Friday, December 5, 2008

Homecare Business Provides Independence

Delivering equipment directly to patients homes, instructing patients on how to use and maintain the equipment and ensuring their safety are just a few of the services durable medical equipment (DME) supply companies offer. The Mining Gazette in Michigan featured Portage Health Apothecary Home Medical Equipment on December 4, mentioning the benefits their company provides to seniors in Michigan including independence.

Apria Healthcare Upper Peninsula Manager Brian Geshel was quoted as saying the equipment they provide "help save healthcare dollars because it's less expensive to care for patients in the home than in the hospital. In addition, people certainly like being in their home compared to being in the hospital."

To read the full story, visit

Daschle to battle for healthcare reform in 2009

Recently, President-elect Barack Obama named former senator Tom Daschle (D-S.D.) as his choice for secretary of the Department of Health and Human Services. In this role, not only would he oversee the departments’ $707.7 billion budget which includes Medicare, but he will also be tasked with pushing healthcare reform legislation through Congress, according to a recent article in the Washington Post.

Reform of healthcare, especially Medicare, is a top issue in Washington, D.C. and Obama has campaigned for the last two years on reform ideas including insurance coverage for all children and reduction of family medical bills by $2,500.

Daschle will have to tackle Medicare spending which is projected to grow annually by 7.5 percent over the next decade as well. Medicare trustees project that Medicare’s Trust Fund will be exhausted in 2019.

To read the full story, visit

Monday, November 17, 2008

How do I find home care for my loved one?

When a loved one requires medical care, many questions and concerns arise. Can the medical care be received in the home or is a nursing facility or some other institutional care required? Who can provide these services? Where do I find information?

Virtually every type of healthcare short of surgery can be performed in the home. Today millions of Americans benefit from oxygen therapy, wheelchairs, skilled nursing, sleep therapy, infusion therapy, diabetes supplies, hospice, and other medical services, supplies, and equipment at home.

The American Association for Homecare has created a webpage with resources and information to help you navigate these questions. Please visit for more information or see

Wednesday, November 12, 2008

Sen. Baucus Touts Services Provided in the Home and Community

U.S. Senator Max Baucus (D-Mont.) released his healthcare reform plan today, saying the need for reform is so great we have to act now. In his introduction to the plan, Baucus stated the need for healthcare policies that “shift the focus from institutional care to services provided in the home and community” in order to improve quality of care and reduce costs.

However, he also proposed in his plan that competitive bidding is an anti-fraud program and is a sound payment methodology for home medical equipment and services in Medicare. The American Association for Homecare disagrees with this statement.

The Association is on record as noting that the competitive bidding program for home medical equipment, which was reformed and delayed by MIPPA, is a price-setting mechanism – not an anti-fraud measure. The Association believes that the federal government should not arbitrarily limit the number of homecare providers who furnish care to seniors and people with disabilities. The number of providers should be determined by the marketplace.

In response to the healthcare plan, Tyler Wilson, president and CEO of AAHomecare, said, “The underlying rationale for competitive bidding completely misrepresents the nature of home medical equipment and related services that are integral to homecare. Competitive bidding would reduce quality of care and access to homecare for millions of seniors and people with disabilities.”

To learn more about AAHomecare’s response to the Senator’s plan, visit the AAHomecare newsroom at

Where Does the Home Medical Equipment Sector Go from Here?

Where does the industry go from here? That topic was discussed by a roundtable panel of leaders from the home medical equipment (HME) community during a general session that started off the first day of Medtrade.

Tyler Wilson, president of AAHomecare, led a discussion about trends driving change. Participants included Invacare VP Cara Bachenheimer, BLACKBURN’S VP Georgie Blackburn, Alan Landauer, chair of Landauer Metropolitan, Pride Mobility Chairman and CEO Scott Meuser, and John Miclot, president and CEO of Philips Respironics.

Alan Landauer observed that the HME sector needs to be realistic and be more active than other healthcare sectors competing for attention in Washington. Many lawmakers still consider cuts to homecare as “low hanging fruit” that can easily be picked off. Going forward, he said, “We need to provide solutions.” His advice to companies facing both tighter credit and lower reimbursement rates: “Make friends with your bank.”

Scott Meuser said survivors in the HME sector will be those companies that innovate and are economically efficient. The HME sector also needs to adopt a marketing perspective to combating the problems in Washington. The fraud issue, he said, is “ruining our brand.” While there has been encouraging progress, Meuser noted “We have to market the value proposition” of homecare. To get that message across, “AAHomecare is the Chief Marketing Officer. We need more providers joining AAHomecare.” Also, he said after the many long battles in Washington, the homecare community needs to “create an era of mutual trust” with the Centers for Medicare and Medicaid Services (CMS).

Georgie Blackburn noted that working with lawmakers on Capitol Hill has been eye-opening and encouraging. Meeting recently with a congressional office, “I found an applaud for our industry. The congressional staff said, ‘How can I help you, Georgie?’” She pointed to the success the HME community has achieved this year as evidence for optimism. “When we speak together, we can make changes.” Her advice to companies: “Payor mix keeps you healthy.” But she noted that Medicare rates serve as a benchmark, and therefore HME must be paid fairly by all payors.

John Miclot commented that the future of homecare will be characterized by patients with a wider range of diseases, and the number of those patients will be “substantially larger.” He said new technologies will be available to help care for people in their homes. “It will be a very exciting time for the industry.” But in the meantime, he noted, “we need some stability over three to five years – that would be very healthy for the industry.”

Cara Bachenheimer said HME will have an evolving role in healthcare involving therapies of greater complexity for and increased variety of illnesses. The HME sector needs to continue to work to “unify and pull together” in order to accomplish some of the key tasks ahead, such as getting the services required in HME recognized and paid for in Medicare. Bachenheimer noted that legislators on Capitol Hill recognize the expertise in the HME sector and appreciate ideas and suggestions from HME. For instance, the AAHomecare 13-point plan to stop Medicare fraud represents “the meat of the matter,” she said.

November is National Homecare Month

During November, which is National Homecare Month, the American Association for Homecare celebrates the thousands of dedicated professionals who provide cost-effective and consumer-preferred homecare.

Among the eight million Americans who depend on homecare for medically required services or equipment are people with chronic obstructive pulmonary disease (COPD), multiple sclerosis, Lou Gehrig’s disease, spinal cord injuries, congestive heart failure, diabetes, and other conditions. Homecare services include oxygen therapy, wheelchairs, skilled nursing, sleep therapy, infusion therapy, diabetes supplies, hospice, and other medical services, supplies, and equipment at home.

The home is the most cost-effective setting for medical care. To learn more about homecare and the benefits of the services offered, visit the AAHomecare newsroom to read the full Homecare Month press release (

Friday, October 31, 2008

Candidates Views on Homecare

This historic election and the past year of policy changes related to homecare has prompted many within the HME community to ask which candidates and parties will be friendlier toward the durable medical equipment sector. The American Association for Homecare doesn’t endorse candidates, but we do work closely with and contribute to both Democrats and Republicans because HME issues are not usually partisan.

To help in your research, AAHomecare has gleaned information from both of the presidential candidates’ websites, the debates, and from the Kaiser Health Foundations 2008 Presidential Candidates Comparison website (

Both Senators consider homecare to be important and want to strengthen long term care policies. Barack Obama’s website state’s he supports the Community Choice Act of 2007 which would allow Americans with significant disabilities the choice of living in their community rather than having to live in a nursing home or other institution. He also supports Community Living Assistance Services and Supports (CLASS) Act which creates a voluntary budget-neutral national insurance program to assist adults with functional disabilities, allowing them to remain independent and in their communities. During the Republican ABC-Facebook debates which took place early in January, in Manchester, NH, John McCain advocated for home healthcare: “We need incentives for home healthcare as opposed to long term care. In my state of Arizona we adopted a proposal which incentivizes health care providers to keep people in home health care settings. It’s dramatically less expensive than long term care. In Arizona we have one half the numbers of people per capita in long term care facilities as the state of Pennsylvania. Incentives to keep cost down…there are no incentives in the system today.”

Both have made statements on Medicare fraud as well. Obama says he would empower the HHS Inspector General to fight fraud, implement anti-fraud measures in CMS contracting, expand the scope of Medicare and Medicaid audits, strengthen the federal False Claims Act, encourage states to go after fraud, and increase funding for Justice Department prosecutors and FBI agents to fight fraud. McCain simply states he advocates a zero tolerance policy towards Medicare fraud.

This is an important election year for congressional seats as well. Homecare has very strong champions in both political parties and we encourage DME providers to introduce themselves to the candidates and make sure new members of the Senate and House understand the value of homecare to their local communities. This is particularly important since most of the homecare policy has come out of Congress (not necessarily the White House) over the years.

AAHomecare encourages you to read both candidates healthcare plans and pay close attention to the congressional races. And don’t forget to vote on November 4!

Monday, October 27, 2008

Thirteen Recommendations for Eliminating Medicare Fraud

Tough new steps must be taken to prevent fraud and abuse in Medicare. The American Association for Homecare announced 13 specific recommendations that could eliminate most of the Medicare fraud attributed to the home medical equipment (HME) sector. The Association has been working with Congress and regulators over the past year to adopt tougher, more effective measures to combat Medicare fraud.

The specific recommendations made by the American Association for Homecare include:

Mandate Site Inspections for All New Home Medical Equipment Providers
A July 2008 GAO report underscored the need for CMS to ensure that its contractors are conducting effective site inspections for all new applicants for a Medicare supplier number.

Require Site Inspections for All HME Provider Renewals
All renewal applications should require an in-person visit by the National Supplier Clearinghouse (NSC), the contractor that CMS uses to ensure integrity in the Medicare program.

Improve Validation of New Homecare Providers
Additional validation of new providers should be included in a comprehensive and effective application process for obtaining a Medicare supplier number.

Require Two Additional Random, Unannounced Site Visits for All New Providers
Two unannounced site visits should be conducted by NSC during the first year of operation for new HME providers.

Require a Six-Month Trial Period for New Providers
The NSC should issue a provisional, non-permanent supplier number to new suppliers for a six-month trial period. After six months of demonstrated compliance, the provider would receive a “regular” supplier number.

Establish an Anti-Fraud Office at Medicare
CMS should establish an office with the sole mandate of coordinating detection and deterrence of fraud and improper payments across the Medicare and Medicaid programs.

Ensure Proper Federal Funding for Fraud Prevention
Increase federal funding to ensure that NSC completes site inspection and other anti-fraud measures.

Require Post-Payment Audit Reviews for All New Providers
Medicare’s program safeguard contractors should conduct post-payment sample reviews for six months worth of claims submitted to Medicare by new providers.

Conduct Real-Time Claims Analysis and a Refocus on Audit Resources
Medicare must analyze billings of new and existing providers in real time to identify aberrant billing patterns more quickly.

Ensure All Providers Are Qualified to Offer the Services They Bill
A cross-check system within Medicare databases should ensure that homecare providers are qualified and accredited for the specific equipment and services for which they are billing.

Establish Due Process Procedures for Suppliers
CMS should develop written due process procedures for the Medicare supplier number process, including issuance, denial and revocation of the Medicare supplier number. The procedures must include, for example, an administrative appeals process and timelines.

Increase Penalties and Fines for Fraud
Congress should establish more severe penalties for instances of buying or stealing beneficiaries’ Medicare numbers or physicians’ provider numbers that may be used to defraud the government.

Establish More Rigorous Quality Standards
Ensure that all accrediting bodies are applying the same set of rigorous standards and degree of inspection to their clients.

For more information, visit the Newsroom at

Monday, September 22, 2008

AAHomecare Takes a Stand Against Medicare Fraud

In recent months the media and Congress have been focusing on Medicare fraud and initiatives to help curtail the rising cost associated with fraud. The American Association for Homecare (AAHomecare) supports Congress efforts. Fraud hurts all legitimate home medical equipment providers.

AAHomecare is currently working on a legislative strategy that will help keep criminals out of Medicare. The Association staff is reviewing specific measures that could be used by the Centers for Medicare and Medicaid Services (CMS) to stop fraud at the front-end of the payment process rather than relying on the current pay-and-chase system. The measures focus on increased scrutiny of new HME providers, real-time claims analysis, and accreditation, among other topics.

Over the past year, AAHomecare has worked closely with congressional offices on two separate anti-fraud efforts, including a rational approach to implementation of surety bond requirements for home medical equipment. In addition, AAHomecare staff provided input to Senators drafting the STOP Act, (Seniors and Taxpayers Obligation Protection Act of 2008, S. 3164) which requires the Secretary of Health and human services to change the Medicare beneficiary identifier used to identify Medicare beneficiaries under the Medicare program.

The Association has gone on record opposing the exemption from accreditation requirements for “eligible professionals” as outlined in section 154 (b)(F) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). According to CMS, this includes physicians, physical or occupational therapists, qualified speech-language pathologists and practitioners are exempt as “eligible professionals.” This list also includes physician assistants, certified registered nurse anesthetists, and clinical social workers, among others. Home medical equipment providers are not exempt. AAHomecare has also opposed an earlier announcement by CMS to postpone the accreditation deadline for providers taking part in Round Two of the DMEPOS Competitive Bidding Program.

Tyler J. Wilson, president and CEO of AAHomecare has commented that “accreditation helps to ensure that patients receive high-quality homecare, and it is also an important tool in preventing fraud in the Medicare program.”

Friday, September 12, 2008

Orlando Sentinel Publishes Industry Response to Fraud and Abuse Column

Home care can help fix Medicare

Tyler J. Wilson, September 12, 2008
The Orlando Sentinel's Sept. 4 editorial, "Congress needs to crack down on Medicare fraud to protect the program," states the obvious by using the word "outrageous" to describe the billions of dollars lost each year to Medicare fraud. There is plenty of blame to go around.

Yes, Congress needs to insist that the federal agency that oversees Medicare receives and wisely spends a greater proportion of resources on fraud prevention.

Yes, the federal agency, Centers for Medicare & Medicaid Services, needs to do a much better job of using its authority and resources that Congress has already approved and implement some fraud-prevention measures that Congress approved more than 10 years ago.

The home-medical-equipment and services industry, which criminals have targeted because it's easy to obtain Medicare-provider credentials, is doing its part to stop fraud. The industry insists on accreditation and other means of raising the bar for entry into Medicare as a provider of equipment and services.
However, some might conclude from the Sentinel's editorial that the decision by Congress to delay the controversial competitive-bidding program in order to reform and improve it was an effort by the industry to postpone or water down fraud prevention.

That is outrageous. Medicare fraud hurts the overwhelming majority of law-abiding home-medical-equipment providers who carefully comply with the crushing volume of Medicare paperwork and the dramatically declining reimbursement rates. The paperwork and declining reimbursement rates are making it harder and harder to provide the level of service that elderly and disabled home-care patients need.

When Congress recently enacted the Medicare Improvements for Patients and Providers Act of 2008, it strengthened the anti-fraud measures for the home-medical-equipment sector, and it closed a loophole that would have allowed unaccredited providers to serve Medicare patients. The Sentinel's editorial also failed to point out that the industry agreed to another large reimbursement cut in order to save taxpayers the more-than $1 billion they would have saved had the flawed bidding program gone forward.

There are many more steps that need to be taken to prevent fraud. The American Association for Homecare is developing an aggressive, comprehensive plan that it will share with concerned lawmakers such as Sen. Mel Martinez and regulators at CMS to prevent fraud.

It's important to avoid smearing the home-care sector in order to draw attention to the criminals who have been allowed to abuse Medicare.

The ultimate victims are Medicare beneficiaries and taxpayers who benefit from high-quality, cost-effective medical equipment and services provided in the comfort of the home rather than in more-expensive institutional settings. Fraud steals away resources that seniors and people with disabilities need. Lawmakers and regulators respond by punishing the entire home community.

Homecare is part of the solution to the Medicare crisis; it's not the problem. Lawmakers, regulators and the media should keep that in mind.

Tyler J. Wilson is president of the American Association for Homecare in Arlington, Va.

To view the Orlando Sentinel version please visit:,0,1327223.story

Tuesday, August 26, 2008

Patient Weighs in on New York Times Article

New York Times
August 26, 2008
Medicare Bidding

To the Editor:
In your Aug. 22 editorial “Medicare’s Claims,” you refer to the postponement by Congress of a new competitive bidding system for durable medical equipment. Such a system might sound great, but it does not serve or help people with disabilities. It can literally kill us.
Fraud is not good. But when a person with a disability needs a specific wheelchair, custom seating system or ventilator, you cannot award the right to supply some lesser-quality piece of equipment to the lowest bidder. That will only result in a greatly reduced quality of life — and possibly death — for that severely disabled person.

Moreover, surgical suppliers of such advanced and often custom equipment are already working on an extremely low profit margin. If the government starts awarding funds to the lowest bidder, it would reduce the ability of surgical suppliers to stay in business.

I use a $20,000 power chair for mobility and a $15,000 vent to breathe. This equipment has allowed me to drive, teach, write books and plays, and enjoy a full life. Allow competitive bidding, and I’d be using inferior equipment and my quality of life would be compromised.

To understand this complicated situation, you need to walk in our shoes — or live in our wheelchairs — for a while. Let’s reduce fraud. But let’s not destroy the equipment suppliers or people with disabilities in the process.

Robert Mauro
Levittown, N.Y., Aug.
22, 2008

Monday, August 25, 2008

New York Times Prints AAHomecare's Response to Medicare Fraud Article and Editorial

Fighting Medicare Fraud

To the Editor:

Re “Medicare’s Claims” (editorial, Aug. 22) and “Report Rejects Medicare Data on Less Fraud” (front page, Aug. 21):

It’s important for the federal agency in charge of Medicare to collect and publish accurate Medicare fraud statistics.

We applaud your effort to get to the bottom of Medicare fraud numbers, but it was disappointing to see your article link two separate issues — pricing through competitive bidding and fraud prevention.

Our industry has favored accreditation as a fraud deterrent for decades. The action by Congress in July to delay and fix the deeply flawed bidding program will not reduce or delay efforts to combat fraud.

The exact opposite is true. Congress strengthened the accreditation requirements in the new Medicare law and closed a loophole that would have allowed nonaccredited providers to serve Medicare beneficiaries. We applaud those measures.

We will continue to support efforts by Congress and federal agencies to find more effective ways of keeping criminals out of the Medicare program.

Tyler J. Wilson
Arlington, Va., Aug. 22, 2008

The writer is president of the American Association for Homecare.

To read the comment at the New York Times and leave a comment, visit

Friday, August 22, 2008

Error in NY Times Editorial “Medicare Claims”

The New York Times published an editorial today which complemented Charles Duhigg’s front page story yesterday. The editorial stated, “Congress must also recognize its own failure to give Medicare an important tool to combat fraud and waste. It postponed a new competitive bidding program for durable medical equipment that would require a more intense look at the qualifications and integrity of the suppliers. With Medicare expenditures soaring, there is no room for any more waste, fraud or complacency.”

To clarify this error surrounding the postponement of the competitive bidding program, AAHomecare submitted the following response to the New York Times comment section: The Medicare bill enacted by Congress on July 15 (the Medicare Improvements for Patients and Providers Act of 2008, HR 6331) INCREASES fraud-prevention measures by setting a statutory deadline for accreditation of home medical equipment providers and by closing a loophole that would have allowed non-accredited homecare providers to serve Medicare beneficiaries. The competitive bidding program is a price-setting mechanism required by the Medicare Modernization Act of 2003. The fraud-prevention piece of that legislation is accreditation. The Times has conflated and confused the two. (The durable medical equipment industry has advocated accreditation for decades and opposed the recent cancellation of deadlines for accreditation of providers in 70 metropolitan areas.) Congress wisely delayed the bidding program in July in order to fix a badly implemented program. Congress insisted that the delay be paid for through a 9.5 percent cut for durable medical equipment to recoup the savings the flawed bidding program would have saved. So the specific criticism of Congress in the editorial is misplaced.

To read the editorial and leave a comment of your own visit:

Thursday, August 21, 2008

NY Times Article Describes CMS-OIG Feud Over Fraud Numbers

A New York Times front page article on August 21 reports of a feud between the Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS) regarding the correct amount of fraud by criminals posing as legitimate home medical equipment providers. OIG says CMS is low-balling the fraud numbers after CMS told Congress the amount of fraud related to medical equipment is $700 million.

The top-ranking Republican on the Senate Finance Committee, Charles Grassley (R-Iowa), calls for “heads to roll” at CMS and in the House, Representative Pete Stark (D-Calif.) called CMS “incompetent.” Meanwhile, CMS has been complaining they don’t have enough anti-fraud resources from Congress.
The American Association for Homecare applauds efforts to get the numbers right and more important, to stop fraud in Medicare. However, the reporter for this article, Charles Duhigg, incorrectly describes competitive bidding as a fraud prevention mechanism that was stopped by industry lobbying. The action by Congress in July to delay and fix the deeply flawed bidding program will not reduce or delay efforts to combat fraud. The exact opposite is true. Congress strengthened the accreditation requirements in the new Medicare law and closed a loophole that would have allowed non-accredited providers to serve Medicare beneficiaries.

We will continue to support and help Congress and federal agencies to seek more effective ways of keeping criminals out of the Medicare program.

To read the NY Times article visit:

Wednesday, August 20, 2008

Local Coverage Determination for PAP Delayed

Recent studies have associated cardiovascular disease with obstructive sleep apnea. More than 12 million people are affected by the disorder, and many receive treatment each year with a continuous positive airway pressure (CPAP) machine, which the Centers for Medicare and Medicaid Services (CMS) acknowledges is safe and effective. Yet, the agency continues to provide conflicting policies on payment and testing related to these machines.

Most recently CMS provided new local coverage determinations (LCD) for PAP devices, requiring the new policies to go into effect on September 1, 2008 without offering a comment period and providing less than an ideal amount of time to implement the changes. The American Association for Homecare worked with industry stakeholders to delay the implementation date by sending a letter stating our concern for the quick implementation date and lack of input from the industry.

Yesterday, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for Jurisdictions A, B, C, and D announced a delay of the September 1, 2008 implementation date.

Full text of AAHomecare’s letter objecting to the September 1 deadline is available at

A revised policy will be published in the near future which we have requested provide at least 90 days before the implementation deadline.

Tuesday, August 19, 2008

“Medicare cuts take air from elderly Benefits capped for portable oxygen tanks”

The AARP Bulletin Today, a bulletin featuring daily news and information for senior citizens, tackled the issue of capping Medicare benefits for portable oxygen tanks and concentrators in a July article. The cap will mean that people currently on oxygen will become responsible for maintenance, repairs and replacement of their existing equipment after 36 months of rental.

At a cost of about $7.60 per day, oxygen therapy is cost-effective and is critical to approximately one million Americans who suffer from respiratory illnesses such as chronic obstructive pulmonary disease (COPD) and who require oxygen therapy under Medicare. Nationwide, as many as 15 million Americans have been diagnosed with COPD, a number that is growing.

The article quoted that the American Association for Homecare, which states that the typical Medicare home oxygen beneficiary is a woman in her 70s who suffers from late-stage chronic obstructive pulmonary disease and as a consequence has severe low levels of oxygen in her blood. Approximately 12 million Americans have been diagnosed with COPD, and an additional 12 million more remain undiagnosed.

The analysis shows more than 1.4 million Medicare beneficiaries will be impacted by the changes, amounting to approximately a $325 cut per patient. AARP said this new change is “cutting off the air supply to millions of elderly Americans.”

To read the full article in the AARP Bulletin visit:

Thursday, August 7, 2008

“A Simple Little Market Test of What Government Must Pay for Bed Pans”

It was a “simple little market test of what government must pay for bed pans.” That’s how former House Ways and Means Committee Chairman Bill Thomas recently described the Medicare competitive bidding program for durable medical equipment.

Thomas is unhappy that Congress decided to delay the program in order to get it right. The roll-out of the first round of the program in 10 metro areas was an unqualified disaster that would have vastly reduced competition and access to care for seniors and people with disabilities.

It should be noted that the bidding program, in fact, is not “simple,” it is not “little” in the context of the home medical equipment sector, it is not a “test,” and it has nothing to do with “government payments for bed pans.” But aside from those errors, Thomas’ comment is 100 percent accurate: It has something to do with the “market.” Sadly Thomas’ angry dig at home medical equipment is emblematic of the distain for homecare and homecare providers that festers in some corners of Washington’s policy world.

But if so-called Medicare reform proponents can’t even describe this one small sector of Medicare accurately or competently, how in the world are they going to actually design and implement reform in the other sectors of Medicare, where more than 98 percent of the dollars are being spent and where the growth is occurring?

By describing the bidding program as essentially dead, Thomas, like top Medicare and HHS officials, has admitted Congress has little confidence in the ability of the federal Centers for Medicare and Medicaid Services (CMS) to implement a fair competitive bidding program.

The American Association for Homecare will continue to work with Congress and CMS toward policies that preserve access to care, foster competition, and are fair to the homecare providers who provide medically required equipment and therapies to people in the most cost-effective setting in the U.S. – at home.

CQ HealthBeat reported Thomas’ comments last Friday. See

Miami Herald Prints AAHomecare's Response

Letter to the Editor, published August 7, 2008 in response to the Miami Heralds series on Medicare Fraud.

Don't ignore Medicare fraud

Several points in The Miami Herald's series on Medicare fraud merit attention. The federal Centers for Medicare and Medicaid Services recently canceled an accreditation deadline -- which is certainly an anti-fraud measure -- for suppliers of durable medical equipment -- oxygen therapy, wheelchairs, diabetic supplies, etc.

We oppose that cancellation. The government should use the ample authority that it already has to combat fraud more effectively. Criminals who have been allowed into Medicare have tainted the entire durable-medical-equipment sector, which provides cost-effective care for seniors and people with disabilities who require medical devices, services and therapies in their homes. Those facts should not be lost in the discussion about the future of Medicare.

Our industry has zero tolerance for fraud. Congress estimates that fraud and improper billing in Medicare cost us $70 billion a year. The share that durable medical equipment makes up is $700 million -- far too much, but about 1 percent of the total. South Florida obviously is a hotspot for equipment fraud and has received extra enforcement efforts and resources. The national figures beg the question: Why aren't the government and media focusing more on the other 99 percent of fraud, which represents $69 billion-plus in taxpayer theft or waste?

TYLER J. WILSON, president, American Association for Homecare, Arlington, Va.

DME Unfairly Serves as “Fall Guy” for Medicare Fraud

$70 billion is lost annually to Medicare fraud. Despite 99 percent of fraud in Medicare occurring outside of the DME sector, homecare seems to be taking the brunt of the press and attention in Congress.

Senator Mel Martinez (R-Fla.) chaired a forum on Capitol Hill to discuss Medicare fraud last week. Many of the examples of fraud presented during the forum focused on the DME industry. The Senator also introduced the “Seniors and Taxpayers Obligation and Protection (STOP) Act”, S. 3164, which is designed to combat fraud in Medicare. The bill would establish a system for unique identifiers of certain durable medical equipment, urge HHS to implement the DME surety bond requirement that was enacted in the Balanced Budget Act of 1997, require monthly verification of the accuracy of charges for physicians’ services, provide for a study of real-time data review, and amend the Medicare enrollment application.

Prior to the forum by Sen. Martinez, AAHomecare released a statement to the media opposing the decision by CMS to cancel the accreditation deadline for durable medical equipment providers in the 70 metropolitan areas throughout the U.S. designated for Round Two of the Medicare competitive bidding program. Tyler Wilson, president and CEO of AAHomecare said, “The home medical industry has advocated accreditation of homecare providers for three decades because accreditation helps ensure quality care for Medicare beneficiaries and can serve as a powerful tool in preventing fraud.

This week more examples of DME fraud were released through a Government Accountability Office (GAO) report. GAO investigators set up “sham” companies to test Medicare contractors, which were awarded Medicare business and passed all checkpoints. The Centers for Medicare and Medicaid Services has the tools already at their disposal to stop fraud and abuse but they continue to fall short on their commitment to Medicare beneficiaries and taxpayers.

AAHomecare is working through a variety of channels to ensure that the DME industry is not unfairly tarnished by misleading statements or by news accounts on the topic of Medicare fraud and will continue to offer help to CMS to combat fraudsters from entering into mainstream businesses.

Thursday, July 31, 2008

NBC Nightly News Botches Story on Competitive Bidding

NBC Nightly News aired a piece on competitive bidding on Saturday, June 26, 2008. To view the piece visit:

AAHomecare responded to the piece with the following e-mail on July 29:

NBC News
Washington, DC

Thanks for hearing me out regarding your segment on Saturday, July 26, “Congress delays Medicare cost-savings bill.” [NBC Nightly News, link:] As I mentioned, your segment is wrong on the central issue – savings for taxpayers, and it is misleading on other points. We would appreciate a correction or a follow up segment that adequately addresses at least these two issues:

First, you do not explain the full cost savings in the recent Medicare bill, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In order to get the reforms and delay in the competitive bidding program under congressional pay-go rules, the durable medical equipment (DME) industry agreed to a nationwide reimbursement cut, plus it will forgo a CPI reimbursement adjustment, which will, according to the Congressional Budget Office, completely offset and possibly over pay for the savings that the flawed bidding program would have reaped. If you need documents from CBO to review, we would be happy to provide them. As you should know, CBO is the final word – the only word – when it comes to what a law will cost. MIPPA saves taxpayers more than a billion dollars in lower reimbursement payments to the DME industry. That makes the title of your segment, and the entire point, misleading at best. Again, the bidding program was not “stopped dead in its tracks” as the lead-in suggests. It was delayed in order to correct the massive problems associated with its implementation.

Second, you fail utterly to account for services required in providing home oxygen therapy or a walker, the two examples of “over-payment” that you cite. As you well know, you can’t just leave an oxygen concentrator at the front door of a senior with COPD who depends on oxygen in order to live. It requires 24-7 on-call service, patient education and compliance, maintenance, delivery, and of course all of the required paperwork if the provider is to have a prayer of getting reimbursed by Medicare. Even a walker ($110) must be delivered, often in conjunction with hospital discharge which can occur at virtually any time (Friday evenings, weekends), it must be adjusted for the height of the user, and instruction is required. The whole point of a walker is what? To prevent falls. To promote safety and independence in the home. To keep the person out of the ER or nursing home. So the typical Medicare user does not have the luxury of driving to Wal-Mart (which charges $70, you say) and taking it home and setting it up on the day they arrive home from the hospital. The higher price in Medicare offsets the delivery and services tailored to the Medicare beneficiary, who is in the cheapest care setting possible – his or her own home. Moreover, the government study you cite only examined equipment costs, by their own admission, leaving an incomplete accounting of what it costs to actually provide these items in the manner required to Medicare beneficiaries.

Finally, your contention you made over the phone that the Centers for Medicare and Medicare Services (CMS) is transparent in its information and decision-making is sadly wrong. And you seem to assume that there are no politics or spin in play from your government sources.

Our industry, which represents about $8 billion in annual Medicare spending (out of about $430 billion annually in Medicare), just agreed to give up $1 billion, which will reduce taxpayers’ burden. That will be a hard pill to swallow from many of our mom-and-pop providers who have served their communities for decades, and we have heard an earful from them since it’s gotten much harder to stay in business given lower Medicare and Medicaid reimbursement rates and skyrocketing transportation costs. But in the meantime, we help save Medicare money by keeping people out of institutions, receiving quality services and equipment at home. It’s a shame you were not able to convey any information along those lines.

Your viewers deserve to understand what’s going on in Washington and they can’t do that without accuracy and context, both sorely lacking in your piece.

Wednesday, July 16, 2008

Fox Business Channel Looks Into Fraud Tied to Deceased Doctors

During a Senate Committee on Homeland Security and Governmental Affairs hearing held Wednesday, July 9, on Medicare fraud tied to deceased doctors, Senators from both parties grilled the Centers for Medicare and Medicaid Services’ (CMS) deputy administrator, Herb Kuhn, on the government agency’s lack of oversight for payment claims.

To learn more about this report read the New York Times article:

Fox Business Channel Wednesday evening (July 9), Tyler Wilson made it very clear that those scamming the government and using deceased doctor’s numbers are not members of the American Association for Homecare, but instead work on the periphery of legitimate businesses.

David Asman questioned Wilson on the program America’s Nightly Scoreboard, about the $76.6 million to $92 million paid by Medicare for false claims and asked whether he believed these numbers would continue to increase. Wilson said the number will expand unless Medicare improves on up-front enforcement. He explained that this issue has been a contention of the industries for some time and the Centers for Medicare and Medicaid have failed to use the tools already at their disposal and already within their authority to police these claims and not pay them.

Monday, July 14, 2008

Price Versus Cost of Effective Use for Home Devices

Response to Michael Leavitt's editorial in the Wall Street Journal by Tyler Wilson.

July 14, 2008; Page A16

It was disappointing to see Health and Human Services Secretary Michael O. Leavitt leading the effort to retain the competitive bidding program implemented this month for medical equipment providers who service Medicare beneficiaries ("Will Congress Continue a Medicare Scam?," op-ed, July 9). He fails to mention the problems with the bidding program.

The Center for Medicare and Medicaid Services (CMS), which the secretary oversees, has implemented a program that is creating havoc for physicians, providers, and hospital discharge officials, and may be endangering the lives of some Medicare beneficiaries. Since the program began July 1, the American Association for Homecare has received numerous complaints.

How disingenuous has Secretary Leavitt been? He is comparing prices of medical equipment from licensed providers to equipment obtained on the Internet. Equipment from the Internet comes without 24-hour support, patient/caregiver education, accreditation, state licensing or quality control. Surely, Secretary Leavitt is aware that the Medicare program requires its traditional providers to ensure that beneficiaries or their caregivers can operate the power wheelchair, hospital bed, oxygen system or other equipment. Is the administration now suggesting that seniors and others on Medicare should order vital medical equipment from and have it dropped at their doorstep by UPS? Is that the answer for improving health care?
In Washington, lawmakers have not been fooled by Mr. Leavitt's "spin" and know this bidding program puts constituents in harm's way. That's why the House voted overwhelmingly to suspend the program for at least 18 months so it can be fixed. The secretary did not mention that the bidding program has loopholes allowing unlicensed companies to provide sensitive equipment, such as oxygen, and has awarded contracts to companies located miles away from the service area to provide equipment they have rarely or never previously provided.

Congress should put this program on hold until we can be assured that Medicare beneficiaries will be treated with dignity once again.

Tyler J. Wilson
American Association for Homecare
Arlington, Va.

To read this letter to the editor online visit:

Wednesday, July 9, 2008

“Delay” Means “Improve” to Seniors and Homecare Providers

An opinion piece written by the secretary of the Department of Health and Human Services, Michael Leavitt, and published on July 9, 2008 in The Wall Street Journal (“Will Congress Continue a Medicare Scam?”) cites the same old argument comparing the cost of homecare services and products to equipment purchased on the Internet. He also discusses legislation which is up for a vote this week. Leavitt says, “Make no mistake: ‘Delay’ means ‘kill.’ Killing this competitive-bidding program would cost taxpayers about $1 billion annually, while unjustly overcharging senior citizens.”

In this case, “Delay” actually means “Improve.” Champions in Congress are trying to improve the program during an 18-month delay because the program has been so poorly implemented. Not only has the first week proved a lack of communication on the part of the Centers for Medicare and Medicaid Services (CMS) when educating providers and beneficiaries of the changes occurring, but the program has also reduced access to care in all competitively bid areas due to unprepared and/or unqualified contract winners. The lack of verification by CMS of supplier capacity, and CMS approval of long-distance suppliers with no location near the service area has created confusion and frustration for many beneficiaries, referral sources, and hospital discharge planners. CMS is also still allowing unlicensed suppliers to be contract providers.

Leavitt says Congress’ failure to uphold this program will mean they do not have the political courage to make harder decisions on healthcare reform. But the opposite is true. If members make the difficult choice of voting for a delay even though the President has threatened a veto and the competitive bidding program has already been implemented, they will be making the honorable choice, the choice to protect seniors from further harm.

Read Leavitt’s Opinion piece at:
Add your opinion to the Opinion Journal Forum at:

Wednesday, July 2, 2008

New York Times Publishes Industry Letter to the Editor

The Medicare Bidding Program
Published: July 2, 2008
To the Editor:

Re “Medicare Savings vs. the Lobbyists” (editorial, June 25) and “High Costs, Courtesy of Congress,” by David Leonhardt (Economic Scene, June 25), about the Medicare competitive bidding program for home medical equipment:Congress is considering reforms to the bidding program for excellent reasons. As presently configured, the bidding program excludes some providers and will undoubtedly reduce access to care for Medicare beneficiaries.

The reforms to the program proposed by Congress would preserve quality of care and save taxpayers every dime that the flawed bidding program would have reaped in reduced payments.

Your editorial dismisses as “overblown” the concerns expressed by patient groups like the A.L.S. Association, the United Spinal Association and the Paralyzed Veterans of America.

Moreover, pricing for home medical equipment and services for Medicare beneficiaries cannot be benchmarked to the cost of equipment purchased over the Internet. That comparison ignores the costs of the essential services required in providing quality home care to the elderly and people with disabilities.

Tyler J. Wilson
American Association for Homecare
Arlington, Va., June 25, 2008

Thursday, June 26, 2008

Response to NPR Marketplace Interview with David Leonhardt

AAHomecare's Response to the NPR Marketplace interview with David Leonhardt on June 25 follows:

Leonhardt failed to mention an extremely important point -- that the congressional proposal to reform the bidding program saves taxpayers billions of dollars. The proposal is fully paid for in terms of cuts that homecare providers would have to accept – a nationwide 9.5 percent payment reduction for the items subjected to bidding. That cut will save taxpayers every dollar that the flawed bidding system would have saved during the time that it takes to make some important improvements to the program.

Reform proponents in Congress want to fix a broken competitive bidding program that, unless improved, will eliminate thousands of qualified providers from Medicare even if they agree to the lower prices. We believe that will ultimately reduce competition and reduce services for the seniors and people with disabilities who require homecare and equipment.

The argument that Internet or Wal-Mart prices should serve as the basis for setting Medicare reimbursement for home medical equipment fails to grasp the service-intensive nature of homecare. That fuzzy thinking discounts the sharp reality that serving frail Medicare patients at home requires essential services that ensure quality of care and keep seniors out of nursing homes.

Finally, Leonhardt’s characterization of expressions of concern by the homecare community as “scare tactics” is ironic. How would you describe his assertion that if you don’t accept the current bidding program you therefore advocate a stifling of competition, higher prices, and obscene profits?

Your listeners deserve better than this type of one-dimensional commentary on an important issue.

To Post your own comment to this interview visit:

Washington Post Endorses Medicare Bill; NPR’s Marketplace Showcases NY Times Article

The Washington Post endorsed the whole Medicare package including a delay for competitive bidding, saying “targeted improvements are justifiable and paid for.” Help for Medicare, published June 26, discusses both the legislative achievements and mischief surrounding the scramble to eliminate the cuts to doctors fees set to take effect on July 1. Describing the deals surrounding competitive bidding as “mischief,” the article credits the bill for making improvements to the bidding program, saying the Medicare package would “expand preventive care, reduce co-payments for mental health services and make it easier for low-income beneficiaries to qualify for extra help.”

To read the full article visit:

In an Interview on NPR's Marketplace, “Medicare looks to the free market,” Bob Moon interviewed David Leonhardt about his article in the New York Times Wednesday on the competitive bidding program. Moon asked about the discrepancy in cost between Medicare, Wal-Mart, and Web prices as well as the congressional action to delay the bidding program. Leonhardt equates the fight surrounding competitive bidding to the difficulties we will see when a true health reform plan takes place.

We encourage you to post a comment after reading the interview transcript at:

Rebuttal to USA Today Article "Our view on health care: Suppliers defend sweet deal"

Opposing view: Fix the bidding program

Flawed rules will trigger service disruptions to Medicare patients.

By Tyler J. Wilson

Competition in Medicare should save money, should be fair and should not lower the quality of home care for seniors and people with disabilities.

That's why Congress is working on a bipartisan effort to improve the competitive bidding program for durable medical equipment. Congress is trying to fix a broken bidding program that, unless improved, will improperly exclude thousands of qualified home care providers from Medicare — and reduce competition.

As it stands, the bidding program will trigger widespread disruptions in service to Medicare beneficiaries who require oxygen therapy, power wheelchairs, diabetic supplies, and other items and services that help them live healthy, independent lives.

Senate Finance Committee Chairman Max Baucus, D-Mont., who proposed several needed improvements, said cost reductions "cannot be accomplished at the expense of low quality and inconsistent care." His Republican counterpart, Sen. Chuck Grassley of Iowa, said the improvements "will help prevent many small home-medical-equipment suppliers from going out of business."

Taxpayers will recoup every dime of the savings that immediate implementation of the flawed bidding program would have reaped. The home care industry has agreed to billions of dollars in reimbursement cuts to pay for the delay.

Another way to save taxpayers' money is by reducing Medicare fraud. Long overdue accreditation requirements will help.

The argument that Medicare rates for home care should be based on prices for medical equipment purchased on the Internet is preposterous. The comparison discounts the hard reality that serving frail Medicare patients at home includes essential services to ensure quality of care.

The law requiring bidding is 5 years old, but the implementation rules were not announced until last year. Those rules are deeply flawed. If not fixed now, a bad program spreads to 70 more cities in the months ahead. The proposed improvements would still save billions and preserve quality.

Submitted by Tyler Wilson and published as a response to the June 26 editorial in USA Today titled "Our view on health care: Suppliers defend sweet deal." Read the editorial in USA Today,, and post a comment.

Wednesday, June 25, 2008

Rebuttal to New York Times, "The Facts about Medicare’s Competitive Bidding Program for Home Medical Equipment"

The Facts about Medicare’s Competitive Bidding Program for Home Medical Equipment

A Response to the New York Times Editorial and Article published June 25, 2008

"Competition in Medicare should be fair and it should not lower the quality of care or reduce access for critical home medical equipment for seniors or people with disabilities.

Unfortunately, the New York Times unwisely brushes aside quality of care concerns and overlooks the additional health care costs the Medicare competitive bidding program will create for Medicare beneficiaries.

Congress has developed a bipartisan proposal aimed at improving the competitive bidding program for durable medical equipment. The program is scheduled to go into effect July 1, five days from now. Congress is trying to fix a broken bidding program that, unless improved, will eliminate thousands of qualified providers from Medicare, reduce competition among providers of DME, and lower the quality of items and services that Medicare beneficiaries have come to expect. As it currently stands, the bidding program will trigger widespread disruptions in service to Medicare beneficiaries who require oxygen therapy, power wheelchairs, CPAPs, diabetic supplies, and other items and services that help them live healthy, independent lives.

In Florida, Ohio and Texas, Medicare has awarded contracts to providers that do not meet basic state licensure requirements. This has occurred despite the fact that Medicare is touting that this program will ensure new quality standards. There are also loopholes that allow winning contractors to employ subcontractors who are not accredited and do not meet any standard of care threshold. The industry has been strongly supporting mandatory accreditation for years; if the government cannot enforce those standards, it is consumers who will suffer.

Senate Finance Committee Chairman Max Baucus (D-Mont.), who proposed several needed improvements, said, "I am supportive of competitive bidding as a means of reducing cost, but that cannot be accomplished at the expense of low quality and inconsistent care." His Republican counterpart, Charles Grassley (R-Iowa), noted, "These improvements also will help prevent many small home medical equipment suppliers from going out of business."

The efforts of Congress are not aimed at eliminating competitive bidding; instead Congress wants to delay the program for about 18 months so the government can get it right. The argument that Medicare rates for home care should be based on prices for medical equipment purchased on the Internet fails to grasp a fundamental feature of home medical equipment. The comparison discounts the hard reality that serving frail Medicare patients at home includes essential services to ensure quality of care. Buying a walker at Wal-Mart, referenced in the New York Times articles, is completely different from the service requirements imposed by both Medicare and the accrediting bodies, even for walkers which appear to be the simplest item of equipment. The Medicare supplier standards and the Joint Commission on the Accreditation of Healthcare Organizations requires providers to conduct patient/caregiver education to prevent falls in the home, and even Medicare supplier standards require patient education. Not to mention the two-hour turnaround that hospitals require for discharge, home delivery, intense paperwork and billing requirements imposed by Medicare for something as seemingly simple as a walker.

The law requiring bidding is five years old, but the implementation rules were not announced until last year. After taking over six months to review bids, Medicare is now rushing implementation, issuing policies via conference calls just three weeks before the go-live date, and mailing thousands of inaccurate brochures to beneficiaries with fewer than six business days before July 1. As a result, beneficiaries are upset and confused.

Taxpayers will recoup every dime of the savings that immediate implementation of the flawed bidding program would have reaped. The homecare industry has agreed to billions of dollars in payment cuts to pay for the delay. If not fixed now, a bad program spreads to 70 more cities in the months ahead. The proposed improvements will still save billions and preserve quality and access for seniors and people with disabilities.

Finally, Medicare does not pay equipment “makers” as the New York Times suggests. Rather, equipment makers, or manufacturers, sell their products to thousands of home care providers, which Medicare calls “suppliers.” Home care providers supply the items and services to consumers in their homes, file claims on behalf of beneficiaries, and comply with scores of federal, state and local requirements, including extensive documentation that Medicare mandates.

Visit to read the full editorial and post a comment or read the article in the business section at:

Thursday, June 19, 2008

Heritage Foundation Says Bidding Delay will Cost Taxypayers $3 Billion

The Heritage Foundation posted a web memo titled Morning Bell: Encouraging Fraud and Waste Is No Way to Stop Rising Health Care Costs on Wednesday, June 18. The article includes statics like “the average citizen can buy a power wheelchair for $2,174, Medicare pays $4,023” and states that “the proposed [competitive bidding] delay would cost taxpayers $3 billion in wasteful spending.”

The article also claims that delaying the competitive bidding program will "make sure medical equipment suppliers can inflate health care costs legally through government price controls."

A rebuttal post by John Shirvinsky, Executive Director of the Pennsylvania Association for Medical Equipment Services, states, “It is a sad day for free market economics when the Heritage Foundation spouts bureaucratic talking points and ignores market-based realities as you have done today in making hysterical claims of “fraud and abuse” in the Medicare durable medical equipment and supplies program and take up the cause of a market-distorting bidding program that has been proven to be anti-competitive, anti-free market, anti-small business and poorly designed and executed to boot.”

To read the Heritage Foundation article and post a comment visit:

Wednesday, June 18, 2008

Kojo Nnamdi Show Highlights the Competitive Bidding Debate

The Kojo Nnamdi Show, a two hour news and political issues program on NPR, decided to take on competitive bidding today in a segment titled “Medicare and the Free Market.”

The piece aired just after 1:00 p.m. ET and featured Cara Bachenheimer, Senior Vice President of Government Relations for Invacare as well as Julie Rovner, Health Policy Correspondent for NPR and Alec Vachon, D.C. consultant and former Republican staffer on the Senate Finance Committee.

Nnamdi introduced the program with a statement alluded to research showing equipment can be purchased online for much less than what Medicare is currently paying. Cara Bachenheimer addressed the Internet argument by saying “services and portability of equipment are the bulk of oxygen equipment and 72-78% of service is not equipment related. This program is a disaster for seniors; health care services are being auctioned off.”

Bachenheimer mentioned the program as it stands is government sanctioned price setting and will be a small business impact. She also made it clear that the industry sees accreditation as a positive.

To download the podcast and listen to the full interview visit:

Tuesday, June 10, 2008

Recent News Coverage of Bidding Delay Efforts

In a Washington Post article published on June 10, Rep. Pete Stark (D-Calif.), chairman of the Ways and Means subcommittee on health, said “he plans to introduce legislation as soon as this week to delay the program by 18 months. But his cooperation comes at a price: The industry must agree to cuts in current fees equivalent to the projected savings of the bidding program.”

The Associated Press national wire story released Sunday, June 8 on congressional concerns about the bidding program. John Reed, executive vice president of PRO2 Respiratory Services in Cincinnati, was quoted as saying, people also need to factor in the cost of deliveries for portable oxygen, for providing a respiratory therapist to set up the machine, for putting in place a backup system in case something goes wrong with the concentrator, for taxes, billing costs and for writing off expenses when a patient can't afford to pay all their co-payment.

"We've provided so much value-added service and care that we've put ourselves in a position to be judged by what the base unit cost," Reed said.

The AP article appears on the websites of several dozen news organizations throughout the US. The Cleveland Plain Dealer and the Austin American-Statesman also had stories on competitive bidding.

AAHomecare communications staff will continue intense media relations on bidding and other HME issues in the weeks ahead, including a teleconference to help instruct providers about working with their media locally to generate news about our key issues and to place issue advertisements created as part of the Stand Up for Homecare Campaign.

We encourage you to post comments on to these stories by visiting the links below.

Washington Post:

Cleveland Plain Dealer:

Austin American-Statesman:

Tuesday, May 27, 2008

125 U.S. Representatives and Cleveland Plain Dealer Urge Delay in Bidding

125 U.S. Representatives and Cleveland Plain Dealer Urge Delay in Bidding
What do 160 homecare advocates do when they descend on the nation’s capital? Collect signatures from as many U.S. Representatives as possible to help delay competitive bidding and continue educating members of Congress on the issues the industry is facing. This was one of the objectives of the May 21 Medicare Bidding Fly-In, organized by the American Association for Homecare.

Thursday, May 22 was the deadline for getting Representatives in the House to sign on to a letter urging a one-year delay in the bidding program for home medical equipment. The sign-on letter stated, “Our overall concern is focused on the implementation of the program thus far and its implications for Medicare beneficiaries receiving high quality health care.”

Efforts to get signatures included visits on Capitol Hill, calls, and e-mails. Unofficial numbers show more than 125 U.S. Representatives agreed to sign on to the letter – which is a terrific accomplishment for a one-week timeline.

Also on May 21, the House Small Business Subcommittee on Rural and Urban Entrepreneurship held a hearing on “Competitive Bidding for Durable Medical Equipment.” Small providers representing the American Association for Homecare (AAHomecare), the North Carolina Association for Medical Equipment Services (NCAMES), and VGM were among the organizations that presented testimony. Casey Hite, vice president of Aeroflow Healthcare in Asheville, North Carolina spoke on behalf of AAHomecare and NCAMES saying, “The Medicare bidding program is poorly conceived and fundamentally flawed. The program is showing many of the serious breakdowns that the American Association for Homecare predicted, based on the failure of CMS to recognize and account for the way that home medical equipment is provided to Medicare beneficiaries.” (

To hear testimony from this hearing visit:

An editorial on Sunday, May 18, in the Cleveland Plain Dealer which endorsed a delay in the Medicare bidding program, also helped fuel momentum. While taking the view that the competitive bidding may be the shape of things to come in Medicare, the editorial stated that, “A delay, at least, in awarding contracts is warranted. A thorough review should cover whether the specifications for suppliers are reasonable, whether the bidding, selection and appeals processes are fair, and whether streamlining to suit the government also serves patients well enough.”

The text of the editorial can be found at:

Thursday, May 15, 2008

More than 125 Homecare Advocates will Lobby Capitol Hill on May 21

At least 125 homecare providers and other advocates are expected to participate in the American Association for Homecare Medicare Bidding Fly-In on May 21, 2008 in Washington, D.C. There is room for plenty more. This is an extremely important opportunity to delay the Medicare bidding program so Congress can take a careful look at the entire concept.

Participants have been asked to schedule their own meetings for this event, in coordination with their state association. By posting your requests and confirmed appointments, you will allow others from your state to know with whom and when appointments will be held. If you see a colleague has already begun the scheduling process with your legislators’ offices, please contact them and work together to book one appointment with each legislator’s office rather than multiple homecare meetings.
States with appointments scheduled are listed below. Please post a comment to update this information.

10:00 AM – Senator Mel Martinez, Russell Building-356 FL
Between 1:00 – 2:00 – Congressman Kendrick Meek, Longworth-1039 FL
11:30 Sam Johnson (Jeannie Assistant) - Texas

10:00 am, Saxby Chambliss / Justin Clay (416 Russell)
10:30 am, Broun, Paul C., Georgia, 10th (2104 Rayburn)
11:00 am, Westmoreland, Lynn A., Georgia, 3rd (1213 Longworth)
11:00 am, Linder, John, Georgia, 7th/ Kelly Kurtz (1026 Longworth)
11:45 pm, Price, Tom, Georgia, 6th / Emily Henehan (424 Cannon)
1:45 pm, Johnny Isakson/ Francie Powers (120 Russell)
2:30 pm, Johnson, Henry C. "Hank" Jr., Georgia, 4th/ Scott Goldstein (1133 Longwowrth)
3:30 pm, Deal, Nathan, Georgia, 9th (2133 Rayburn)

George Kucka is scheduling appts.
3:30 p.m., Senator Bayh
12:30 p.m., Senator Lugar
2:00 p.m., Representative Visclosky
2:00 p.m., Rep Steve Buyer (not sure of Rep Buyer is available...still working)
3:00 p.m., Rep Joe Donnelly (Rep Donnelly is NOT available)

10:00am, Rep Ed Whitfield with Jeff Mortier (Cong Whitfield is NOT available)
10:30am, Rep. Ron Lewis
11:30am, Rep Ben Chandler with Jennifer Prather (Cong Chander MAY BE available…still working)
2:30pm, Rep. Hal Rodgers
3:00pm, Senator Mitch McConnell with Scott Raab (Senator McConnell is NOT available)
4:30pm, Rep John Yarmuth with Congressman Yarmuth
Pending- Rep. Geoff Davis and Sen. Jim Bunning

Kathleen Sheehan at the Maryland National Capital Homecare Association is scheduling appts. (202-309-4919 or Go to for updated list of appointments. RSVP for all Hill meetings to

11am Sarbanes, John P.(D-MD-3)202-225-4016 CHOB 426
Staff: Delicia Reynolds
11:30 Ruppersberger, C.A. Dutch (D-MD-2) 202-225-3061 LHOB 1730
Staff : Walter Gonzales
10 am Hoyer, Steny H (D-MD-5) 202-225-4131 LHOB 1705
Staff : Elizabeth Thomas
1 pm Cummings, Elijah E. (D-MD-7) 202-225-4741 RHOB 2235
Staff: Danielle Grote

Requests in for:
Wynn, Albert Russell (D-MD-4) 202-225-8699 RHOB 2470
(Rep. Wynn leave office end of May)
Staff : Erika Appell
Van Hollen, Chris (D-MD-8) 202-225-5341 LHOB 1707
Staff: Ray Thorn
Gilchrest, Wayne T. (R-MD-1) 202-225-5311 RHOB 2245
Staff : Kathryn Godburn
Bartlett, Roscoe G. (R-MD-6) 202-225-2721 RHOB 2412
Staff: Faye Powers
Senator Mikulski Barbara A. (D)Hart -503 (202) 224-4654
Staff: Ellen Marie Whelan
Senator Cardin, Ben (D) Hart -509 (202) 224-4524
Staff: Priscilla Ross

10:00 a.m., Lindsey Schwartz with Knollenberg's office (2349 Rayburn)
10:30 a.m., Lindsey Beck, L.A. for Dale Kildee (2107 Rayburn)
12:30 p.m., Kristina Ko, Carl Levin (269 Russell)
2:30 p.m., Katherine Haley in Pete Hoekstra's office (2234 Rayburn)
4:00 p.m., Andrew Hawkins in Mike Rogers office (133 Cannon)

New England:
Robin Boardman of NEMED is scheduling appts.
9:00 Rep. B. Frank, 2252 Rayburn
11:30 CT Sen.Chris Dodd 404B Hart
12:00 CT Sen.Joe Lieberman 706 Hart
12:45 CT Rep.J Larson 1005 Longworth
1:30 CT Rep.Chris Murphy 501 Cannon
2:00 ME Rep. Tom Allen 1127 Longworth
2:30 MA Rep. Rich Neal 2208 Rayburn
3:15 MA Rep. Ed Markey 2108 Rayburn

New York:
Appointments (per Carol Napierski, NYMEP)

10:00 a.m. - Rep. Louise Slaughter, Michelle Adams (staffer), 2469 Rayburn
10:00 a.m. - Rep. Gary Ackerman, Jared Frost (staffer), 2243 Rayburn
10:00 a.m. - Rep. Kirsten Gillibrand, Jill Greco (staffer), 120 Cannon
10:30 a.m. - Rep. Jose Serrano, Munir Madyun (staffer), 2227 Rayburn
11:00 a.m. - Rep. Brian Higgins, Matthew Fery (staffer), 431 Cannon
11:00 a.m. - Rep. John Hall, Michael Apfel (staffer), 1217 Longworth
11:00 a.m. - Rep. Vito Fossella, Ryan Mckee (staffer), 2453 Rayburn
11:30 a.m. - Rep. Jerrold Nadler, Jillian Youngblood (staffer), 2334 Rayburn
12:30 p.m. - Sen. Charles Shumer, Meghan Taira (staffer), 313 Hart
12:30 p.m. - Rep. Steve Isreal, Karen Agostisi (staffer), 432 Cannon
1:00 p.m. - Rep. Maurice Hinchey, Tera Sabag (staffer), 2431 Rayburn
1:30 p.m. - Rep. Michael Arcuri, 327 Cannon
2:00 p.m. - Sen. Hillary Clinton, Ann Gavaghan (staffer), 476 Russell
2:00 p.m. - Rep. Tim Bishop, Joanna Serra (staffer), 225 Cannon
2:00 p.m. - Rep. Thomas Reynolds, Kelly Dickson (staffer), 332 Cannon
2:30 p.m. - Rep. Peter King, Alexandra Valenti (staffer), 436 Cannon
3:00 p.m. - Rep. Yvette Clarke, Bridgette Dehart (staffer), Jehmal Hudson (staffer), 1029 Longworth
3:30 p.m. - Rep. Randy Kuhl, Karen Livingston (staffer), 1505 Longworth
3:30 p.m. - Rep. John McHugh, Mike Holland (staffer), 2366 Rayburn
3:30 p.m. - Rep. Nydia Velazquez, Max Trujillo (staffer), 2466 Rayburn
4:00 p.m. - Rep. Edolphus Towns, Julie Rones (staffer), 2232 Rayburn
4:00 p.m. - Rep. Elliot Engel, Emily Gibbons (staffer), 2161 Rayburn
11:30 a.m. - Rep. Michael McNulty David Torian (staffer), 2210 Rayburn
5:00 p.m. - Rep. Joseph Crowley, Eli Kogan (staffer), 2404 Rayburn

North Carolina:
1:15AM - Congressman David Price
10:30AM - Danielle HOH for Congressman Melvin Watt
1:00PM - Congressman Etheridge
2:00PM - Casey Murphy HOH for Senator Dole
2:30PM - Jennifer Mundy HOH for Congressman Patrick McHenry
3:00PM - Jane Miller HOH for Congressman Howard Coble
3:30PM - Heather Parsons HOH for Congressman Brad Miller
3:30 pm w/ Jen Rubino, Sen. Burr, 217 Russell

Kam Yuricich of KAMESA is scheduling appts.
10:00 a.m. Betty Sutton (1721 Longworth)
1:00 p.m., Steve LaTourette (2371 Rayburn)
2:30 p.m., Tim Ryan (1421 Longworth)
3:15 p.m., Steve Chabot (129 Cannon)
4:00 p.m., Dennis Kucinich (2445 Rayburn)
John Boehner- request for appt.
(other Members will be called on the 21st)

Kevin Gouy of United Seating and Mobility is scheduling appts. (503-929-8255,
Sen. Wyden- request for appt.
Sen. Smith- request for appt.
Rep. Wu- request for appt.
ALSO- possible meetings with Senator Brownback of Kansas and Sen. Susan Collins of Maine.

10:30 a.m., John Myers (Sen.Specter)
11:50 a.m., Rep. Jason Altmire
1:00 p.m., Morna Murray/Gillian (Sen. Casey)
1:30 p.m., Ken DeGraff/Cong. Mike Doyle
3:00 p.m.,Mike Mathis/Whitney Morton (Cong. Murtha)
4:30 p.m., Cong. English/Kelly Lavin

Gene Ray of Southern Diabetic Supply Co. is scheduling appts. (
11:00 a.m., Steve Cohen
3:30 p.m., Hunter Bethea with Sen. Corker’s office
2:30 p.m., Curtis Swagger with Sen. Alexander’s office
Congressman Blackburn- request for appt.

C.W. Bell M.S.B. Inc is scheduling appts. (
1:00 p.m., Representative Kay Granger
1:00 p.m., Rep. Joe Barton, meeting with Aarti Shah (Senior Legislative Asst.)
11:00 a.m., John Cornyn
10am appt with Martin Sobel, Healthcare Advisor for Senator Cornyn.
Faxed a request to Sen. Kay Bailey Hutchison's office.

Tom Inman is scheduling appts.
2:30 p.m., Rob Wittman
3:00 p.m., Bobby Scott

Tuesday, May 6, 2008

The Industry’s Impact on Capitol Hill

As the House Ways and Means Health Subcommittee gears up to hear from the American Association for Homecare and CMS on the DME competitive bidding program today, their reading material will include articles in the Washington Post and the Wall Street Journal.

The Post quotes Rep. Pete Stark (D-Calif.) talking about oxygen patients lobbying Congress, saying, “It’s a gimmick the providers have used for years. I think it's hokey… I like to think we are able to make an objective decision based on facts. I don't want to make these decisions based on an emotional appeal."

However in the Wall Street Journal Stark says he’d like to see the competitive bidding program “scrapped.” He feel action will be taken again the program but is uncertain of whether it will be done in 2008 or 2009. For the homecare industry and Medicare patients they serve, the question of timing is a big issue and they will continue to lobby Congress until concerns for the program are addressed.

We encourage you to visit these articles and post comments online.
Washington Post:

Wall Street Journal:

Wall Street Journal Blog:

Thursday, May 1, 2008

Coordinate Your Capitol Hill Appointments for May 21 Fly-In

A nationwide grassroots effort is underway to suspend Round One of the competitive bidding program. Letters, calls, e-mails and visits with members of Congress are all part of the strategy to raise awareness about the flaws with this program.

On May 21, 2008 all of these efforts will be redoubled as the homecare industry visits Washington D.C. for the AAHomecare Medicare Bidding Fly-In. All efforts will be focused on lobbying Congress to instruct Medicare to suspend Round One of the competitive bidding program and delay Round Two. To register for this event visit:

Participants have been asked to schedule their own meetings for this event, in coordination with their state association. If you are attending the Fly-In and have already begun setting up your appointments, please post the key information on this blog to let others from your state know with whom and when the appointment will be held. If you see a colleague has already begun the process with your legislator, please contact them and work together to avoid dual efforts.

In your posted comment which will appear below, please include your name, contact info, whether you have requested an appointment or have secured an appointment. and with which member of Congress.

Tuesday, April 29, 2008

Wall Street Journal Article Quotes Proponent of Competitive Bidding

In an article by Laura Meckler about presidential candidates’ platforms on healthcare, the Wall Street Journal quoted a member of the Medicare advisory panel as saying the demonstration projects for competitive bidding showed no compromise of quality.

“Mr. Reischauer, who serves on a Medicare advisory panel, pointed to a demonstration project that showed competitive bidding for durable medical equipment, such as oxygen tanks or wheelchairs, lowered Medicare costs without compromising quality. But he said spreading that practice to the rest of the country is meeting resistance in Congress because some equipment makers will lose business.”

However, reimbursements for durable medical equipment were cut by an average of 26% which will lead to lower quality products and service. As many as 3 million beneficiaries in the First Round of competitive bidding are susceptible to disruption in service as they search for approved contractors and the hospital discharge process will be slowed causing taxpayers more money.
To respond to this article or read more about the candidates stances on health care visit: or write to Laura Meckler at

Monday, April 7, 2008

Errors Plague Medicare “Competitive Bidding” Program

A new Medicare bidding program for durable medical equipment (DME) scheduled to be implemented in 10 metropolitan areas starting on July 1, 2008 will put many DME providers out of business and will disrupt services for many of the three million seniors and people with disabilities living in those areas. Executive directors from "the state associations affected by Round One of competitive bidding have provided the following thoughts.

Cincinnati and Cleveland, Ohio
"Whether you accept or reject that a blind auction is a sound method for establishing health care reimbursement, one has to strongly question how this actual concept is currently being rolled out through the DME bidding program. In my two decades of involvement in the home medical equipment industry, this is the most severe and life-threatening issue this small, but vital segment of our nation's health care delivery system has faced. It's disheartening on a personal level as a taxpayer and consumer, shocking as a business professional witnessing chaotic and arbitrary processes by the government, and distressing as a free-enterprise advocate observing the unraveling of respectable organizations that have provided years, sometimes generations, of service to their communities."

"At the core of this problem is the public's inability to understand, thereby trust, the internal method for how "winners" were selected because the program rules provide no transparency. Even more alarming, since losing these bids can be the death of your business, the rules do not allow for any formal appeal mechanism. Many of Ohio 's Congressional delegation have been strong allies helping home medical equipment providers in Cincinnati and Cleveland work through the chaotic phases of the bidding program -- from bid submissions last summer, to bid announcements of winners and losers today. Their efforts to protect the recipients and providers of important homecare services are commendable and realistically, the last line of defense for these small businesses who are facing serious harm to, or possibly elimination of, their livelihoods."

-Kam Yuricich, Executive Director, Ohio Association of Medical Equipment Services

Charlotte, North Carolina
“Our story in North Carolina is no different than those all across the country in the first 10 CBAs. I am hearing story after story of providers who were unfairly disqualified for not providing financials (as one example) when in fact they did provide the information they were required to; and in their follow-up conversations with the proper authorities, they seem to get no help. Providers that have received contracts are skeptical about not only the pricing but the language used in those contracts. CMS’s response to the 120 Members of Congress did nothing to reassure them or the patients they serve; in fact, I believe it did the opposite by infuriating them even further. They are coming to NCAMES for help and we are telling them as much information as we can but until we can TEAM UP TOGETHER across the country, we will have a hard time offering them a solution other than the fact that NCAMES will continue to work hard for our members. CMS has to hear from our industry loud and clear that we will NOT accept this Competitive Bidding Program as it is and providers across the country should be able to “play the NCB game” without the rules being changed. NCAMES has to count on AAHomecare to lead the way by using all the most powerful resources it can throughout the country to come to bat for providers and beneficiaries who count on US!”

-Beth Bowen, Executive Director, North Carolina Association of Medical Equipment Services

Kansas City, Missouri
“For the providers who have received contracts, it has to be difficult for them to determine what the impact to their business is because they do not know how many other providers received contracts. For planning purposes, how are they going to know what the impact to their business will be and whether or not they should be ramping up to prepare for the July 1 start. There will be many issues with patient access. Contracted providers may not be able to handle the sudden increase of service. Example, for those providers who are not contracted, there is just no way to know if they plan on holding onto those patients who can be serviced under grandfathering, or chose to no longer service them and will send them to contracted providers. The real losers in this program will be the Medicare beneficiaries.”

-Rose Schafhauser, Executive Director, Midwest Association for Medical Equipment Services

Miami and Orlando, Florida
“Now that the initial shock has worn off and we're getting more and more information from our members in the two Round One Florida competitive bidding CBAs, we're deeply concerned and very alarmed at the volume of the mistakes made in the CBIC's provider-selection process. I've known many of the Florida bidders for several years, and have absolutely no doubt that their bids were thorough and complete when they were sent in. A process this obviously flawed needs to be stopped, analyzed, and corrected if it can't be done away with altogether; if it's not, I think the ramifications for beneficiaries and small businesses alike will be much worse than we anticipate.”

- Heather Allan, Executive Director, Florida Association of Medical Equipment Services

Pittsburgh, Pennsylvania
“Some of the most seriously ill and disabled Medicare patients in Southwestern Pennsylvania will be profoundly affected by this ill-considered program. Competitive bidding will directly impact the manner in which most will receive in-home medical equipment, supplies and related services. It will greatly reduce the number of providers who can serve Medicare beneficiaries and will eliminate community-based suppliers for many. In other words, Medicare beneficiaries will lose their ability to choose the provider who best meets their needs. The ability to choose a provider safeguards quality and continuity of care because it allows Medicare patients to establish long-standing relationships with providers who are most responsive to their individual needs.

Additionally, many patients may have to contend with the likelihood of several different services being offered by several different suppliers—suppliers who may be located far outside of their own community. The result is a process that is both confusing to patients and largely inconvenient when compared with the current single-supplier system.”

-John Shirvinsky, Executive Director, Pennsylvania Association of Medical Suppliers

"Round One of Competitive Bidding is proving to be every bit the nightmare the industry feared. MESA has only one MSA in this round, but we've heard from so many providers who had bids rejected because of allegedly missing documents -- documents they can prove they'd submitted! Extrapolate our numbers across all 10 of the Round One MSAs and the scope and impact of the faulty process boggles the mind. Well run, competitive bidding will be harmful to the industry; as it is now, it can only be disastrous. Far too many companies will be driven out of business while we wait for CMS and the CBIC to first admit, then clean up, the mess they've made."

-Liz Moran, Executive Director,Medical Equipment Suppliers Association

Thursday, March 27, 2008

Ms. Wheelchair America and State Associations – a perfect match

The New England Medical Equipment Dealers Association (NEMED) began supporting the Ms. Wheelchair America program in the New England area about three years ago. We had heard about the program many times through VGM but it wasn’t until we met Laurel Labdon, Ms. Wheelchair Massachusetts 2005, that we became hooked. Laurel had arranged a program at the State House and several NEMED members attended. We were so impressed with her that we continued to support her efforts whenever possible. That same year, NEMED sponsored Laurel’s trip to D.C. for the AAHomecare legislative conference. I have made the trip to D.C. many times over the past 10 years. Having Laurel in the room was an amazing experience. Hearing her story gave life to the issues we have been discussing for years and had a great impact. Everyone who met Laurel fell in love with her. This has been our experience with every Ms. Wheelchair America representative we’ve worked with. They are amazing women.

NEMED has organized a silent auction at our annual meeting for the past three years to raise money for the program in New England. We have been able to support several candidates in several states over the past few years. Our Ms. Wheelchair America fund has paid the entrance fees for several state delegates ($1,500) and has contributed funds to pageants in Rhode Island and Massachusetts. We formed a committee comprised of NEMED members in all six states to try to get a program up and running in each New England state. It has been a challenge to accomplish this but we continue to work at it. Currently there are two active programs- Rhode Island and Massachusetts.

These women are amazing advocates for our industry. State associations can benefit from becoming involved with the program.

Guest Blogger- Karyn Estrella, Executive Director of NEMED

Tuesday, March 25, 2008

Flawed Competitive Bidding Process Strikes Again

Seven business days are left to scrutinize contracts and determine whether your company can afford to continue doing business at the competitively bid price. It’s a difficult decision many providers are facing this week as they read through the contract offers provided by CMS on Friday via certified mail. Providers have until April 3 to make a decision and return their contracts.

But this decision is only for the bid winners who successfully made it through the CBIC/CMS bid selection process. Many more were not so “lucky,” and AAHomecare is learning that flaws in the bidding process may have unfairly disqualified many bidders. AAHomecare is encouraging providers who have problems or complaints related to Round One of the competitive bidding program to contact the Association with information about the specifics of those issues through a submission form located at Comments will allow AAHomecare to identify problems so they can be quickly addressed and shared with CMS and Congress.

Tuesday, March 18, 2008

“I’m an Example of Successful Homecare,” Says Reigning Ms. Wheelchair America 2008

An active advocate, organizer, speaker, writer, researcher, and peer mentor, the reigning Ms. Wheelchair America 2008, Kristen McCosh, spreads the word about the accomplishments and achievements of people who use wheelchairs. Kristen uses a wheelchair because of a spinal cord injury she sustained at the age of 15. She proudly asserts she is “an example of successful homecare.”

She attended the AAHomecare 2007 Washington Legislative Conference as Ms. Wheelchair Massachusetts, sponsored by the New England Medical Equipment Dealers Association (NEMED). However, through NEMED’s support and encouragement Ms. McCosh returned to the 2008 conference as the reigning Ms. Wheelchair America 2008.

“Ms. Wheelchair America is not a beauty contest,” McCosh said. According to the pageant’s website, it is instead a competition to select the most accomplished and articulate spokesperson for the millions of Americans with disabilities. Many state homecare associations are working to bring the Ms. Wheelchair America contest to new states.

Visit her blog at: McCosh can be reached at

Thursday, March 13, 2008

DME Fraud Story- Small Step in the Right Direction?

Last week’s Los Angeles Times and Associated Press (AP) stories on an anti-fraud initiative by the Office of Inspector General (OIG) represent modest progress because they did not condemn the HME industry. What a concept.

The homecare community and AAHomecare have explained to Kimberly Brandt, CMS program integrity director, and the media many times how important it is to make the distinction between criminals posing as legitimate providers and the vast majority of law-abiding HME providers working to serve patients. For once, two articles have correctly looked to CMS as the agency accountable for preventing fraud. Brandt commented in the AP story that criminals committing fraud in the DME sector “aren’t real medical suppliers.”

CMS’s accountability was also made evident in an OIG report (“Los Angeles County Suppliers’ Compliance with Medicare Standards: Results from Unannounced Visits”).

You can view the AP article for more information.