Small Company, Big Expertise

Larger accreditation agencies may view The Compliance Team (TCT), Spring House, Pa, as a thorn in their side. Sandra Canally, RN, president of TCT, does not mind the thorn comparison, because she is only interested in making life easier for her clients.

She cuts into the business of her competitors by offering simplification where others offer reams of guidelines. Her simplified approach has been embraced by sleep labs across the country, but it’s still difficult to get the word out through a considerable fog.

Canally attempts to clear this fog by convincing sleep lab directors that operational efficiency must match clinical excellence. Her competitors may undervalue the former, but clients ultimately see the logic. From this rationale came the sleep center accreditation program, now in effect for 5 years under the familiar Exemplary Provider™ brand started more than a decade ago.

TCT officials know they have their work cut out for them, but Canally continues to burnish her credentials in the sleep world, building on a foundation already long established in the world of DME. Sleep Diagnosis and Therapy caught up with the high-energy Canally to talk about the state of sleep lab accreditation, and the ongoing process of breaking into a business dominated by an aggressive “big dog.”

You are Well Known in Other Areas of Medical Accreditation, but TCT Still has Work to Do in the Sleep World. What Makes this Arena so Challenging?

Sandra Canally, RN, president, The Compliance Team, Spring House, Pa: Take hospitals for instance, so many people only thought of JCAHO. It’s a similar thing that is going on in the sleep market, with everyone saying they are bound to the American Academy of Sleep Medicine (AASM).

Why Do People Feel this Way?

AASM is the big dog. They were the first accreditor among sleep labs, and AASM is still the lead dog.

Why Do the Sleep Labs Continue to Choose the AASM for Accreditation?

It’s the only thing they know. They’re wondering what to do with their small business, and who is best suited to deal with them. Who is going to give them the best service and value for the dollar?

They must think carefully, because they are going up against competition that might be hospital-based or larger. Ultimately, providers must choose who is able best to meet their business needs.

How Do you Help Meet those Needs?

We help them through it with our conference call series ahead of time, which nobody else does. We’re saving them money up front because they don’t need to hire a consultant. They can get through the process in terms of preparation just by talking with us with during our conference call series. When they’re ready, we do an onsite evaluation. It’s all about education and continuous quality improvement.

We’re there to verify and validate that they meet the standards, but where they don’t meet the standards, we’re going to tell them how to meet it. We help them improve better and quicker than the AASM. We will help them reach their business goals, as well as their patient care goals better and easier.

What is the Difference Between TCT and AASM?

If you get back to simplification, the biggest difference between us and them is the fact that we are looking at the entire business. With AASM, it’s all about the sleep study and the medical director. We are looking at those things, but we are looking at much more.

Why is it so Important to Look at the Business as a Whole?

It’s my belief that you can’t have clinical excellence without operational excellence. You must have people properly trained and educating consumers appropriately. That means maintaining equipment the way you need to and paying attention to infection control. If you don’t do this, you will not have good results.

What Do you Consider a Good Outcome?

The outcome is not just a successful sleep study that determines the presence (or lack) of sleep apnea. The outcome is that the patient was able to follow instructions and everything worked.

How can that Outcome be Attained?

Pay attention to what the patient is told in terms of pretest and pretest instruction. They should know how to dress and what to bring, because it’s all about the patient, and whether or not the patient is comfortable and is adhering to the instructions by the sleep center. They should know what they’re supposed to do ahead of time.

It’s about patient expectations. Has the patient been appropriately instructed prior to coming?

Does Accreditation Cover these Specifics?

Good accreditation leads to a facility that checks throughout the night with techs who know how to check the leads and properly apply the mask and the leads.

How Do you Make Sure this All Happens Correctly?

We go in during the evenings so we can observe what happens to the patient, as opposed to just looking at the administrative aspects. We also pull files and look at studies, but it’s better to be there.

How Important is Staff Training?

Staff members must be trained in case of an emergency such as chest pains, a heart attack, or a seizure. Have the staff trained appropriately to deal with the unexpected, not just the expected.

You are Relatively New to the Sleep Lab World, but What’s your Rank in the DME Accreditation Market?

In the DME market space, we hover around two or three. I think of us as a littler guy that does a lot. It’s not about the size of our staff, it’s what we’re able to do with the staff we have—but we are a small business.

How Does Being a Small Business Give you an Advantage?

We’re not a bureaucracy, nor do we want to be one even when we do expand. It’s true that we are in the hospitals, and our plans are to be in every health care sector as it relates to accreditation. The key is that we still remain able to turn on a dime, which many of our competitors are not able to do.

Why is Turning on a Dime So Important these Days?

If something happens with regulations, or something changes and the people in the field on the front lines need to know, we’re certainly more able to implement change easier than other folks tied to ‘we have to have a task force and three committees’ to get the same thing accomplished. For us, it’s all about innovation and improving.

What Problems Do you See with Modern Sleep Labs?

It becomes all about the sleep study, and they’re not looking at things that affect patient care and service.

One of the things easy to overlook is infection control. If you go to a hotel, you want to be assured that the sheets have been handled appropriately as it relates to cleaning.

People tend to not think about that. It’s all about the machines and the waves and the leads, and everything being placed correctly on the patient—and the study and if they go to sleep. But we’ve got to look at the whole picture.

Consider the size of the room. If there was an emergency, is there enough room to deal with it? Is it handicapped accessible? What about the bathroom? All of those environmental factors are important, because the patient isn’t coming in for an hour and having a test done.

Does Accreditation Help with Private Insurance?

Some of the private insurers are much like Medicare looking for accreditation. Accreditation is best business practices. It’s quality recognition branding. Not only are they able to differentiate themselves from the competition, but also when they go to private payers they can show that an outside agency has come in and evaluated them onsite. That definitely gives them the leg up.

How Do Sleep Labs use Accreditation for Marketing Purposes?

We give them a certificate and a door decal with the logo. We have the brand “exemplary provider.” We also have the trademark that the quality standards are related to safety, honesty, and caring. So as an exemplary provider they are telling the world that they excel in safety, honesty, and caring. If they excel in those three things, what else matters?

What are your Goals for the Future?

We want to be in every health care sector that exists as a provider related with helping all of the smaller providers across the country. That’s DME, home health, hospice, critical access hospitals, rural health clinics, sleep labs, pharmacies, long term care, infusion, specialty, and mental health. It’s about helping the little guy, and helping the smaller providers to stay in business, stay focused, and continue serving the patients the best way they can.

You have to have the little guy. We can’t just have all the giants. That’s what America is all about. Yes, there is hope. The little guy has to continue fighting, going forward, and expanding. We can help them do that.

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