MedPAC Could Examine DME Reimbursement
WASHINGTON--At a Sept. 4 meeting, the Medicare Payment Advisory Commission said it might examine Medicare reimbursements for durable medical equipment and make new recommendations to Congress resulting from delay of the program’s controversial competitive bidding project.

The Medicare Improvement for Patients and Providers Act halted the bidding program two weeks after its July 1 implementation, but in exchange, reimbursements for items and services that were selected for bidding were cut by 9.5 percent. That cut that will become effective Jan. 1, 2009.

Along with the bid delay, round one contracts that had been awarded to 325 providers were terminated.

According to a press report, Commissioner Nancy M. Kane, professor of management in the Department of Health Policy and Management and associate dean of education at the Harvard School of Public Health, said a program that reduces the number of providers from thousands to 325 is doomed to failure.

But the American Association for Homecare noted several other points discussed during the meeting raise "serious concerns." In its newsletter last week, AAHomecare said:

--MedPAC staff repeated a statement by acting CMS Administrator Kerry Weems, who testified before Congress in May that Medicare prices DME items inaccurately compared to Internet prices, and that little in the way of services is involved in the durable medical equipment benefit.

--The commission chairman indicated “there is a seemingly egregious problem between what Medicare is paying and the generally available prices.”

--MedPAC staff said the competitive bidding program provided a means of arriving at “realistic” pricing while weeding out providers prone to fraud--with no reduction in patient access to care.

At the meeting, it was decided that MedPAC staff would return to members with recommendations for different approaches to study the issue.

In 2006, MedPAC wrote former CMS Administrator Mark McClellan in support of competitive bidding.

AAHomecare: Accreditation Exemptions are Risky Business
ARLINGTON, Va.--Exempting physicians and others who provide home medical equipment from accreditation could affect quality of care and eliminate a valuable tool to fight fraud and abuse, according to the American Association for Homecare.

Last week the organization came out in opposition to CMS’ decision to exempt certain DMEPOS providers from Medicare’s Sept. 30, 2009, mandatory accreditation deadline.

“Accreditation helps to ensure that patients receive high-quality home care, and it is also an important tool in preventing fraud in the Medicare program,” said Tyler Wilson, AAHomecare president and CEO.

The announcement came in response to a Sept. 3 Open Door Forum in which CMS’ Sandra Bastinelli said mandatory accreditation does not apply to those the agency considers “eligible professionals.” That list includes physicians, PTs and OTs, qualified speech-language pathologists and practitioners, physician assistants, certified registered nurse anesthetists and clinical social workers, among others. (See HomeCare Monday, Sept. 8.)

While physicians on the call sent “hugs and kisses” to CMS for exempting them, AAHomecare questioned the wisdom of such exemptions.

“We really believe that accreditation and supplier standards should apply to all [who provide HME],” said Walt Gorski, AAHomecare’s vice president, government affairs. “AAHomecare believes that if you are going to provide and bill for DMEPOS items, there should be no exceptions to the accreditation requirements.”

Under the Medicare Improvements for Patients and Providers Act, which established the exemptions, orthotists and prosthetists are also currently exempt from the accreditation deadline, but CMS plans to publish a notice of proposed rulemaking in 2009 that will address quality standards for those providers.

Gorski said AAHomecare champions both accreditation and quality standards for HME providers of all stripes.

“Quality standards and accreditation are aimed at improving quality of care,” he said, adding that both are effective tools to fight fraud and abuse.

“Not only do we want to make sure quality is maintained and improved, but we want to make sure that only legitimate suppliers bill and provide DMEPOS items,” Gorski said. “We thought that a third-party check (accreditation) to verify a provider's status was legitimate. It was good to move forward with.”

While the quality standards are a move in the right direction, Gorski has reservations about the final version of the standards, which could be released next month.

“The quality standards have been finalized and are under final review by the administrator,” he said. “CMS has indicated that the final quality standards could be published in October.”

There are numerous issues with the proposed quality standards, however, and he is unsure how those will be addressed, Gorski noted.

“We are hopeful that ultimately CMS will revise the quality standards so that all suppliers compete on a level playing field to ensure that patients are receiving the highest quality of care possible,” he said.

CMS, MACs Mum on CPAP Payment, Coverage Policies
ATLANTA--Two weeks after the local coverage determination for PAP devices was to have been implemented and the comment period closed on payment policy for CPAPs, CMS and its jurisdictional DME MACs remain silent on what, if any, changes might be made to either controversial policy.

As of Friday, neither the American Academy of Sleep Medicine nor the American Association for Homecare had received a response to letters objecting to proposed changes in the Medicare Part B physician payment policy for CPAP reimbursement as outlined in CMS-1403-P, or to the LCD.

“We have not yet received a formal reply from CMS,” said Kathleen McCann, director of communications for AASM, which noted its objections to the payment rule in a letter to the Department of Health and Human Services.

Among other stipulations, CMS-1403-P would “prohibit payment to the supplier of the CPAP device when such supplier, or its affiliate, is directly or indirectly the provider of the sleep test that is used to diagnose a Medicare beneficiary with [obstructive sleep apnea].”

AASM said it is concerned that such a policy would inhibit access to sleep testing and recommended that rural providers be exempted from the rule. In addition, it requested that sleep disorder facilities accredited by the AASM be exempt from the policy.

The two exemptions “will prevent an access issue and also serve as an assurance of quality care for patients,” Mary Susan Esther, M.D., president of AASM, asserted in the letter.

AAHomecare also voiced objections to the payment policy, saying “the proposed rule would limit appropriately trained and qualified DMEPOS suppliers’ ability to furnish home sleep tests to Medicare beneficiaries.”

The association called the provision “unnecessarily restrictive” and said it “created barriers to care that undermine the recent CMS national coverage determination on the use of CPAP devices to treat individuals with OSA diagnosed using home sleep testing.”

“There are access-related issues,” said Walt Gorski, vice president, government affairs, for AAHomecare.

The comment period for the physician payment policy ended Aug. 28.

“A final physician payment rule for 2009 comes out right around Nov. 1,” said Gorski, “so we will have to see whether the policy was stripped from the physician payment rule or whether they revised it or moved forward with it in November.”

Earlier, AAHomecare had sent the DME MACs an 11-page letter outlining objections to the new LCD covering CPAPs, but has not heard back on that, either.

The Sept. 1 implementation date for the LCD was delayed after industry stakeholders said they were blindsided by the DME MAC policy, which prohibited HME providers from conducting home sleep tests. The policy was published without going through a public comment period.

“We were very concerned with this policy as we believe it made new policy recommendations without appropriate notice and comment,” Gorski said. “We believe that the approach that the LCD put forth would harm access, therapy and raise various concerns.”

In its letter, the association charged that the LCD “contains significant new and detailed coverage criteria that restrict access to PAP therapy and limit who is eligible to furnish diagnostic test interpretations, which are Medicare-covered services.”

Gorski said he had no idea what action, if any, will be taken on the policy. “We believe that a new policy will be issued as soon as November, but we have no confirmation for that,” he said. “We still do not know if that would be open to a comment period.”

The DME MACs have said only, “A revised LCD will be published in the near future and will include a new effective date for those criteria.”

HME Company Newswire
Otto Bock, Invacare Help Athletes Shine at Paralympics
BEIJING--Two well-known HME manufacturers are keeping athletes running and rolling during the Paralympics in Beijing.

Otto Bock Healthcare, the Duderstadt, Germany-based maker of orthotics and prosthetics with U.S. headquarters in Minneapolis, has sent a team of 136 technicians from 19 nations to ensure the athletes’ equipment is in top working order for the games, which began Sept. 6 and end on Wednesday.

The technicians are spread among the central main workshop in the athletes’ village and 13 satellite workshops at each competition site. They are called upon to do everything from welding protective braces to 30 wheelchairs to fixing a broken arm prosthesis just before a competition. As of Friday afternoon, the team had provided 1,466 services to athletes, all free of charge.

Meanwhile, the good times are rolling for Team Invacare as the athletes sponsored by the Elyria, Ohio-based manufacturer continue to rack up medals.

By Friday, Invacare-sponsored athletes had amassed 20 medals: nine gold, five silver and four bronze in racing, and one gold and one silver in handcycling. Tennis and basketball athletes were yet to compete.

Invacare and its sports and recreation division, Top End, are sponsoring 18 competitors from homelands as diverse as South Africa and Canada. Top End also customized 240 wheelchairs for the Chinese Paralympic team.

SleepQuest, ResMed Trial Wireless Technology
SAN CARLOS, Calif.--SleepQuest has partnered with ResMed, San Diego, to conduct clinical trials of a new wireless technology used to monitor patients with obstructive sleep apnea from wherever they are sleeping.

In a release issued earlier this month, SleepQuest explained that using Bluetooth technology, sleep data transmits instantly from a CPAP or other medical device to the company's Sleep Care Specialists. Ultimately, the technology could not only reduce the need for office visits to download data but also allow monitoring to ensure better compliance.

A total of 30 patients are currently participating in the trial and have reported no technical problems.

“Ensuring that patients properly manage their condition through nightly CPAP treatment is our main goal,” said Cody Parker, SleepQuest regional office manager. “Helping ResMed develop this wireless technology will benefit our patients by making CPAP treatment more comfortable and effective.”

ResMed selected SleepQuest, which provides home testing and treatment of sleep apnea, to participate in the trial because of its disease management approach to OSA and its patient therapy compliance rate of 90 percent, compared to the industry average of about 50 percent, according to the release.

Without continued support and encouragement, the company said, many patients stop treatment after a few weeks.

“We are always looking for ways to provide convenient treatment and follow-up care for our patients,” Parker said. “Immediate data transfer allows us to serve our patients more efficiently, saving them time and money.”

Newsmakers
King-Shaw Appointed CEO at All-Med; Daniels Moves Up at Anodyne
Ruben Jose King-Shaw Jr. has been appointed CEO of All-Med Services of Florida, Miami, and Clinical Medical Services, the company's Puerto Rico-based operations. Raul Rodriguez, who founded both companies, will serve as executive chairman. King-Shaw served in the George W. Bush administration from 2001 to 2003, where he led a number of health care initiatives as deputy administrator and COO of CMS. He was also senior advisor to the Secretary of the Treasury, where he led the administration's health coverage tax credit initiatives. King-Shaw was a spokesperson for the administration on health care disparities, prescription drug benefits, Medicare and Medicaid reform, rural health and the uninsured in America. Also joining the company as vice president of operations is Roger Lopez, who brings over 20 years of operational experience.

Anodyne Medical Device, Los Angeles, has appointed Abbey Daniels as the company’s CEO. Formerly the company’s COO, Daniels will fill the CEO role held by company founder Mark Bidner. Bidner will remain active with the specialty support surfaces manufacturer, retaining his role as chairman of its board of directors.

The Amputee Coalition of America has named Kendra Calhoun its president and CEO. Calhoun previously served as COO of the Samueli Institute. She replaces Paddy Rossbach, who spent seven years in the position.

The Medicare Rights Center of New York has named Deborah Dinkelackeras COO. She will oversee the organization’s internal operations, including human resources, finance and operations, marketing and technology.

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