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| March 2, 2009 | Volume 15, Number 9 |
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ADVERTISEMENT Rethink one size fits all – DME businesses have unique needs and require personalized solutions. MedAct has helped DME businesses for over 20 years increase revenue, expand product offerings and save money. Whatever your goals, MedAct can deliver - accreditation, managing margins or streamline payments that are customized to your unique needs. Find out how you can get free patient eligibility checking www.dynamicenergy.com or 800-326-0314  Table of Contents - Big-Ticket Budget May Not Be So Rosy for HME - No-Show Patients a Stumbling Block to CPAP Payment - 123 Representatives Ask for Change in O2 Reimbursement Rules - DME MACs Issue Standard Common Repair Allowances - HELP Committee Gets Request for White House Office of Health and Wellness - GF Promotes Spett; Capper Takes Over at HDI - Medtrade Offers CEUs; CMS Extends Date of Appeals Process Final Rule For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com. Headline News Big-Ticket Budget May Not Be So Rosy for HME WASHINGTON--President Barack Obama’s proposed 2010 budget might be lacking in details, but there was enough in the $3.6 trillion document to make industry stakeholders wary of what it might mean for the home medical equipment sector of health care. Unveiled Wednesday, the budget calls for, among other things, $316 billion in Medicare/Medicaid cuts over the next 10 years to help finance a $634 billion reserve fund for health reform. More than half of that savings--$176.6 billion--would come through implementation of a competitive bidding program for Medicare Advantage plans. “It does have some very serious potential repercussions for us,” acknowledged Don Clayback, vice president of government relations for The MED Group, Lubbock, Texas. “I think there’s no doubt, given the financial pressures, that they are going to be looking for a great deal of savings from various sectors. “We are going to be on the chopping block just like everyone else,” he said. “I think the pressures have ramped up and we now will be, in essence, battling against other segments of the health care market, because there’s no doubt the president and Congress are going to need to come up with these savings.” John Gallagher, vice president of government relations for Waterloo, Iowa-based VGM Group, agreed the budget is “not good at first blush.” He pointed specifically to a proposed $37 billion cut to home health over a 10-year period and to the Medicare Advantage competitive bidding proposal. “Those are the very folks keeping mom at home,” he said, referring to the home health proposal. “If they don’t see any need for home health, what does that mean for HME?” As to the Medicare Advantage bidding plan, he said, “The Obama administration is becoming attracted to competitive bidding as a means to find savings. And that’s not good for us as we try to eliminate competitive bidding on the DME side.” While she is not sure how the Medicare Advantage proposal will play on Capitol Hill, Cara Bachenheimer, senior vice president of government relations for Elyria, Ohio-based Invacare Corp., pointed out there is a significant difference in how the payments for such a program would be determined. “The little detail that was released said that payments would be set on the average of bids submitted, which is very different from how they were set under the HME competitive bidding program last year,” she said. Whether that will have any effect on HME competitive bidding remains to be seen. “You can read stuff into it, but you have to stop yourself before you go too far,” Bachenheimer said about the proposed budget. “It’s in flux. A lot is to be determined.” The proposed budget’s biggest threat to HME “is language strengthening the Medicare program by reducing excessive Medicare payments,” said Seth Johnson, vice president of government relations for Pride Mobility Products, Exeter, Pa. “It is unclear if it is still believed that DME costs are excessive.” If that turns out to be the case, aggressive reimbursement cuts could be the result. However, Gallagher cautioned, “people shouldn’t get het up over this because there is no meat yet … They floated a trial balloon and a lot of changes are expected.” Details aren’t likely to come before the end of March, he and others said. Even as industry thought-leaders considered the grimmer aspects of the proposed budget, they also spotted some possible opportunities for the HME sector. A plan that would pay hospitals less if patients are readmitted within a 30-day period could be a boost for HME, suggested Bachenheimer. “That’s a great argument for home care,” she said, explaining that if patients are prescribed appropriate HME, readmissions could be lessened greatly, a boon for hospitals. Johnson pointed out that Obama has pledged to protect American jobs and small businesses. “This is what his [agenda] is all about,” he said. “Those are clearly words we need to be using on the Hill and in our discussions with the administration, because nearly 90 percent of the industry is comprised of small businesses.” It is important for the industry to point out to legislators, he said, the effect certain actions would have on HME. For example, the major threat hovering over the industry now--competitive bidding--“will most likely result in great consolidation in the industry,” Johnson said. “That consolidation would result in the loss of tens of thousands of jobs. That is counter to what the new administration has outlined as its agenda.” All of the HME advocates agreed that now is the time for the industry to come to a consensus on its message to legislators. “We have to come to a consensus on what we are willing to give up, if anything, and what must we focus on to get immediately,” said Gallagher, noting that getting the 36-month oxygen rental cap rescinded would be high on the list. “We have to get energized now,” he added. “We can’t wait for the long-term debate.” Added Bachenheimer, “We’ve got to be at the forefront and ready. We’ve got a good story to tell.” Part of that story is that HME is a solution to paring costs, said Clayback. “I think we need to continue to push with members of Congress and members of key committees like the Senate Finance Committee and the House Ways and Means Committee so that they recognize even more dramatically than they do now that HME is part of the solution for savings; it’s not another source to gain additional savings from.” Clayback said in an environment that could well see HME competing with hospitals and physicians--two formidably powerful sectors--for dollars, “I don’t think we can sugarcoat what [condition] we are in, because people need to realize that things are going to be tougher than they ever have been, so our message needs to be stronger and even louder. “Our message,” he continued, “needs to be packaged in terms of, ‘We are part of the solution, we provide benefit in the home, we’re more economical, we’ve taken significant cuts, we’ve paid our dues--give us stability.’” For a PDF of the full budget (142 pages), click here. A section on the Department of Health and Human Services begins on page 67. For a HomeCare report on the president's message to the nation Feb. 24, click here.
How do you feel about President Obama’s plan/budget for health care reform? To vote in HomeCare's monthly Web poll, visit www.homecaremag.com. No-Show Patients a Stumbling Block to CPAP Payment ATLANTA--Sleep therapy providers said last week they are logging significant losses as a result of the new PAP policy instituted Nov. 1, and some are appealing to physicians to intercede with Medicare on their behalf. Rob Brant, president of the Accredited Medical Equipment Providers of America and owner of City Medical Services in Miami, said 25 percent of his patients have refused to revisit their physician within the mandated 90-day period after being prescribed a CPAP. Under the new policy, CMS requires Medicare beneficiaries to have a face-to-face evaluation by the treating physician between day 31 and day 90 of the therapy. But Brant said a quarter of his new patients are balking at another visit. Their reasons range from being unable to afford the copay to not being able to get to the doctor’s office; one patient even thought the provider and the physician were working a scam because the patient hadn’t heard anything about this requirement from Medicare. “This is a real problem,” Brant said. “I am not going to bill for something I know I may have to be refunding to Medicare, so there’s 25 percent I can’t bill. Most of the [providers] I talk to say there’s 20 to 25 percent they can’t bill. I have no legal recourse to get my equipment back, and now I can’t get paid.” Kelly Riley, director of the National Respiratory Network for The MED Group, Lubbock, Texas, said the issue was a hot topic at a series of roundtable discussions she hosted during the network’s annual meeting, held Feb. 17-19 in San Antonio. “Without exception, the folks at the table indicated they were having trouble with that exact same thing,” she said. She noted some providers had taken aggressive steps including making return appointments for patients during the initial evaluation, but with limited success. Patrick Clevidence of Medical Services Company in Cleveland, Ohio, said his company has had its respiratory therapists schedule the follow-up for patients. “You can set up the appointment, but we still have no guarantee that the patient is going to go,” he said. “It’s a sticky wicket.” There’s been a little pushback from both patients and physicians, too, he added. Physicians don’t like the extra time required to do the face-to-face and prepare the documentation that providers need, so it has been difficult at times to get that documentation. And beneficiaries sometimes are not able to pay for another visit or can’t afford the gas to drive into the doctor’s office from the rural area in which they live. “The patients are concerned that if they are not compliant, this is not going to be paid for and they can’t afford this [treatment],” Clevidence said. “It’s a little scary for the patient.” Robert D. Hoover, MD, senior medical director for Cigna Government Services, the Jurisdiction C DME MAC, said he is not aware of any problems. “I have not received any complaints about this requirement from beneficiaries or suppliers,” he told HomeCare Monday. “In fact, in the discussions with several clinicians leading up to the development of our policy, it was stated as standard of care to see a patient for a return visit within the first four-to-six weeks after being started on positive PAP therapy. Moreover, we received numerous comments about the local coverage determination when it was released back on July 18, 2008, and there were no comments related to the timing or necessity of the follow-up face-to-face visit.” Hoover said the purpose of the follow-up visit is “to make sure that the beneficiary is benefiting from the use of the PAP device and that the symptoms that led to the prescription of the PAP device are resolved or resolving.” That’s all well and good, said Brant, “but Medicare has given us no tools to handle this task. Without a piece of paper from Medicare saying, ‘Look, you’ve got to do this,’ [many patients won’t cooperate].” Hoover said that the DME MAC medical directors published an FAQ in November on what to do if patients are not compliant. “One recommendation is to obtain an advanced beneficiary notice advising the beneficiary specifically that Medicare coverage is contingent upon adherence to the use of the device (four hours per night, 70 percent of the night in a 30-consecutive-day period) and a follow-up visit within the 31st to 91st day. We also detail what options a supplier has if the beneficiary is unable or unwilling to comply with the policy.” Riley said some providers have taken that approach with some success. Still, she said, there is no guarantee that patients will be compliant. “We all know that this is a busy world, and if the patient decides they would rather get their hair done that day or they go on vacation or they get sick, they forget. The onus has to be on the patient. “The physician is in no better position than the HME provider in following along behind the patient to make sure they get back in,” she added. “Our industry is not used to that and it’s unfortunate. But that’s where the success metric seems to change significantly.” Brant is hoping that physicians have greater leverage than HME providers with Medicare. AMEPA is asking its members to urge physicians to write a letter to Medicare “asking them to postpone the follow-up requirement until these issues can be resolved. If a patient refuses to return to the doctor's office then CMS cannot hold the CPAP provider financially responsible.” Emphasized Brant, “We really shouldn’t be held financially responsible because the patient is refusing to go back.” To read the DME MACs’ FAQ on the Jurisdiction C Web site, click here. 123 Representatives Ask for Change in O2 Reimbursement Rules WASHINGTON--When it was all said and done last week, 123 members of the House of Representatives had signed on to a "Dear Colleague" letter to ask that CMS revise the post-36-month oxygen payment rules. The letter, authored by Reps. Tom Price, R-Ga.; Mike Ross, D-Ark.; Jo Ann Emerson, R-Mo.; and Heath Shuler, D-N.C., urges leadership of the powerful House Ways and Means and Energy and Commerce committees to recommend to CMS that appropriate payments for home oxygen therapy be continued through the beneficiary's period of medical need. According to the letter: "Home oxygen providers are more than just suppliers of equipment, they are also front-line caregivers. They educate patients on the proper use their equipment, answer patients’ questions, make repairs and adjustments, and ensure that patients are receiving the prescribed amount of oxygen. These providers are on the first line of care for Medicare beneficiaries who require home oxygen therapy. They take calls at all hours and in rural areas drive long distances to make sure that their patients receive the care they need. Without reimbursements for these visits, suppliers will not be able to afford to provide the current level of care for many of these oxygen patients ... Without immediate changes to the Medicare oxygen policies, patient care will be compromised and Medicare costs will increase." To read the full text of the letter, click here. For a complete list of representatives who signed on to the letter, posted on the AAHomecare Web site, click here.
On Feb. 13, CMS issued a change request transmittal on payment for repair, maintenance and servicing of oxygen equipment a a result of the Medicare Improvements for Patients and Providers Act of 2008. For a Medicare Learning Network article related to CR6297, click here. CMS has also released information on the use of certificates of medical necessity related to its new oxygen rules. Click here for a PDF of the full message on the Jurisdiction A (NHIC) Web site. DME MACs Issue Standard Common Repair Allowances ATLANTA--Last week, the DME MACs said they are instituting a billing and payment policy for common repairs based on standardized labor times effective for claims with dates of service on or after April 1, 2009. The effective date of the policy, which applies to non-rented and out-of-warranty items, coincides with the effective date of the new code for repairs of non-oxygen equipment: K0739 - repair of non-routine service for DME other than oxygen requiring the skill of a technician, labor component, per 15 minutes. One unit of service equals 15 minutes, according the MACs’ message, and code E1340 will no longer be valid for repairs with dates of service on or after April 1. A table in the notice contains repair units of service allowances for commonly repaired items. The notice said units of service include basic troubleshooting and problem diagnosis and reminded providers “that there is no Medicare payment for travel time or equipment pick-up and/or delivery.” To view the table and read the message in full from NAS, the Jurisdiction D DME MAC, click here. HELP Committee Gets Request for White House Office of Health and Wellness WASHINGTON--The White House Office of Health Reform sits vacant as the Obama administration regroups from former Sen. Tom Daschle's withdrawal as the person to run it, and to head the Department of Health and Human Services. But last week, the Senate HELP committee heard a request to create another White House office focused specifically on health and wellness. At a Senate Health, Education, Labor and Pensions Committee hearing Feb. 23, witnesses called for such an office. Under their terms, the central office would coordinate work across government departments and agencies to refocus the health care system on prevention and wellness. "There may come a time when we won't need one, but right now there needs to be a spotlight on this issue," said Dr. James Gordon, director of the Center for Mind-Body Medicine. "We need somebody, some office that's going to really keep an eye and make sure that what's put forward here in Congress, what's put forward by the administration, actually is enacted." Gordon described the current system as one in which "silos" prevent policy from being implemented successfully across a range of agencies that play a critical role in the health of Americans. According to Gordon and other witnesses, a White House Health and Wellness Office could ensure implementation of health care reform across agencies including HHS, the Department of Agriculture, the Environmental Protection Agency and others. Other witnesses at the hearing outlined the benefits of integrated health care and said the system needs to shift not only focus, but money as well, from acute care and treatment of diseases toward prevention and wellness. Wayne B. Jonas, president and CEO of the Samueli Institute, told the committee that if the witnesses' recommendations were applied in a coordinated fashion, "a 'triple multiplier' of health, productivity and economic stimulus would result for the nation." As Congress mulls health care reform, Sen. Barbara Mikulski, D-Md., who presided over the hearing, said, "Talking about health care and the changes in it is not simply about expanding access to acute care or even expanding access to physicians' care, though they will be a pillar to whatever ultimately Congress does … Our goal in health care reform is to focus on improving quality of care." Simply having access to more doctors will not help without policy changes in areas like agriculture, community planning and environmental protection, she said. At a second hearing on the subject of integrative health care Feb. 26, witnesses told the committee that incorporating prevention and alternative medical approaches into health care reform could both cut costs and improve patient health. According to Dr. Andrew Weil, director of the Arizona Center for Integrative Medicine at the University of Arizona, “there’s nothing finer in the world than American medical technology, but we’re trying to use this for everything that comes in the door.” Healthy choices about diet, stress, exercise and other lifestyle factors can prevent disease and reduce chronic conditions, he and other witnesses said. Read and watch last week’s testimony at the "Principles of Integrative Health: A Path to Health Care Reform" and the "Integrative Care: A Pathway to a Healthier Nation” hearings. Newsmakers GF Promotes Spett; Capper Takes Over at HDI Graham-Field Health Products, Atlanta, has promoted Ken Spett to executive vice president. In his new position, Spett’s responsibilities will encompass the medical/surgical, home care, consumer and international divisions, along with global operations and marketing. Spett has over 30 years of diverse health care industry experience in a variety of senior executive, sales and marketing positions with companies such as Lumiscope and Whitestone Products. He began his career with Graham-Field in 1983 as vice president of operations for Labtron Scientific Corp. and became corporate vice president of marketing when Labtron and Graham-Field merged. Home Diagnostics Inc., Ft. Lauderdale, Fla., has appointed Joseph H. Capper as president, CEO and director. Capper was most recently president and CEO of CCS Medical, a medical supply company, where he was responsible for acquiring and integrating Becton Dickenson's blood glucose monitoring division into the CCS product line under the Nova Max brand. Before joining CCS, Capper worked with Bayer Healthcare's diabetes care division, where he served as national sales director. Capper replaces J. Richard Damron Jr., who served in the president/CEO capacity since 2001 and will be leaving the company. Invacare Corp., Elyria, Ohio, has elected recently retired Senior Vice President Dale C. LaPorte to the company’s board of directors. “For years, Invacare’s board has relied on Dale’s wise counsel, and we are pleased that we will continue to have the benefit of his insight and expertise as a member of the board,” said A. Malachi Mixon, III, Invacare chairman and CEO. The National Association of Independent Medical Equipment Suppliers, Halifax, Va., has added Larry Pierce, president of Oklahoma City-based Care Source, to its board of directors. Pierce replaces outgoing member Tom Coogan, director of industry affairs for Care Medical and Rehabilitation Equipment in Portland, Ore. In Brief Medtrade Offers CEUs; CMS Extends Date of Appeals Process Final Rule Rehab and respiratory providers can earn CEUs at Medtrade Spring in Las Vegas, March 24-26. The University of Pittsburgh has approved CEUs for seven sessions from the Rehabilitation & Assistive Technology Track. The CEUs will also be accepted by both RESNA and NRRTS for credentialing purposes. Additionally, the University of Pittsburgh School of Health and Rehabilitation Sciences CEUs meet the requirements for accruing NBCOT Professional Development Units (PDU), National Board for Certification in Occupational Therapy, under the approved provider category. The American Association for Respiratory Care (AARC) has approved eight sessions for CEUs from the Oxygen & Respiratory Issues Track at the show. For further information, check www.medtrade.com. Medtrade Spring's educational conference offers over 70 educational sessions in nine tracks. Use promo code "Home2009" to receive $50 off your conference ticket if you register before the show! CMS Extends Date of Final Rule for Appeals Process CMS posted its second extension of the timeline for publication of the Medicare claims appeal procedures final rule until March 1, 2010, in Friday’s Federal Register. The agency said it was not able to meet the timeline for publication of the final rule because President Obama's new staff needed an opportunity to further review the policies that will be set out in the rule. In February 2008, CMS announced a one-year extension because it could not meet the three-year timeline that had been scheduled for publication of the final rule. According to the agency, the rule requires collaboration among other HHS agencies, including the Office of Medicare Hearings and Appeals and the Departmental Appeals Board, as well as the Office of the General Counsel. An interim final rule now in effect includes changes to appeals procedures required by the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 and the Medicare Modernization Act of 2003. CMS said the IFR will remain in effect through March 1, 2010. The full notice is available here. Alzheimer's Disease to Double in California The number of Californians with Alzheimer's disease will nearly double to 1.1 million by 2030, according to a new report from the Alzheimer's Association. Already the sixth leading cause of death in the state, the report said, now California baby boomers age 55 and older, those of all race and ethnic groups and from every region, have a one-in-eight lifetime risk of developing the fatal disease. And that’s just in California … National Sleep Foundation Kicks Off Annual Awareness Week The National Sleep Foundation's Sleep Awareness Week, March 1-8 this year, is a week-long public information, education and awareness campaign that coincides with the return of Daylight Savings Time. For information, see the NSF Web site at www.sleepfoundation.org. Florida Mechanic Sentenced in DME Fraud Scheme A Miami Lakes, Fla., motorcycle mechanic has been sentenced to more than 11 years in prison and ordered to pay more than $1.3 million in restitution for his role in a $5.4 million Medicare fraud and money-laundering scheme. In December, a Miami jury convicted Jimmy A. Soto, of a series of health care fraud and money laundering charges stemming from false claims for DME. The claims involved a Hialeah-based company operating as Med-Pro of Miami. Medicare paid Med-Pro about $1.3 million based on the bogus claims for items that were neither prescribed by doctors nor delivered to patients, according to a press release from the U.S. attorney for the Southern District of Florida. Soto was also found guilty of laundering more than $1 million in Medicare money. Three other co-conspirators have already been sentenced to prison for their roles in the scheme, the release said. NGS Clarifies Signature and Date Stamp Questions In a clarification sent last week, National Government Services, the Jurisdiction B DME MAC, said it has received several questions about MLN Matters article 6261 regarding signature and date stamps. According to the MAC's message, one of the highest Comprehensive Error Rate Testing (CERT) errors continues to involve "multiple issues related to physician orders, including the lack of a legible identifier." But as of Feb. 2, the MAC message reminded, "signature and date stamps are not acceptable for use on Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs)." In fact, signature and date stamps "are not acceptable on any medical record documentation," the MAC said, including detailed written orders, dispensing orders, detailed written orders prior to delivery and signed and dated statements of compliance from the treating physician. The clarification said more information is available in the Program Integrity Manual at http://www.cms.hhs.gov/manuals/downloads/pim83c03.pdf. McDermott Introduces Single-Payer Bill, Again In every congressional session since 1993, Rep. Jim McDermott, D-Wash., has re-introduced legislation that would create a single-payer health care system. This year was no different. On Feb. 26, McDermott introduced the American Health Security Act, under which each state would create its own health care system with a federally mandated floor for basic health benefits. While care would be privately delivered and managed, McDermott said, the plan would be publicly financed and the federal government would act as the single payer. To revisit this news any time during the week, go to www.homecaremonday.com. ADVERTISEMENT |
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