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| April 20, 2009 | Volume 15, Number 17 |
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ADVERTISEMENT VGM Insurance is your Medicare Bond Expert and is committed to providing: • A simple, 15-minute online process - Minimal amount of information required • Bonds priced below market rate - Extremely competitive prices and several opportunities to receive discounts • Partnerships with Treasury-listed companies Bond Hotline 1-866-497-047  Table of Contents - IFR Clears Way for Round One Do-Over - CMS Statement on Competitive Bidding IFR - DeParle: Work with Congress on Bid Program - Podiatrists Exempt from Accreditation - Christopher and Dana Reeve Paralysis Act Signed into Law - Bill Would Allow PT Services without Physician Referral - Claypool Named Director of Office on Disability - Apria Cuts 90 at Billing Facility; Other HME Company News - CMS Targets Hospital Readmissions; DME MAC A at PAMS Meeting For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com. Late-Breaking News IFR Clears Way for Round One Do-Over WASHINGTON--Ignoring pleas from scores of legislators, consumer organizations and HME associations representing thousands of home medical equipment providers, CMS refused Friday to rescind the interim final rule for DMEPOS competitive bidding. The IFR, which requires a rebid of Round One in 2009, went into effect Saturday, April 18. “Based upon its review and on the need to ensure that CMS is able to meet the statutory deadlines contained in [the Medicare Improvements for Patients and Providers Act of 2008], the administration has concluded that the effective date should not be further delayed,” CMS said in a statement issued Friday afternoon. (See the full text in this issue.) The decision to forge ahead in spite of numerous letters from federal lawmakers calling for the rule to be rescinded surprised some industry stakeholders. The latest, a bipartisan letter sent last week to HHS, CMS and the Obama administration, contained the signatures of 84 members of Congress. “I really am disappointed. I thought that, at the minimum, they would delay the program,” said Seth Johnson, vice president of government affairs for Pride Mobility Products, Exeter, Pa. “I am quite confident that the CMS statement is not going to be well received by the members of Congress [who called for the IFR to be rescinded].” Tyler J. Wilson, president of the American Association for Homecare, also said CMS’ decision was unexpected. “Given the problems highlighted in recent months and the congressional concerns, we are surprised by the decision to move forward,” he said. Since issuing the IFR Jan. 16, CMS has been inundated with individual and collective letters from members of Congress about the rule. Among serious problems, they said, the IFR does not adequately address the issues that compelled Congress to halt Round One of the bidding program two weeks after its implementation last July. “They’ve made absolutely no changes from last year, and that doesn’t sit well with people,” said Cara Bachenheimer, senior vice president of Elyria, Ohio-based Invacare Corp. Stakeholders had hoped CMS would stay implementation if only because there is no permanent leadership at the agency’s helm. Bachenheimer noted that, if confirmed, Kansas Gov. Kathleen Sebelius, President Obama’s nominee to head the Department of Health and Human Services, could yet come to the industry's aid. Sebelius said in testimony before the Senate Finance Committee she would review comments about the controversial Medicare bidding program. “The administration extended the comment period for CMS’ recent competitive bidding rule to ensure that all stakeholders have an opportunity to review CMS’ proposed policies,” Sebelius told the committee, adding that if she were confirmed, the comments would be “reviewed very carefully in order to implement the policies fairly.” “The significance [of Sebelius’ comment] shows she has every intention of coming in and looking at the program,” Bachenheimer said, adding that she expects Sebelius could be confirmed as early as Tuesday. “It’s going to be our job to pressure them to look at this program and do what a lot of members of Congress are asking [to suspend the rule].” Johnson, too, said he is optimistic Sebelius could make a positive difference. “I am hopeful that, based on what we have heard about Gov. Sebelius … she will do a comprehensive review and analysis about the problems that have been identified by both the provider community and articulated in the numerous [communications] from Congress and make some administrative changes prior to the restart of the program,” he said. Industry Fight Continues Even with implementation of the IFR, Bachenheimer said, “I don’t think this is the end.” She said the industry has an opportunity to convince the new administration that, at the least, the IFR is fundamentally flawed and should be tabled. And there are numerous arguments for doing so, she said. For example, Bachenheimer pointed out that the Obama administration has already floated the idea of competitive bidding for Medicare Advantage plans. While there aren’t many details as to how that might be accomplished, there are two that could be helpful to the HME industry, she said. “One is that any willing provider can participate,” Bachenheimer explained, contrasting that with the DMEPOS bidding model that could eliminate as many as 90 percent of the providers in a bidding area. Another detail in the industry’s favor, Bachenheimer said, is looking at the way bids are calculated. For Medicare Advantage competitive bidding, the bids would be calculated based on the average of all submitted bids rather than on the complicated DMEPOS formula. “The ‘any willing provider’ is by far the more important of the two,” Bachenheimer said, but both comparisons carry weight in an argument against the IFR. Johnson agreed the any-willing-provider card could make a strong play
in the current economy because the IFR would drive thousands of
providers out of business. ”The new Congress is saying that they want
to do everything they can to protect small business,” he said, “and
on the other hand, the administration is going forward with these
projects that … are counterintuitive to those overall goals.”
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. CMS Statement on Competitive Bidding IFR BALTIMORE--On Friday afternoon, CMS issued a statement regarding the April 18 effective date for the interim final rule on DMEPOS competitive bidding. The full text of the statement follows: "The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, made limited changes to the competitive bidding program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), including a requirement that the Secretary conduct a second competition to select suppliers for Round 1 in 2009. The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule with comment period (IFC) on January 16, 2009. The rule incorporates into existing regulations specific statutory requirements contained in MIPPA related to the competitive bidding program. "The Administration delayed the effective date for the IFC to allow CMS officials the opportunity for further review of the issues of law and policy raised by the rule. Based upon its review and on the need to ensure that CMS is able to meet the statutory deadlines contained in MIPPA, the Administration has concluded that the effective date should not be further delayed. The rule will become effective tomorrow, April 18, 2009. However, there will be no immediate effect on the Medicare DMEPOS benefit and Medicare beneficiaries may continue to use their current DMEPOS suppliers at this time. "During the comment period, CMS received many suggestions by a range of stakeholders to make further improvements to the competitive bidding program, such as ensuring that CMS’s processes for collecting and evaluating bids are fair and transparent. In the upcoming weeks, CMS will be issuing further guidance on the timeline for and bidding requirements related to the Round 1 re-bid. In finalizing these guidelines, CMS will continue to seek input from all affected stakeholders to ensure program implementation consistent with the legislative requirements." Headline News DeParle: Work with Congress on Bid Program WASHINGTON--According to Nancy-Ann DeParle, director of the White House Office of Health Reform, Congress has "been convinced before that a more competitive marketplace for durable medical equipment is the right way to move forward, and I think there is a way to do that and to meet them halfway." At an 8 am breakfast meeting with reporters on Wednesday, DeParle responded to a question on two of MedPAC’s recommendations for Medicare savings--competitive bidding for DME and new calculations for medical imaging payments--and the fact that Congress has been fighting back on both. “I don’t have all the details about those two items. I don’t run the Medicare program anymore,” said DeParle, former head of the Health Care Financing Administration (CMS’ predecessor) during the Clinton administration. However, she noted, “Competitive bidding isn’t just something that MedPAC recommended, but it was enacted into law 12 years ago by Congress." In fact, said DeParle, referring to competitive bidding demonstration projects in Florida and Texas during her term at HCFA, "I did those demos in durable medical equipment, and my observation is that those demos were successful. But they were quite different than what I think was going on last year with competitive pricing for medical equipment, and that may be why Congress decided it didn’t like what it saw. So obviously the answer here is to work with Congress, and that's what we'll do." Congress delayed competitive bidding after a two-week run last July,
but an interim final rule issued by CMS in January re-started the
program effective April 18 (see top story this issue).
Podiatrists Exempt from Accreditation BALTIMORE--A DME MAC notice last week added podiatrists to the list of providers who are exempt from CMS' accreditation requirement. While they were not specifically listed as exempt in the Medicare Improvements for Patients and Providers Act, the notice said, podiatrists are included under the definition of a physician as defined in section 1861(r) of the Social Security Act. CMS clarified in December exactly which professionals are exempt from the Sept. 30, 2009, DMEPOS accreditation deadline--and which aren't--based on changes under MIPPA (the same law that delayed competitive bidding last July). An agency accreditation fact sheet lists those "eligible professionals" who are exempt as: • Physicians (as defined in section 1861(r) of the Social Security Act) • Physical therapists • Occupational therapists • Qualified speech-language pathologists • Physician assistants • Nurse practitioners • Clinical nurse specialists • Certified registered nurse anesthetists • Certified nurse-midwives • Clinical social workers • Clinical psychologists • Registered dietitians, and • Nutritional professionals. In addition, "other persons" including orthotists, prosthetists, opticians and audiologists are also exempt from CMS' mandatory deadline. CMS said it would define by rulemaking in 2009 how the accreditation quality standards apply to the "eligible professionals" and "other persons" groups. In its earlier clarification, the agency also specifically noted that pedorthists, mastectomy fitters, orthopaedic fitters/technicians and athletic trainers are not exempt and must meet the accreditation deadline. Last week’s MAC notice repeated that “pedorthists are not exempt from the accreditation requirement at this time.” Alex Bennewith, senior manager, government affairs, for the American Association for Homecare, reminded HME providers that under the MIPPA statute, they are not exempt from accreditation. "We are making sure all of our members are aware of the requirement and ready to comply with all of the regulations," she said. Meanwhile, pharmacists are seeking exemption from DMEPOS accreditation in proposed legislation introduced in the House (H.R. 616) with a companion bill (S. 511) in the Senate (see “Bill Would Exempt Pharmacists from Accreditation,” Jan. 26). But CMS' Sandra Bastinelli, who has oversight of the DMEPOS accreditation program, has estimated there are 25,000 pharmacy locations already accredited. If a pharmacy bills Medicare Part B for DMEPOS, it must meet the Sept. 30 deadline, she said during an Open Door Forum Feb. 18. Christopher and Dana Reeve Paralysis Act Signed into Law WASHINGTON--The Christopher and Dana Reeve Paralysis Act has been signed into law by President Obama as part of the Omnibus Public Land Management bill. The landmark legislation, which had bipartisan support, includes three main components to promote collaborative research, rehabilitation and quality-of-life initiatives for Americans living with paralysis and spinal cord injuries: • Paralysis Research - Expands research on paralysis at the National Institutes of Health. This will encourage collaborative research by connecting scientists conducting similar work to further enhance understanding and speed discovery of better treatments and cures. • Paralysis Rehabilitation and Care - Builds on research to enhance daily function for people with paralysis, including a Clinical Trials Network, to measure effectiveness of certain rehabilitation tactics and encourage shared findings on paralysis to improve rehabilitation. • Improving Quality of Life for Persons with Paralysis and Other Physical Disabilities - Works with the Centers for Disease Control and Prevention to improve the quality of life and long-term health status of persons with paralysis and other physical disabilities. “Advancements are made every day in spinal cord injury research, but the Christopher and Dana Reeve Paralysis Act will speed progress and make research efforts more efficient,” Peter T. Wilderotter, president and CEO of the Christopher & Dana Reeve Foundation, said in a statement applauding the new law. The act was named for the late husband and wife, “whose courage and grace in the face of adversity, coupled with their extraordinary activism, were an inspiration to millions around the world,” the statement read. The legislation authorizes congressional funding of $25 million each year through 2011. Bill Would Allow PT Services without Physician Referral WASHINGTON--The Medicare Patient Access to Physical Therapists Act (H.R. 1829), introduced March 31 by Reps. Earl Pomeroy, D-N.C.; Tim Murphy, R-Pa.; and Tammy Baldwin, D-Wisc., would allow physical therapists to evaluate and treat beneficiaries without a physician referral. "Direct access under Medicare would remove unnecessary barriers to the cost-effective rehabilitation services provided by physical therapists," said American Physical Therapy Association President R. Scott Ward, PT, PhD, in a statement. "Currently these health care consumers, which include seniors and people with disabilities, often have the greatest need for physical therapy services and experience unnecessary burdens to access these services. “The referral/certification process can often cause delays that can impede a patient's ability to achieve his or her optimal functional outcome,” he continued. “In light of today's economic environment, timely access to cost-effective physical therapy services for Medicare beneficiaries is critical." Forty-eight states and the District of Columbia have eliminated the physician referral requirement for patients to access PTs for an evaluation, while 44 states and D.C. allow access to some form of physical therapy treatment without referral. The legislation would defer to the state law on access regarding physical therapy. "Requiring Medicare patients to get a physician referral before they can see a physical therapist puts an undue burden on residents of rural areas who often travel long distances just to see their doctor," Pomeroy said. "Removing the physician referral requirement would save valuable time and money for Medicare patients in North Dakota and across the country." A Senate companion bill is expected in the next several weeks, the APTA said. Read the text of the bill. Newsmakers Claypool Named Director of Office on Disability WASHINGTON--Long-time disability advocate Henry Claypool has been named director of the HHS Office on Disability. In his new position, Claypool will serve as the primary adviser to the HHS secretary on disability policy and will oversee the implementation of all HHS programs pertaining to Americans with disabilities. With 25 years of experience developing disability policy at the federal, state and local levels, Claypool has lived the same number of years with a spinal injury. He is "uniquely prepared to expand and improve services that will empower more Americans with disabilities," according to HHS CHief of Staff Laura Petrou. From 1998-2002, Claypool advised HHS through various positions,
including senior adviser for disability policy to CMS during the Clinton
administration. From 2005-2006, he served as a senior adviser in the
Social Security Administration’s Office of Disability and Income
Support Programs and was appointed by Virginia Gov. Tim Kaine to serve
on the Commonwealth’s Health Reform Commission in 2007.
As an expert adviser to the SSA on interim medical benefits, he was
also a member of CMS' first Program Advisory and Oversight Committee,
formed to advise the agency on its initial implementation of competitive
bidding.
Apria Cuts 90 at Billing Facility; Other HME Company News LAKE FOREST, Calif.--Apria Healthcare announced last week the giant provider will eliminate 90 jobs at its billing office in Machesney Park, Ill. Citing consolidation due to Medicare cuts, Apria Executive Vice President Lisa Getson told Business Rockford that seven billing centers nationwide will be affected over the next 12 months. “Oxygen therapy took a 27 percent reduction in reimbursement compared to 2008,” Getson said in an interview. “That’s a severe reduction for all companies that provide respiratory care, and we had to reduce our nonpatient care costs while continuing to provide direct patient care services, such as in-home delivery, clinical visits and 24/7 on-call services through our branch network. Billing is something that can be done anywhere.” Billing work from the Machesney Park center will be transferred to centers in Phoenix, Kansas City, Kan., and Jackson, Tenn., Business Rockford reported, although Apria will maintain a presence in the area. Seventy-one employees bill for the company’s home infusion therapy division at the Machesney Park billing office, and 23 workers at another office provide direct care to area residents. Apria, which has approximately 550 locations in all 50 states, was purchased by private equity firm Blackstone Group in a $1.7 billion deal last year. Bilt-Rite/Mastex Moves to New Digs Schaer Promoted to President at CU Dynamed Pilots CPAP Software with Sleep Services of
America Sleep Services of America, Glen Burnie, Md., will use the multi-modal platform-independent service for remote monitoring of CPAP patients without the use of proprietary devices or smart monitoring equipment at its Maryland locations. The Software as a Service (SaaS) system assigns patients to numerous series of reminders aimed at managing chronic conditions, preventive services, medications and healthy lifestyles. Patients can get reminders via email, text message, interactive voice response or live phone engagement. They respond with messages aimed at tracking compliance and providing clinical values back to the provider. Patients will receive daily questions about how many hours they used the machine each night and how well they are adjusting to sleeping with CPAP. SSA will intervene with patients who report problems. "One of the biggest challenges we face with new CPAP patients is how they adjust to using this new piece of equipment in their homes," said John Mathias, president of SSA. "HealtheTrax gives us the ability to monitor patiens through the critical first 12 weeks of treatment and beyond without unduly burdening either the patients or our staff. We see this as the first step towards a more comprehensive sleep management program." New Products Get the Nod at Medtrade Spring The Innovation Award is given in honor of the product that best demonstrates top design and advanced technology. Infopia’s Ecocene System is a comprehensive disease management system specializing in the monitoring of patients with diabetes. The system's Virtual Tracker collects data from devices such as glucometers, blood pressure cuffs and scales and displays it in ways that enable patients and their health care providers to better manage the patient’s disease. VirtuOx was the winner of the Providers Choice Award, given to the company whose product offers the best use of technology. The VirtuOx VPOD-Wrist HD is part of the VPOD line, which includes handheld and wrist-worn oximeters that can store up to 72 hours of recorded memory. The Merit Award, presented to the company whose product best improves the quality of life for patients, went to ATMOS for its S 041 Wound Pump. The pump supports quick mobilization of patients and requires less frequent dressing changes. By pushing a button, the vacuum adjusts quickly and precisely to set levels. According to Nielsen Business Media, show producers, plans for a new, more interactive New Product Pavilion are underway for the 30th anniversary of Medtrade, set for Oct. 12-15 in Atlanta. For more information, visit www.medtrade.com. In Brief CMS Targets Hospital Readmissions; DME MAC A at PAMS Meeting Fourteen U.S. communities have been chosen for CMS’ Care Transitions pilot to eliminate unnecessary hospital readmissions. The project, to continue through summer 2011, will promote “seamless transitions” from hospital to home, skilled nursing care or home health care to keep patients from returning to the hospital for ongoing care needs. The communities include Providence, R.I.; Upper Capitol Region, N.Y.; western Pennsylvania; southwestern New Jersey; metro Atlanta East; Miami; Tuscaloosa, Ala.; Evansville, Ind.; greater Lansing, Mich.; Omaha, Neb.; Baton Rouge, La.; northwest Denver; Harlingen, Texas; and Whatcom County, Wash. "Our data show that nearly one in five patients who leave the hospital today will be readmitted within the next month, and that more than three-quarters of these readmissions are potentially preventable,” said CMS Acting Administrator Charlene Frizzera. DME MAC A Participates at PAMS Meeting To revisit this news any time during the week, go to www.homecaremonday.com. ADVERTISEMENT |
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