief of Quality and Performance Management who reports to Dr. Garthwaith, had sent memos to all Veterans Integrated Service Networks (VISNs), advising them that there were no VA policies restricting them from contracting with Durable Medical Equipment suppliers that are accredited by alternative programs as long as they met or exceeded the standards of the JCAHO—a criterion that ACHC had already upheld and maintained. Although the VA Headquarters clearly stated that there were no restrictive policies regarding accreditation, the fact is that some of their medical centers accepted ACHC, and some did not. This struggle for acceptance within the VA system continued for many years. In 2002, Tom Cesar met with Dr. Tom Edes, Chief of Home and Communitybased programs for the VA. After completing a crosswalk, in which the standards of the JCAHO, CHAP, and ACHC were compared, Dr. Edes formed a task force to analyze the three companies. The workgroup determined that all three accrediting programs were equal. Moreover, these three organizations were represented on a panel to educate VA physicians and nurses about their programs at the VA National Home Care Conference in New Orleans in 2003. In the succeeding years, many VA Medical Centers have now come to accept ACHC’s accreditation of their contractors. In December, ACHC again faced another significant cash flow problem. The CEO felt that the company’s continued operations were in jeopardy. Cathy Chapman, Board Chair, reviewed the crisis and asked the CEO if he would continue for a short interval period of time at a half-salary rate to help ACHC survive the crisis. He agreed to do so and 38

The Next Chapter remained on half salary for seven months until revenues began to increase once more. Again, Board members made personal cash contributions to help raise the charitable donations which remedied the situation, and also, wherein possible, to do surveys at no charge.

The Year 2000: The Board meeting in Burlington, NC, in January 2000, was again hosted by the Board Chair, Cathy Chapman, who reported on positive growth and gave special recognition to several of the surveyors for their generous contributions to ACHC. Those surveyors included Sil Anderson, Steve Wilson, Cindy Hardin, Mary Snyder, Dr. Betty Reynolds, Floyd Boyer, and Dr. Sterling Whitner. Don White, the new Chair for the American Association for Home Care (AAH), asked Tom in February 2000, to attend an AAH Executive Committee meeting in Washington, DC. The Executive Committee proposed a possible affiliation with ACHC as an arm of AAH to administer a national certification program for Home Medical Equipment providers. Due to new fiscal challenges that emerged from Medicare shortly thereafter, the proposal was tabled and put on the back burner. Because of continued financial losses, due to payers and provider service contracts that continued under the insistence on JCAHO accreditation, “Operation Freedom of Choice” was jointly initiated by the ACHC’s CEO Tom Cesar and CHAP’s President Jerry Cohen. The losses to both companies were real and substantial. Bill Shenton, Counsel from Poyner & Spruill for ACHC, conjointly with the attorney for CHAP, participated in Board discussions. At the time, an urgent mandate was motioned to assess the true business climate for the accrediting companies in the United States. It was clearly determined that JCAHO’s business practices, directly and indirectly, hindered the growth of its competitors. Members of the 39

ACHC and CHAP Boards participated in conference calls for several months. It was ascertained in a document prepared by ACHC that over a four-to-five-year period the organization had lost revenues of more than five hundred thousand dollars ($500,000). These were known losses. CHAP had similar losses over the same period. Eventually, the two organizations concluded that it would be too expensive to litigate, and that any legal maneuvering by the JCAHO could stall both organizations until their funds were exhausted. ACHC and CHAP agreed that better standards and programs, with higher quality services, would eventually make the more preferable choice between either one of their companies rather than the JCAHO. In June, a telephone call was received by Tom from Garry Carneal, President of the Utilization Review Accreditation Commission (URAC). URAC had been approached by Arthur H. Horowitz and Associates to partner with them. They were to answer back with a statement concerning their availability to participate in a Request for Proposal (RFP) for a grant of five million dollars ($5,000,000) to develop accreditation standards on genetic research for the Veterans Administration. URAC was already fully occupied with two major projects in progress and was not prepared to respond. Therefore, ACHC was asked to be a partner. The Horowitz Company was a well-respected Food and Drug Administration (FDA) consultant company in Washington, DC. They were widely knowledgeable and highly experienced with FDA-regulated audits, trials, and clinical monitoring. They also had a comprehensive understanding of the VA’s internal systems and policies. But Horowitz lacked an accreditation organization to round out the partnership, and ACHC filled that void. ACHC worked with Horowitz and Associates on an RFP. The VA reviewed only the final three RFPs out of those that were submitted. The National Commission for Quality Accreditation 40

The Next Chapter (NCQA) was awarded the contract, and the Horowitz/ACHC proposal came in second. In August, Donna Steele, Cindy Hardin, and Tom Cesar met with the management at the Health Care Financing Administration (HCFA) regarding re-applying for Medicare Deeming Authority Status. After two hours of discussions, ACHC was informed that the HCFA did not consider ACHC as a national organization. HCAF’s internal guidelines required ACHC to have considerable accredited home health agencies in contiguous states from coast to coast. As a result, re-application was tabled for the second time. In October, ACHC began a dialogue with the JCAHO to consider participation with their Cooperative Accreditation Initiative (CAI) program. But ACHC tabled the consideration after a number of months’ exchange of viewpoints. The JCAHO $2,500.00 application fee and position that their review of ACHC’s program was mandatory, but that ACHC’s review of JCAHO’s program was unnecessary, could not be accepted. In July 2001, the consideration was dropped. In December, ACHC reported that it had one hundred seventy-eight accredited sites in twenty-two states from coast to coast by the end of the year.


Chapter 4 “The future belongs to whoever best measures quality of care… Whoever does it well will absolutely control the market and everybody else who doesn’t will disappear” Market-Driven Health Care, Regina Herzlinger, Harvard University

National Breakthroughs 2001-2005 The Year 2001: The new year began with three significant developments. The first one was collaboration with Kate Douglass, Vice President of Coram Healthcare, the nation’s largest home infusion company with seventy-five locations. Tom had learned from Sylvia Haist at a convention that Kate was likely looking for an alternative to the JCAHO. Tom later, through the efforts of Rod Okamoto, RPH, and Thomas Diamantidis, Pharm.D, co-owners of Nutrishare, became acquainted with Eric Kastango, Pharm. D who personally knew Ms. Douglas. Eric then helped facilitate an introduction and meeting with Kate. By summer, an agreement was reached, and the announcements were made. The other breakthroughs were with two national provider buying groups that became partners with ACHC. Those companies were US Rehab and the MedGroup. Efforts were stepped up by ACHC’s President to contact more healthcare management companies and to gain more confidence and acceptance with payers. But most significantly, Coram Healthcare was the first major customer that set ACHC permanently on the map as a viable competitor to the JCAHO and CHAP. The January Board meeting was held at a restaurant in Charlotte, 42

The Next Chapter where special recognition was given to honor Congressman Melvin Watt in his efforts of support for ACHC. He helped ACHC to respond to the bureaucratic pushACHC staff function, Christmas 2001.

back from the Health Care Financing Admin-

istration (HCFA) regarding the application for deeming authority with Medicare. By February, ACHC had been approached by a number of home care providers to develop of standards that could be tailored to their markets. ACHC became the first in the country to develop standards for two of these markets—Respiratory Nebulizer Medications, and Mail Order Medical Supply Services (later renamed Medical Supply Provider). Moreover, by summertime, three more companies agreed to be the beta test sites for a new mail order program—Liberty Medical in Fort St. Lucie, FL; Uromed in Alpharetta, GA; and Carolina Diabetic Supply in New Bern, NC. Liberty Medical was the largest medical home delivery company in the country serving diabetic patients. During the summer of 2001, ACHC completed discussions with Trigon Blue Cross Blue Shield (BCBS) that had lasted for six years and included an on-site visit. As a result, Trigon finally decided to accept ACHC accreditation for Durable Medical Equipment (DME) companies. DME providers in Virginia had helped by registering complaints with their State Insurance Department. This opened the door of change for many more companies that wanted ACHC accreditation. Within a short time, a presentation was made to a network of providers and the state 43

trade association for DME. Subsequently, twelve companies purchased manuals and later became accredited. Also during the summer, members of the Hospice Provider Network that represented the ten largest hospices in the Carolinas, decided to decline their annual renewals with the JCAHO. Tom Cesar made a presentation to their representatives in Winston-Salem, NC, and they responded with a positive decision for all of their hospices to choose ACHC. By the end of the year, one hundred thirteen manuals were sold, compared to sixty-one sales in 2000. Moreover, twenty-two new and fifteen renewal applications were received for the second half of 2001. Due to the dramatic increase of business volume from the beginning of the year, one part-time and three full-time employees were added to the staff. In September, a consultant, Alan Lassiter, MD, was retained to assist ACHC in planning and building the company’s infrastructure. ACHC urgently needed to prepare itself for its anticipated growth. Members of both the Board and the staff were required to read the book, Built to Last, by Jim Collins and Jerry Porras. It was important for everyone to be acquainted with the contents of this volume prior to attending a strategic planning retreat for January.

The Year 2002: The Board retreat at Myrtle Beach, SC, was led by Dr. Lassiter and Eric Ritzen, Board Chair. A prepared workbook was provided as guidelines for the retreat, and the President wrote the following preface to set the tone of the event: • Lessons Were Learned! As we enter a new era for ACHC, we reflected upon a number of accomplishments over the past fifteen years that has brought us to this place. The path has been strewn with obstacles every step of the way. Yet, defying the odds, visionary risktakers from among the Board, staff, surveyors, and supporters have 44

The Next Chapter been key for ACHC’s recognition as one of the three major national accrediting bodies in the home care industry. • The Setting Is Clear! ACHC is in a unique position of all accrediting organizations. The “status quo” for selecting accrediting bodies has changed. Interest in new approaches, relevant processes, and better updated services for accreditation is high. • The Mission Is Evident! As a rising new leader, ACHC must be responsive to the voice of the industry. Courage, perseverance, and resourcefulness will be needed to meet this challenge. The measure of success will be determined by the measure of commitment. • The Future Is Bright! As Harvard’s Professor Regina Herzlinger has said: “The future belongs to whoever best measures quality of care…whoever does it well will absolutely control the market, and everybody else who doesn’t will disappear.” As a result, the Board adopted an aggressive strategic plan for 20032007. The strategic objectives included the following: • Recognition from CMS (Medicare) for Deeming Authority • Recognition with the Veterans Administration and TRICARE • Certification to ISO 9000 • Implementation of an annual Balanced Score Card • Practice of Malcolm Baldridge’s requirements for operations • Fortification of the infrastructure with clinical VP/managers; IT personnel; a director of marketing and development; additional clerical and accreditation representatives • Definition of ACHC “quality” standards. Consider various innovative methodologies for measuring quality. Analyze current applications and tools for the survey process • Visibility enhancements at trade shows and increased mailings to targeted populations 45

The Board also adopted its first Big Hairy Audacious Goal (BHAG): that is, to become the provider’s choice for accreditation by 2007. In another sudden thrust of business, Walgreens Health Initiatives Home Care decided to choose ACHC. This penetration into the marketplace is a major breakthrough with nationwide known companies! In July, ACHC held an Open House in celebration of its new office suite on 5816 Creedmoor Road, which more than doubled the square footage to 4,000 for the organization. The President was appointed to the Editorial Advisory Committee for HomeCare magazine, a widely known, national voice of the industry. The two artiSherry Samuels, Eric Ritzen and John Griswold visit the Open House at the Creedmoor Road office.

cles he authored for the publication effectively increased the visibility of ACHC.

The annual CPA audit rendered ACHC a “Going Concern” for the last time. Auditor Mastin Simmons, of Romeo, and Wiggins Company, LLP., explained to Tom Cesar that this phrase meant “your company had been at risk of going out of business within a year.” Three cheers! And hallelujah! For the good news was another breakthrough and turning point for ACHC! Mastin, along with Kelly Lanier, had been auditing ACHC’s financial records during the many years of limited resources. Persistent efforts were doubled to secure the recognition of the Veterans Administration and TRICARE (i.e., health insurance for active military personnel and their families). By the end of the year, TRICARE 46

The Next Chapter endorsed ACHC as an approved accreditor and announced it in their system-wide memorandum.

The Year 2003: The Capital Area Workforce Development program approved a grant proposal of $50,000 for ACHC to prepare and become certified as ISO 9000 (an international organization for the standardization of quality management procedures). Charlie Hoilman, Quality Paradigms, Inc., was hired to help the company evaluate and improve all business processes. Sherry Samuels, Vice President Accreditation Services, and Leslie Knuth, Quality Assurance Manager, worked diligently to carry out two assignments: 1. Learn the process, principles, and procedures of ISO; 2. Lead the staff over a period of months to make changes necessary for an on-site audit. Their achievements significantly improved ACHC business operations. John Rains, a nationally known pharmacist specializing compounding pharmacy, approached ACHC to develop a set of accreditation standards designed for his industry. ACHC received grant money from pharmacy stakeholders to create standards for compounding pharmacies. Preliminary work was carried out by a volunteer group of leading pharmacists from around the country. Task force participants were affiliated with the National Association for Community Pharmacies, the Professional Compounding Centers of America, the International Association for Compounding Pharmacies, American Society of Healthcare Pharmacists, the United States Pharmacopeia, and others. A special meeting was later called in March 2004 in Washington DC, with seven national trade associations that represented pharmacy interests to discuss the project. At the close of the day, the National Association of Pharmacy Boards made two proposals: 1. Create the “Pharmacy Compounding Accreditation Board� with trade association funds; 2. Let this Board take over 47

the project begun by ACHC. As a result, ACHC discontinued its direct participation in the project and provided assistance by furnishing its draft standards to the new agency. In December 2003, ACHC finished the year with a large increased number of accredited locations, including branch offices in forty-five states, Puerto Rico, and Guam. The third-party payer recognition continued to grow with thirty more companies approving ACHC.

The Year 2004: At the beginning of the year, the Board approved the development of standards for sleep programs. ACHC initiated a relationship with the Accreditation Association for Ambulatory Health Care (AAAHC) to explore a partnership for the advancement of standards and alliances in the sleep industry. After several meetings and discussions, ACHC decided to postpone the project and to commit to its development in an independent sleep lab program in the spring of 2009. In spring of 2004, after months of preparation, ACHC became the first healthcare accrediting organization in the world to achieve the international distinction of certification to ISO 9000:2001. The certification finally puts to rest the question most often asked by healthcare providers, “Who accredits the accreditor”? What is the ISO? The International Organization for Standardization (ISO) is a non-governmental federation of the national standard bodies of one hundred fifty-seven nations and is the world’s leading developer of International Standards. Its standards specify the requirements for the state-of-the-art products, services, processes, materials, and systems, as well as the requirements for quality conformity assessments and managerial practices. ISO standards are designed to be implemented worldwide. ISO is a global network that identifies what international standards are required by business, government, and society and develops them in 48

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ACHC’s ISO 9001:2000 ISO certificate.

partnership with the sectors that will put them to use. ISO adopts standards by transparent procedures based on national input and delivers them to be implemented worldwide. Each ISO member is the principal standards organization in its country. In all, there are some fifty-thousand experts contributing annually to the work of this international organization. They distill the latest in 49

expert knowledge and make it available to all. In this way, they facilitate trade, propagate new advances, transfer technology, and share good management practices- making them an invaluable source of knowledge. When their work is published as an ISO International Standard, it may be adopted as a national standard by the ISO members. Option Care, another well-known national home infusion company, decided to choose ACHC.

The Year 2005: In April of 2005, the Board arranged a retreat in Tampa, FL, led by both Richard Lynch, Vice President of Operations, and Rebecca Linton, Board Chair. Firstly, Rebecca directed the group through some brief activities for strategic planning. Then the majority of the time was taken up by the new Board member, Richard Wetherell, who conducted several educational sessions and guided many functional exercises. He especially piloted the use of ‘the balanced score card’ for the integral part of the company’s business operations. This new tool steered both the staff and the Board to another step forward in the cultivation and maturation of better business practices. This accomplished one of the goals set in 2002. Nutrishare achieved the corporate donation level of “Platinum,” the only company to reach that level during ACHC’s history. The company over a period of years contributed more than $100,000 under ACHC’s sponsorship program, which was critical in sustaining ACHC’s business operations during the dire times of financial crisis. In previous years, the Women’s Healthcare Educational Network (WHEN) had accomplished the level of “Gold” sponsorship of $50,000. Several other companies had fulfilled the level of the “Bronze” category of sponsorship up to $25,000. The first Humanitarian Circle Award was given to Donna Steele in recognition for her fifteen years of volunteer services to ACHC. The award was prerequisite upon the candidate’s following qualifications: 50

The Next Chapter • Exhibiting exceptional dedication, knowledge, and skill • Providing leadership and service • Inspiring and facilitating the exchange of ideas, solutions, and information • Increasing the recognition, value, and stature of ACHC • Advancing the mission and goals of ACHC No person, then or since, has compiled the same number of volunteer hours that she has given to ACHC. Over the years, she has served three times as ChairperThe first Humanitarian Circle Award which was given to Donna Steele.

son of the Board, and she continues to serve as a

valued member of the Standards and Accreditation Review Committee. During the summer, Sherry Hedrick, RN, and Paul Hetzel were hired to occupy two key managerial positions for clinical compliance and Information and Technology (IT) management. They, along with Leslie Knuth, Quality Assurance Manager, become vital members of the leadership team in coordination with the President. In her first year of employment, Sherry led the ACHC to the successful achievement of acquiring “deeming authority” with Medicare for Home Health. And Paul created the Accreditation Management System (AMS), the first automated system for staff use in daily operations. Both contributions were important and noteworthy for maturing ACHC in its continued growth process. In August, ACHC again relocated its offices and increased its square footage to 10,000 in an office building at 4700 Falls of Neuse Road, 51

Raleigh, NC. The property was located by Eric Ritzen, past Chair, who negotiated the contract specifics with the landlord. Richard Lynch, Vice President of Operations, coordinated all aspects of the physical move to the new office. Along with assistance from Cynthia Freberg, Director of Support Services, Richard was instrumental in the design, outfitting, and move to the new suite. In November, the company held an Open House in celebration of its new location. During the fall, SGS U.S. Testing Company, Inc. Systems, and Services Certification Division agreed to partner with ACHC in a united effort to start the develTom and Amber Cesar hosting the Open House at the Falls of Neuse office, 2005.

opment of an accreditation/ISO hybrid product for home care. For sev-

eral years, quality experts had suggested searching for better ways to assess the quality of healthcare. It was believed that, by combining process management with the accreditation standards of the best practices, an advantageous outcome would help decrease medical and clinical errors, decrease costs, and improve the quality of healthcare. Donald Berwick, MD, formerly of the Institute for Healthcare Improvement in Boston, along with co-author Troyen Brennan, Professor of Law and Public Health at Harvard, had this to say in their book, entitled, New Rules, Regulation and the Quality of American Health Care: “What has not yet occurred is an integration of the modern understandings of ideal management practices into an inspection system.


The Next Chapter The ISO 9000 standards for quality assurance processes formulated by and now widely adopted in non-health-care industries are far more sophisticated than the conventional criteria applied to hospitals.” ACHC took this charge seriously. After many months of work and preparation, in October the world’s first Home Medical Equipment hybrid dual audit of accreditation and ISO beta test was conducted in Gulfport, MS, just weeks after Hurricane Katrina made landfall in August, 2005. When the test company, Southern Pharmaceuticals Corporation (SPC), did not initially pass the beta test, the company had to rethink its processes, communications, and disaster mitigation plan because of ISO requirements. Therefore, because of their improvements, the company was able to serve patients in Gulfport the day after the hurricane disaster, although eleven out of twenty employees were not available. So the day after Katrina hit, SPC was fully operational, supplying oxygen not only to its own patients but also to the Red Cross/FEMA shelters and local fire departments. “We have been accredited by ACHC since 1996, but that focuses on the clinical side and doesn’t look at the business or resource side,’ explains SPC Vice President Doug Martin (ACHC Board member). “ISO is more of a continual process where you learn from your mistakes, identify corrective actions and develop processes and policies that will fix things for good.” News of this spread among the local regional home care providers. The HomeCare magazine also learned of it and reported its findings of the successful events that took place. Consequently, the magazine wrote a feature article entitled, “Katrina! What Went Right.” SPC later rose to the success level of passing both ISO and ACHC requirements. 53

Tom Cesar received an invitation to write a chapter on the ACHC program for a college-level textbook, The Handbook of Home Care Administration, fourth edition, published by Jones & Bartlett. By the end of the year, ACHC successfully completed the year with an incredible nine hundred four accredited locations including branch offices.

A feature article in HomeCare magazine mentions ACHC and the world's first hybrid dual audit of accreditation and ISO, conducted with Southern Pharmaceuticals Corporation just weeks after Hurricane Katrina made landfall.


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Chapter 5 “Success is not achieving revenue goals, but seeing our customers succeed in providing better services and being a better run company.” A Passion for Excellence, by Tom Peters and Nancy Austin

National Recognition and Success Benchmarks: 2006-2010 The Year 2006: In February 2006, ACHC representatives made a presentation to the Centers for Medicaid and Medicare Services (CMS) leadership team. ACHC demonstrated the value of a process management system of ISO 9000 with traditional accreditation standards to improve the performance of healthcare organizations. The proposal for this hybrid approach in healthcare accreditation received positive comments. The CMS leadership team favored the proposal and charged ACHC to move forward with the ‘Research & Development’ project. However, due to the lack of sufficient funds, ACHC was not able to continue this project. Later, another company, Det Norske Veritas (DNV), in 2007 submitted a hybrid program for hospitals, which CMS approved. The DNV’s accreditation process, known as the National Integrated Accreditation for Healthcare Organizations (NIAHO), became the first organization to offer the new model. Finally, after two failed application attempts, Sherry Hedrick, RN, Director of Clinical Compliance and Accreditation, received deeming authority for Medicare home health agencies from the Centers for Medicare and Medicaid Services (CMS). At last, ACHC had surmounted many obstacles and difficulties in order to win the deeming authority. Later in the year, ACHC secured an additional deeming authority from 55

CMS for Durable Medical Equipment, Prosthetics and Orthotic Supplies (DMEPOS). HomeCare Magazine conducted a 2006 survey with rating results demonstrating that ACHC was the number one preferred accrediting organization in the country for Durable Medical Equipment (DME) Suppliers. This rating achieved one of ACHC’s goals, the 2001 BHAG, for DME companies. Again, the 2007 survey results exhibited an even wider gap between ACHC and the number two rated national accreditor. A new website, Customer Central, was introduced to better serve ACHC customers. This new service was developed so that updated Accreditation Standards and Policies can be downloaded immediately by customers in real time, rather than waiting for some UPS delivery. Another new website, Surveyor Central, was designed to make access more available to over one hundred ACHC contract surveyors. This updated communication method delivered information quickly. Surveyors could now read their own satisfaction performance reviews after each site visit ACHC customers. As a result of the ISO certification and quality improvement (QI) initiatives, stronger efforts were made to strengthen ACHC services to customers. Because of this, the Accreditation Department was redesigned, the Accreditation Coordinators were better trained, and their titles were changed to Account Managers. Once a provider orders ACHC standards, the company is assigned to an Account Manager, who will assist it throughout the entire accreditation process. Doug Martin was elected as the new ACHC Board Chair. He made changes in the Board’s agenda that followed the ISO 9001 standards more closely for the quarterly meetings. He also assigned a committee to re-write the corporation bylaws to comply with these standards.


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The year 2007: Bill Shenton, Poyner and Spruill General Counsel to the Board, nominated Tom Cesar as one of the area’s “Health Care Heroes,” an award approved and presented by the Triangle Business Journal at its annual awards dinner. The award was given for the category of “Health Care Manager.” The local business community acknowledged his aggressive drive to expand services and to improve quality in the home healthcare industry. A Checklist for Success, published for DMEPOS, was designed by Tim Safley, Home Medical Equipment Clinical Manager. This booklet helped providers to answer their practical questions about standards, policies, and procedures. It promoted better understanding and increased greater focus on what must be done in the content of their policies and procedures in order to satisfy accreditation requirements. ACHC—after submitting financial information about its business growth to Inc. magazine—was currently recognized and rated number 2,308 in the range of the first Inc. 5,000 of the country’s fastest-growing and privately held companies. For more than 25 years, Inc. magazine has celebrated the remarkable achievements of today’s entrepreneurial men and women who lead the five hundred fastest-growing companies with the Denise Martin and Doug Fletcher accept the Inc. 5,000 award.

annual Inc. 500 list. The 2007 issue of Inc. magazine presented the top

5,000 companies for the first time. All types and sizes of companies had 57

been encouraged to submit information on their growth. Meanwhile, Doug Martin, Board Chair, and Denise Fletcher, Board member, were the appointed representatives from the ACHC Board to attend the Inc. magazine Gala for the award recipients in Chicago. ACHC introduced the latest convenience of a paperless submission of the Preliminary Evidence Reports for its customers’ accreditation applications. All policies, procedures, and supporting documentation needed prior to the on-site review are now accepted in the electronic format of CDs or USB devices. During the year, ACHC conducted ten workshops, with hundreds of participants attending, to prepare companies for successful achievement of their accreditation.

The Year 2008: The HME Educator, a quarterly e-newsletter, was developed by Marketing Coordinator Deric Rutledge, who introduced it as the first educational electronic publication dedicated to one segment of the home care industry of its kind among ACHC’s competitors. This publication offers helpful information and instruction to its readers. Moreover, it links its readers to the respective web pages of the listed authors, and it features articles by experts in the industry. In the spring of 2008, Maxim Healthcare—one of the largest national home health companies- chose ACHC as their national accreditor. And in the fall of 2008, Amedysis—the nation’s largest home health company— made the decision to select ACHC. Jim Ramsey, Consultant of Medical Services International, arranged important meetings with Dr. Doris Tyler, the Director of Accreditation, and with Kathryn Enchelmayer, the Director of Quality Standards. Both Directors represented the Department of Veterans Affairs in the Health Administration. Richard Wetherell, ACHC Board Chair, and 58

The Next Chapter Darrin Washington, Director of Business Development from Computer Technology Associates and the President of ACHC, made a PowerPoint presentation on the unique hybrid approach in the development of standards for accreditation. The proposal was to create standards for one department within a VA hospital and to beta-test the effectiveness and outcome of those standards. Both VA representatives were impressed with the concept. They commented that this could be a big help for the VA and wanted to move forward. At the end of the meeting, both agreed that this proposal needed to go to the next level of approval from the two Medical Directors at the VA headquarters. The following response was received in a letter a few weeks later: Hello Mr. Cesar, Thank you for the follow-up. Kate and I have discussed your presentation/services with Dr. Duncan and Dr. Fihn. While we were impressed by your services at this time, there doesn’t appear to be a niche for your services at a national level; as such, a follow-up meeting is not going to be possible. However, your company is more than welcome to market to individual VHA facilities. Thank you again for your presentation. Dody Tyler Doris D. Tyler, PhD, RN Director, Accreditation Programs & Joint Commission Corporate Liaison Department of Veterans Affairs, Office of Quality and Performance (10Q) 59

Arrangements were made to meet with Major General Elder Granger, Deputy Director of TRICARE, for a presentation of the hybrid approach to accreditation. After the two presentations, General Granger decided that he would like TRICARE to work with ACHC to develop standards with the hybrid approach for dental care. In a meeting of three senior dental officers, representing the Army, Air Force, and Navy, he set a preliminary course to launch a project with this goal, including preliminary discussions of targeted dates. However, just weeks before his retirement in the spring of 2009, resistance to the project emerged from other military dental service leaders. Apparently, the Department of Defense (DoD) legal services were used to delay the proposed project beyond his retirement, effectively causing the project to stop. To make the necessary accommodations for an anticipated increase in customers, applications, and staff, ACHC decided to expand its current 10,000 feet of office space for an increased ACHC's office located on Falls of Neuse.

space totaling 12,000 square feet.

The Board decided to begin the journey of adopting and integrating the Malcolm Baldrige Criteria into ACHC business operations. Richard Wetherell, Board Chair, set the course by providing a day of instruction for the leadership team. Leslie Knuth, Vice President for Quality Assurance, guided the way for ACHC. The Malcolm Baldrige National Quality Award is the highest level of national recognition for performance excellence that a U.S. organization can receive. Moreover, it is the most 60

The Next Chapter difficult business standards that a company can implement in its operations. Congress established the program in 1987 for two reasons: To recognize U.S. companies based upon their achievements in quality and business performance, and to raise awareness for quality and performance excellence as an important competitive edge for attaining organizational success. Organizations that receive this award are considered as worldclass companies. To receive the Baldrige Award, an organization must have the following role-model organizational management system: 1. It must ensure continuous improvement in the delivery of products and/or services; 2. It must demonstrate efficient and effective operations; 3. It must provide an effective way to engage and respond to customers and other stakeholders. The criteria for this role-model status award are classified into seven categories: 1. Leadership; 2. Strategic Planning; 3. Customer Focus; 4. Measurement, Analysis, and Knowledge Management; 5. Workforce Focus; 6. Process Management; and 7. Results.

The Year 2009: In January of 2009, Lt. Col. Richard Peterson, Director of Professional Services for the Army and Air Force Exchange Service (AAFES), initiated contact with ACHC. He proposed the development of an accreditation program that could be tailored to convenient care clinics in a military setting. After meetings with AAFES leadership, the ACHC Board approved the program, with expectations that the project could start later in 2011. The reason for this delay was that the AAFES Board of Directors, who actually did approve the project in 2010, needed further approval of Department of Defense (DoD) and congressional committees for budget allocations. In an effort to strengthen the viability of the project and to build relationships in the convenient care industry, ACHC in 2010 joined the 61

Convenient Care Association (CCA), the national trade association representing clinics. In the ensuing months, ACHC made two PowerPoint presentations to the CCA Board of Directors in order to educate its members regarding the initiation and progress in developing standards for convenient care clinics in both the military and public settings. Matt Hughes, Accreditation & Business Relations Manager, developed an effective and efficient process to address one thousand eighty applications for accreditation that were received in January and February—the largest number ever submitted to ACHC in such a short period of time. Brittany Bouwer, President Tom Cesar helps out at the front desk to help process applications.

Accreditation Supervisor, was instrumental in executing the plan.

ACHC announced a new program for the Sleep Lab Accreditation, which was primarily designed by Tim Safley, DMEPOS Clinical Manager, specifically for facilities that provide Sleep Diagnostic Testing, either in hospital-based testing facilities, or in Independent Diagnostic Testing Facilities (IDTF), or even in home settings. The program covers a comprehensive approach to sleep-related testing and involves the clinical aspects of patient care. ACHC made a break-through announcement in July 2009 that accreditation standards from now would be offered without charge. The outcome of this new approach tripled the distributions of standards each month. ACHC made news in the home care industry when Wal-Mart, the 62

The Next Chapter nation’s largest company, decided to select ACHC for their DMEPOS accreditation. Hospital-based home care applications began to increase. Aurora Medical System, Mayo Clinic Stores, and Sister Saint Mary’s Hospital System all chose ACHC for their home care accreditation. After much diligent preparation and mentoring from Vice President Leslie Knuth, ACHC finally achieved the Commitment Level Two Award from the North Carolina Awards for Excellence program (NCAfE). This milestone placed ACHC on track with the elite group of companies on the journey to the highest national level. Preparation for Level Three began immediately. Members of the leaderLeslie Knuth accepts the Commitment Level Two Award from NCAfE.

ship team attended a Regional Malcolm Bald-

rige Conference to gain new information and to meet with other recipients of this National Award. Application for the next level is scheduled for 2011. In the fall of 2009, ACHC received the status of deeming authority from CMS for Medicare hospice programs. Since employees of the ACHC staff have always given back to the community, the staff felt it was important to stress the charitable care of those in need. As a result, ACHC team members at a volunteer event.


a Volunteer Committee

was created to plan events

in which employees may choose to participate. The monthly allstaff meetings now include reports and new challenges for ACHC in order to encourage better volunteerism.

The Year 2010: Britt Welch, Behavioral Health Manager, announced ACHC’s first stage of the development of Behavioral Health ACHC staff volunteering. Top during one event, Standards had been comACHC raised over 1,000 cans of food to donate to the local food pantry. Bottom ACHC helped pleted. The decision to build a home with Habitat for Humanity. offer this program was in response to requests from our accredited home health providers, which already offered available behavioral health services. These companies serve persons challenged by mental health, substance abuse, and/or intellectual development disabilities. Final results of completed beta tests are anticipated in early 2011. Mary Lou Seufert-Fleming, Regulatory & Governmental Affairs Liaison completed a comprehensive listing of regulatory updates specific to each state and licensure links on the ACHC Surveyor Central web page. The information now readily available for surveyors to access during on-site surveys greatly improves the ability for reviewers to be most up-to-date on state requirements while conducting surveys. 64

The Next Chapter The Board approved the purchase of land in Cary, NC, for a future building to house the headquarters of ACHC. Nita Fowler, Home Health, Hospice & Private Duty Clinical Manager, rewrote ACHC’s private duty nursing and private duty aide standards. Increased interest from the National Private Duty Association (NPDA) encouraged ACHC to better tailor standards to the industry. Their assessment of the industry is that there is a trend moving toward care organizations that provide private duty needing to be accredited. The new standards found favor with NPDA and were released. Det Norske Veritas (DNV)—an international Nita Fowler conducts surveyor training.

ISO registrar and the first company in forty years to

receive deeming authority from CMS for hospitals in 2007—approached ACHC with a proposal to work together in hospitals. The concept was to market a one-stop shop approach for the accreditation of hospitals and hospital-based home care. The two companies decided to work together. Jay Lucido, Accounting Supervisor, and Cynthia Poole, Accounting Clerk, did an outstanding job in successfully completing our financial audit for the year. Comments from Mastin Simmons, the auditor, included, “Jay does excellent work, and I found everything in very good order and all financial documents in compliance with all GAAP requirements.” Since Jay was hired in 2004, the organization’s accounting affairs have grown, and he has kept the Accounting Department in good order.


The Year 2011: ACHC received the Small Employer Award for implementing innovative people practices in the workplace. These modern, updated practices have impacted ACHC’s business with positive results. The Ovation Award for Human Resource Excellence was presented by Capital Associates Industries, Inc. The award was the result of the combined efforts of Paul Hetzel, the Vice President for Information Technology and Operations, and Cindy Brammer, the Operations Administrator. After months of meetings with crossPresident Tom Cesar accepts the Ovation Award.

functional Category Champion Teams and compiling the necessary

information, Vice President of Quality Assurance Leslie Knuth and Quality Assurance Specialist Archana Sridharan submitted an application for Leadership Level (Level four) with the North Carolina Awards for Excellence. Information learned from this exercise will help ACHC achieve the goal of winning the Malcolm Baldrige National Quality Award in 2015. Barb Sylvester, Vice Barb Sylvester leads a brainstorming session.


President of Clinical

The Next Chapter Compliance & Accreditation, announced that the “Specialization of Standards” was released, which was the end result of an innovative product developed by ACHC. After producing the industry’s first, significant differentiated computer program, ACHC was able to customize accreditation standards to fit into every integrated service mix of any applicant. After many months of a comprehensive team effort, ACHC initiated reorganized, individualized standards that allowed customers to select appropriate standards that can best match the services the customers provide. After satisfying the concept of “the shoe Paul Hetzel speaks to the staff during a meeting.

fits the foot,” ACHC could now introduce a more efficient accredita-

tion product for the customer. In addition, the standards were now clearly defined, making them more easily understood and realistic. IT Development Manager Marcel Plante led his team in successfully designing the computerized program. The new product provided a great benefit to ACHC surveyors. Data Collection Documents are now downloaded for assigned surveys, which, in turn can be directly reviewed and matched by services tailor-made for the customer. This new system allows surveyors to upload customer survey data to the ACHC’s office more quickly and efficiently, thus improving the turn-around cycle time of survey results by quickly returning the accreditation decisions to our valued customers. The ACHC Behavioral Health standards were finalized, approved 67

by the Standards and Review Committee, and beta tests scheduled with several organizations throughout the country. The complexity of Behavioral Health warranted the development of twenty separate service lines. This year, as ACHC celebrates its 25th anniversary, President Tom Cesar celebrates his 20th anniversary.

Leslie Knuth presents Tom Cesar a plaque during a luncheon celebrating his 20th anniversary at ACHC.

Paul Hetzel and Matt Hughes at Tom Cesar's 20th anniversary luncheon.


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Chapter 6 “Contrary to popular wisdom, the proper first response to a changing world is not to ask, How should we change? But rather to ask What do we stand for and why do we exist?” Built to Last, by James Collins & Jerry Porras

Looking to the Future The Year 2011: The ACHC project team is continuing its efforts with the Army and Air Force Exchange Service (AAFES) to develop standards tailored for its convenient care clinics. These projected clinics will be built on military installations over the coming years. This model of healthcare treatment is designed to better serve military families, which will solve the present overload and lengthy wait time at the base hospital Emergency Room. The new program is expected to expand into the civilian market to meet the growing trends of tomorrow’s needs. Research and Development will look at ACHC’s role in the new programs emerging with healthcare reform, particularly with Accountable Care Organizations (ACOs) and the Patient Centered Medical Home models delivery systems. The apparent emphasis of integrated healthcare along with behavioral health will be of great interest for future development of standards. ACHC will determine a progressive strategy for its future business. The 2010-2011 Fiscal Year ended with a report to the Board that ACHC has 3,602 parent organizations with 8,636 branches for a total of 12,238 accredited locations nationwide. ACHC has purchased land in Cary, NC, and is currently working to develop building plans for the organization’s future home. The building is 69

expected to be 30,000 square feet to accommodate the company’s growth. Ground breaking is scheduled for late 2011, and occupation of the new facilities is projected to take place in late 2012. Board members visit ACHC’s new land in Cary, NC.

Looking Back Benchmarks of Achievement at a Glance • National recognition with private third-party payers • First accreditor to offer programs for Specialty Pharmacy, Medical Supply Providers, Complex Rehabilitation and Assistive Technology Supplier Services, Post Breast Surgery Fitter Services 1996-2000 • International certification to ISO 9000 by 2004 • National recognition with Centers for Medicaid and Medicare Services 2005, 2007, 2009 • First accrediting organization to achieve hybrid survey of traditional accreditation standards and criteria of ISO 9000 process management in 2005 • National recognition with Inc. 5,000 fastest-growing businesses in 2007 • First U.S. accrediting organization to achieve Malcolm Baldrige commitment to Level Two recognition at the state level through the North Carolina Awards for Excellence program in 2009 • Capital Associates North Carolina Employee Engagement (Ovation Award) Initiative Award for small companies in 2011 70

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History at a Glance From: One accredited location in January 1987 To: 12,000+ locations in June 2011 From: One accreditation program with 1 service To: Seven accreditation programs and 41 services From: Accreditation in one state To: Accreditation in fifty states and territories by 2002 From: One part-time employee To: Forty-five full-time employees in 2011 From: Six contract surveyors in 1987 To: One Hundred Forty contract surveyors in 2011 From: A 250 square foot office in 1987 To: 12,000 square foot office suite in 2009 From: A small single-location customer To: Customers with hundreds of branches

A map showing every ACHC-accredited location, 2011.


2011 renderings of what ACHC’s new office building could look like. ACHC purchased land in Cary, NC, and plans to break ground in late 2011. The building is expected to be 30,000 square feet to accommodate the company’s growth.


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The Next Chapter “Eye has not seen, nor ear heard, neither has it entered into the heart of man, the things which God has prepared for those that love Him� 1Corinthians 2:9

A few comments from the President Since beginning with the organization in June 1991, I have had the uncommon privilege of working with a variety of talented and dedicated professionals. These competent, capable people have been fellow employees, Board members, surveyors, volunteers, providers, industry colleagues, and even competitors. From many people, I can confidently say that I have learned many lessons, including guidance in business strategies, pointers in marketing techniques, information about leadership styles, tips in presentation methods, and direction for behavior to emulate and behavior to avoid. A number of challenges have been surmounted both in the external healthcare environment and in the internal circumstances of the staff and Board. I have learned to accept team members with whom I had relationships, regardless of whether they have been agreeable or not. This educational development from the experiences of others has proven to be invaluable for me while leading ACHC during these past twenty years. This uncertain road traveled has been at times rocky and risky. There were times when it seemed like the track on which the company stayed was impossible. More than once I packed up my belongings believing it was in the best interests of the company for me to resign, and let the Board assume the responsibility of leading the organization. There have also been for me years of absolute amazement when I considered the incredible accomplishments and growth of ACHC. Espe73

cially in recent years, I have witnessed benchmarks of success that were never dreamed of in the 1990s. There were challenges that appeared too massive for this small company. Yet, in spite of the lack of resources and notwithstanding our limitations, they were met again and again. The times of uncertainty have tested my skills at leading as well as my faith. The people who are around me know that I am a person of faith—one who believes that Jesus Christ is the Son of God, in Whom I firmly put my trust. Frankly, there were occasions when I complained to the Lord and doubted my capability. Yet often, I saw the sovereign hand of the Lord in the perplexing situations I faced, and I witnessed how He preserved the business and made me stronger, while at the same time upheld me to advance the opportunities of the company. I have learned to be persevering, flexible, and patient. The outcome of all these experiences has only confirmed and established my inner faith in the Lord. I give special credit to my fellow co-workers, surveyors, and Board members for their passion and contribution to the organization. The dedication and the hard work of the ACHC staff are both commendable and exemplary. Human language cannot tell how proud it is for me to be a component of this great team composed of both vibrant leaders and facilitating support staff. They truly have made the ACHC the company that it is today. It has been my extraordinary privilege to be a part of it. I deeply appreciate you all for your vital contributions to ACHC. I also want to thank my wife, Amber, who has always been there behind the scenes to support and encourage, especially in times of crisis. And, most of all, I praise the Lord, Whose good hand, with His abundant blessings, has been evident upon me and upon the company this past twenty years. Tom Cesar, MPM ACHC President 74

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Appendix A “Visionary companies maintain momentum: It is the feeling among a group of people that their lives and work are intertwined and moving toward a recognizable and legitimate goal” The Art of Leadership, by Max DePree, Herman Miller, Inc.

The Board Chairs 1986-Present • Judy Jay


• Gale Hallenbeck


• Donna Nixon


• Mary Jo Littlewood


• Donna Steele


• Suzanne Lafollette-Cameron


• Cassie Wasko


• Cathy Chapman


• Eric W. Ritzen, Sr.


• Rebecca Linton


• Douglas Martin


• Richard Wetherell


The Board 2011-2012 • Richard Wetherell, Chair • Chris Clasen, Vice Chair • Denise Fletcher, Secretary • Rick Ferris, Treasurer • Gibbie Harris, Assistant Treasurer • Barbara Stover Gingerich • Denise Lippy

Board Chair Richard Wetherell.

• Floyd Boyer 75

• John Barrett

• Matthew Whittington

• Leonard S. Holman

• Richard Bulich

• Linda Griffin

• Susan Niewenhous

• Marshelle Thobaben

• Tom Tucker

Leadership Team

The Staff

• Tom Cesar, President • Barb Sylvester, VP of Clinical Compliance & Accreditation • Leslie Knuth, VP of Quality Assurance • Paul Hetzel, VP of Information Technology & Operations

Management Team • Britt Welch, Behavioral Health Manager • Brittany Bouwer, Accreditation Supervisor • Cheryl Dyer, HR Manager • Deric Rutledge, Marketing Communications Manager • Jay Lucido, Accounting Supervisor • Julie Pazun, Home Health, Hospice & Private Duty Clinical Manager • Marcel Plante, IT Development Manager • Matt Hughes, Accreditation & Business Relations Manager • Tim Safley, DMEPOS, Sleep & Pharmacy Clinical Manager

Accreditation • Aimee Brothers, Account Manager • Christoper Becker, Account Manager • Danny Hupp, Account Manager • Grace No, Accreditation Expeditor • Iris Castillo, Account Manager 76

The Next Chapter • Jennifer Smith, Accreditation Assistant • Jessica Pellas, Account Manager • Josh Boatright, Account Manager • Kim Karvelas, Account Manager • Lindsey Cover, Accreditation Expeditor • Nellie Plascencia, Account Manager • Sonya Jackson, Account Manager • Stephanie Mausolf, Account Manager

Administration • Archana Sridharan, Quality Assurance Specialist • Cathy Stover, Administrative Assistant • Cindy Brammer, Operations Administrator • Cynthia Poole, Accounting Clerk • Kevin Collins, IT Development Specialist

Clinical Compliance • Crystal Flynt, Home Health & Hospice Corporate Surveyor • Dana Everett, Administrative Assistant- Clinical Compliance • Gregory Stowell, Clinical Compliance Educator- DMEPOS, Sleep & Pharmacy • Jeff Reeses, Accreditation Corporate Surveyor • Kris Ravotti, Accreditation Corporate Surveyor • Mary Lou Sefert-Fleming, Regulatory & Governmental Affairs Liaison • Michael Farmer, Home Health/Hospice Corporate Surveyor • Patricia Ann Webster, Home Health/Hospice & Private Duty Corporate Surveyor • Sheryl Johnson, Home Health & Hospice Corporate Surveyor • Teresa Harbour, Project Contractor 77

Marketing • Brandie Unden, Marketing Event Coordinator • Harrison Brendle, Sales/Marketing Representative • Tracy Hinman, Marketing & Graphic Design Specialist

2011-2012 Board members: Back L-R Denise Lippy, Marshelle Thobaden, Rick Ferris, Denise Fletcher, Richard Wetherell, John Barrett. Front L-R Barbara Stover Gingerich, Susan Niewenhous, Matthew Whittington.

ACHC staff, 2011.


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The Surveyors • Nancy Allen • Sil Anderson • Susanne Beckett • Carol Bennett • Julie Bowman • Floyd Boyer • Marta Braun-Kane • Bruce Brothis • Roseann Cabral • Anita Cannon • Judy Cappell • Karen Chrapek • Janice Clark • Chris Clasen • Charles Cole • Cecil Cook, Jr. • Michelle Cooper • Alan Cross • Susie Culbertson • John Davis • Pam Doyle • Edward Dressen • Constance Dreyer • Donna Ford • Juanita Fowler • Jeffrey Freeland • Johnny Galan • Debbie Goings • Courtney Goldson • Carolyn Goodall • Susan Grantham • Cynthia Gray

• Judy Green • Pam Greeson • Joe Groden • Gloria Gross • Verna Gross • Pam Guy • Sylvia Haist • Carolyn Hale • Terri Hall • Teresa Harbour • Fraunces Hardy • Kim Heagy • Teressa Houston • Lee Hughes • Randy Hughes • Randy Hunter • Margo Hurd • Cynthia Jarman • Rhoene Jessup • Lisa Johnson • Gina Kelly • Nancy Kendrick • Chris Kennedy • Kathleen Kennelty • Joseph Kleinklaus • Roger Klotz • Suzanne Kluge • Geoffrey Krueger • Patricia Kuhl • Julio Larralde • Carolann Liebold • Tammy Lindgren 79

• Wayne Link • Barbara Linscott • Sharon Litwin • Rebecca Mackavage • Marian Marcoccio • Frank Marr • Janice Maslaniak • Kevin McNamara • Lisa Meadows • Jeffrey Meischen • Chris Miller • Gaye Moone • Kimberly Morris • Cathy Mulawka • Nicole Munns • Kaye Nance • Peter Nasios • Jennifer Newberry • Anna Nowobilski • Marsha Orr • Barbara Petroff • Stephanie Purser • Herman Randall • Towanna Roberts • Wendy Russalesi • Michele Rutledge

• Sabrina Sanders • Allan Saposnick • Ronn Schuman • Sue Sciabbarrasi • Mary Scordino • Kathleen Sgro • Bruce Shafer • Nancy Shambach • Natalie Sharpe • Angie Shoemake • Jean Stadtfeld • Rayleen Stubbs • Gary Swartz • Sue Tayloe • Catherine Therrell • Deborah Thomas • Bob Thornburg • Stephen Toy • Alberto Vasquez • Karen Wade • Carol Watson • Susan Weber • Leeanne Whisnant • Lynn Whitener • Susan Wozniak

A group of ACHC surveyors during surveyor training.


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Appendix B What People Are Saying about ACHC “You had me at ‘Hello’! A real live person answers the phone when I call—must be a fluke!  But when she connected me to my rep, Nellie HERSELF answered her line! What a concept!” Sharon Medical Services “I could not have done it without ACHC’s help and support, directing me to other organizations in similar circumstances and providing contact information to key people. Most importantly, everyone at ACHC was wonderful during this time, putting up with all my questions, frustrations, and fears of the unknown.” Loma Linda University Home Care Services “The surveyors were great with best practice suggestions and education to better our company. They answered all of our questions and then some. This was a great educational experience. It really made us take a look at our processes and focus on areas we need to improve on, and showed us what a great job that we do here at Sirona. We learned a lot from the surveyors while on-site. We gained valuable experience going forward and being the best Home Infusion Pharmacy in Arizona.” Sirona Infusion “Our Account Manager was friendly & very attentive to our needs. She responded promptly to any requests for assistance. The process was straightforward, expectations were well defined, & the PER was easy to interpret. The surveyors were professional, open & honest as to our strengths and weaknesses & offered suggestions based on their experiences for best practices. The survey helped us to identify our strengths & weaknesses & improve processes, which will ultimately provide a better end product for our patients.” EMH Regional Healthcare System 81

“The experience we have had with ACHC has been positive. We have learned a lot of information from the surveyor and feel confident moving forward. Our surveyor was very professional and very informative throughout our survey.” Danielson Pharmacy “It was an absolute pleasure to work with ACHC. The surveyors were so gracious and awesome. They both were very kind and informative. Their approach positively welcomed us to participate in the survey. Our staff members were very anxious with the survey practice initially and trying to escape from it. But it was totally opposite to what we expected out of a survey. The whole process went with ease because of the surveyor’s approach. My Account Manager corresponded frequently with me. I’m extremely satisfied with your service and absolutely recommend your people to other industry associates. It was a delight to work with ACHC.” Amedisys Hospice, L.L.C. “We found ACHC was the preferred choice because their experience in specialty pharmacy (SP), relevant standards as it relates to SP, and the approachability and willingness to assist Axium in our success for accreditation. ACHC exceeded Axium’s expectation in the area of providing timely feedback, professional mentoring, and partnership. Axium has been extremely pleased with the experience with ACHC accreditation, and we are looking forward to the return visit and discussions in the coming years.” Axium Healthcare Pharmacy, Inc. “We had very professional, timely and informational experience with ACHC. All items we rate 5 plus for the surveyor and the account manager performance. We would highly recommend ACHC to our peers and would like to use ACHC for our future needs. Thank you very much!” Advanced Family Home Health 1, Inc. 82

The Next Chapter “You’ve come a long way in 25 years. Makes all of us who believe in hard work and dedication and a worthwhile service very proud! Way to go, Tom!!!!!” The Carolinas Center for Hospice & End of Life Care “We are not new to the Accreditation experience and have been accredited by CHAP in the past. This process was smooth and efficient.  I can’t say enough about how quickly the survey team arrived and how professional they were when they got here. Iris is the best. I felt as though she was our partner in this process. That means a lot to my organization since we are so small.  Iris gets it.  Her customer service, attitude and ability to coordinate all of these services through ACHC so quickly made a huge impact on me and my company.” Generations Home Care & Hospice “I’ve been through other accreditors in the past, and ACHC has a totally different way of doing the accreditation process. Some others have been extremely difficult to deal with. We felt that we were lost in the actual process with them—we felt that they had a more punitive and negative system. However, I really believe ACHC’s unique culture makes a difference and an impact. ACHC is different because of the way they have ties to their customers and really want us to learn and succeed.” Access Diabetic Supply “Having been through numerous accreditations with various agencies, I can state without reservation that ACHC has been the most beneficial. Their surveyors have always been cordial and respectful of my staff, going out of their way to assure them ACHC was there to educate and guide us, not reprimand us. All of my expectations of a quality accrediting agency have been exceeded by ACHC, and I look forward to working with them in the future.” Arcadia Healthcare


“Overall, the entire experience was extremely helpful on many levels. Specifically, we matured a great deal in this short amount of time working with ACHC and while we developed our company documentation, including the QI/Performance plan. We truly feel we have a strong foundation now to build upon which we credit to working with ACHC.” Avalon Medical, LLC “ACHC has made a difficult and time-consuming accreditation process seem organized, efficient, and extremely thorough. It is my personal belief that as an owner/operator, this accreditation process has enabled our company to delivery a higher quality of patient care.” Diabetic Health Agency “It was an exciting experience. The structure and organization of the PER were very helpful. The PER helps you put your agency’s policies and procedures together step-by-step. I truly appreciate the way our Account Manager and the ACHC staff helped us. Thank you for answering all our questions. I strongly recommend any agency seeking accreditation to go through ACHC.” Wisdom Health Care Services “I have to say working with ACHC made all the difference from the workshops to the Account Manager right down to the surveyor. Everything was FANTASTIC! I feel that we are a stronger company because of our accreditation. Thank you all for the great support, and we would only use your company! We were scared to death at the beginning, but I have to say, it went very well and was very informative. All fear was left by the wayside after five minutes!” Alliance Homecare Systems Inc., Miami, FL


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Index of Acronyms AAAHC

Accreditation Association for Ambulatory Health Care


Army and Air Force Exchange Service


American Association for Homecare


Assisted Living Foundation of America


Accreditation Commission for Home Care


Association for Home and Hospice Care of North

Carolina (cf. NCHCA) BCBS

Blue Cross Blue Shield


Big Hairy Audacious Goal


Behavioral Health Home Care

CARF Commission for Accreditation of Rehabilitation Facilities CHAP Community Health Accreditation Program CMS Centers for Medicare and Medicaid Services (cf. HCFA) DSS Division of Social Services DME Durable Medical Equipment DMEPOS Durable Medical Equipment, Prosthetics and Orthotic Supplies DNV

Det Norske Veritas

DoD Department of Defense FDA Food and Drug Administration FEMA Federal Emergency Management Agency HCFA Health Care Financing Administration (cf. CMS) HPC Homecare Providers Co-op HME Home Medical Equipment ISO

International Organization for Standardization


Joint Commission of Accreditation of

Healthcare Organizations 85


Kate B. Reynolds Foundation


Kate B. Reynolds Health Trust

NAHC National Association for Home Care NCACIAS North Carolina Accreditation Commission for In- home Aide Services NCHCA North Carolina Home Care Association (cf. AHHCNC) NCQA National Committee for Quality Assurance NHCC National Home Care Council NIAHO National Integrated Accreditation for Healthcare



Pharmacy Buyers Inc.


Public Service Announcement

RFP Request for Proposal SGS

Société Générale de Surveillance

(Global certification company)

SPC Southern Pharmaceuticals Corporation TPN

Total Parenteral Nutrition


Utilization Review Accreditation Commission


Veterans Administration


Van G. Miller and Associates Group


Veterans Integrated Service Networks


Women’s Health Care Educational Network


ACHC Staff At Work and Play

ACHC's staff enjoys dinner during the 2011 ACHC trip to the Grove Park Inn in Asheville, NC.

ACHC staff members socialize during the trip to the Grove Park Inn.

ACHC employees celebrate the Holidays with one another.


ACHC's accreditation team attends a cooking school as a team building activity.

ACHC's accreditation team.

ACHC's staff attends a Durham Bulls baseball game together.


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ACHC employees exhibiting at one of the many conferences that they attend a year.

ACHC's staff acting silly for a group picture.

ACHC's staff works together to complete a project during a strategic planning meeting.


ACHC's volunteer committee planned a volunteer day for Raleigh Parks & Recreation.

ACHC hosts an open house at their Falls of Neuse location in 2009.

ACHC's employees work hard to process applications during a rush in January 2009.


TomCe s a rha s be e nPr e s i de nt oft heAc c r e di t a t i onCommi s s i onf or He a l t hCa r e , I nc . ( ACHC) s i nc e1991. Tomhol dsa Ba c he l orof Sc i e n c ed e g r e ef r o mCa l i f or ni aSt a t e Un i v e r s i t ya tLo sAn g e l e sa ndr e c e i v e dh i sMa s t e ro fAr t sde gr e ei n Pub l i cMa n a g e me n tf r omt heUni ve r s i t yo fMa s s a c h u s e t t si nBos t on. Heh a s3 0y e a r so fe x pe r i e nc ewor ki ng i nh e a l t h c a r ea dmi ni s t r a t i on. Pr i o rt oACHC,h ewa saUni tMa na ge ra t Mt . Au b u r nHo s pi t a l , i nCa mbr i d g e ,MA a n dEx e c ut i veDi r e c t or ofRe h a b i l i t a t i o nSe r vi c e sofWa ke Co u n t yi nRa l e i g h ,NC.

IThi nkIcan Thehi s t or yofACHCha sbe e nt het e s t i monyof t he“ Li t t l eEngi net ha tc oul d” . St a r t e dbyaf e w homec a r epr ovi de r sdi s s a t i s f i e dwi t ht he a c c r e di t a t i onopt i onsa tt het i me , t he y de c i de dt oc r e a t eapr ogr a m j us tf orNor t hCa r ol i na . I ni t i a t i ngs t r a t e gi e sf orqua l i t ypr ogr a msa nd pr oduc t st hr oughus eofours t a nda r dst ohe l p pr ovi de r sde ve l opa ndi mpr ovet he i rown ke ypr oc e s s e sa ndpa t i e nts e r vi c e swa s t hepr i ma r ygoa lf r omt hebe gi nni ng. Thee a r l yye a r swe r ee xha us t i vei nt hec l i mb uphi l lt os ur vi vea nde s t a bl i s ht hebus i ne s s whi l ebe c omi ngavi a bl eopt i on f orhomec a r epr ovi de r s .


celebrati ng 25years ofexcellence

Re a c hi ngt het opoft hehi l lbe c a memor ee vi de nt i n2, 000whe nt hef i r s twe l l knownna t i ona l c ompa nyc hos eACHC. By2007, wewe r e na me da soneofAme r i c a ’ sf a s t e s tgr owi ng c ompa ni e sont hef i r s te ve rI nc . 500l i s t .

Tomi sa na d v o c a t ef o rqua l i t yhe a l t h c a r es e r v i c e sb yme a nsofpr ovi de r e du c a t i o na n dp e e rr e vi e wt hr ough a c c r e d i t a t i o na n d ma ke s pr e s e nt a t i on sa ts t a t ea n dn a t i ona lc onve nt i on s .Heh a sp u b l i s h e dava r i e t yof a r t i c l e so na c c r e d i t a t i o ni nt r a dej our na l s .

Ove rt heye a r s ,weha vea l s ohe l dour s e l ve st ot he s a mehi ghs t a nda r dofout s i depe e rr e vi e w t hr ougha nnua lI SO9001: 2008a udi t s , Ma l c ol mBa l dr i gee xa mi ne rvi s i t s a ndCMSons i t er e vi e ws .

Her e s i d e si nRa l e i g h , Nor t hCa r ol i na wi t hh i swi f eAmb e r .Al s ol i vi ngi n t heRa l e i g ha r e aa r et h e i rs ons -Todd wi t hh i swi f eKa t h y ,a ndgr a nds on Mi c h a e l ;a swe l la st he i rot he rs on Er i c .

Ther e l a t i ons hi pwi t hourc us t ome r sa sa l wa ys be e nt ha tofa“ pa r t ne r s hi p” . Thi si swhy, whe n l a unc hi ngourpr ogr a mna t i ona l l yi n1996, we us e dt hemot t o,“ bypr ovi de r sf orpr ovi de r s ” . Toda y,wes oundoutt heme s s a ge , “ e xpe r i e nc et heACHCdi f f e r e nc e ” .

Tom Cesar

Wha tPe o pl eAr eSa y i ng Abo utACHC “ Th eo v e r a l le x p e r i e n c ewa sg r e a t .I d i dt h ed u ed i l i g e n c eo no t h e r a c c r e d i t a t i o ns e r v i c e sb u tACHC i s b yf a rt h eb e s t .I t ’ sb e e n at e a m a p p r o a c hi nh e l p i n g Da r tMe d i c a l a c h i e v eAc c r e d i t a t i o ns t a t u sb u tmo s t i mp o r t a n t , t h e mu t u a l wo r k i n g t o g e t h e r . ACHC i s s e t t i n g t h e s t a n d a r db y wh i c ho t h e r swi l lb e j u d g e d . ”Da r tMe d i c a l ,I n c . “ To m,h e a r t f e l tc o n g r a t u l a t i o n so n ma n yy e a r so fh a r dwo r kt h a t h a sp a i d o f fi ni mp r o v i n gt h eq u a l i t yo fs o ma n yp a t i e n t ’ sl i v e s .Yo u rc o mp a n y h a sp u r s u e de x c e l l e n c ei n af a i r , e q u i t a b l e ,a n dp r o f e s s i o n a lma n n e r t h a ts p e a k s we l lo fy o u rg o o d l e a d e r s h i p ,a n dy o u rf i n es t a f f .Yo u d e f i n i t e l yma d eu sab e t t e rc o mp a n y a n dh a v ep r o t e c t e du si nma n ywa y s . Onb e h a l fo fmy s e l f ,s t a f fa n dt h e c h i l d r e n wea r eh o n o r e dt os e r v e t h a n ky o u .Wewi s hy o uma n ymo r e y e a r so fs e r v i c e . ”He n l e yMe d i c a l . “ Th a n ky o uf o rwo r k i n g wi t hu s c o l l a b o r a t i v e l yi no r d e rt oa c h i e v et h e h i g h e s tq u a l i t yo r g a n i z a t i o np o s s i b l e . Wev a l u et h ei n f o r ma t i o ny o u rt e a m o fe x p e r t sh a st os h a r ewi t hu sa n d a l t h o u g hi tt a k e sal o to fp a i ns t a k i n g t i me t o a c h i e v et h i s , we h o l d o u r s e l v e s a tt h i s s t a n d a r d a n d a p p r e c i a t et h ei n f o r ma t i o n .I ti sn i c e t ob ea b l et owo r kt o g e t h e ra n dn o tb e a f r a i dt oa s kq u e s t i o n st h a tweh a v e a b o u tc e r t a i ns t a n d a r d s .Th a n ky o u ! ” Ad v a n c e dMe d i c a lCo n c e p t s ,I n c .

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