Ask Your Representative and Senators to Include MPP in Legislation

As last week wound down, Congress averted another threatened government shutdown, passing an appropriations bill funding federal operations through September 2012.

Meanwhile, Senate leadership worked on a separate agreement to extend the payroll tax holiday, extend unemployment insurance protections and prevent a 27 percent cut in Medicare physician reimbursement (the “doc fix”). Earlier in the week, the House passed a payroll tax/UI/doc fix bill by a vote of 234-193. As we reported to AAHomecare members on Saturday, the Senate voted 89-10 to approve their own short-term package that would extend a payroll tax holiday and prevent for two months a reimbursement reduction for Medicare physicians. We have learned from Capitol Hill sources that House Republican leadership will reject the Senate legislation, and additional negotiations will be required to reach an agreement acceptable to both the House and Senate.

In any event, it remains vital that HME providers contact their Representative and Senators and strongly urge them to contact their respective leadership to ask that the MPP proposal be included in the final doc fix bill that is sent to the President.

Use our Take Action Center to quickly send a message to your members of Congress.

A full, section-by-section breakdown of the Market Pricing Program is available to our members (login required). A brief summary of the MPP is available to everyone.

You can reach your Representative and Senators’ office by calling the Capitol switchboard at 202-224-3121. If you have any questions or feedback from House staff, please contact Jay Witter at jayw@aahomecare.org.

AAHomecare Urges Congress to Enact Market-Based Alternative to Medicare’s Bidding Program for Home Medical Equipment

Sustainable Market Pricing Program Corrects Flaws in Current Bidding Program, Preserves Access to Home-Based Care for Millions of Americans

The American Association for Homecare urges Congress to enact the Market Pricing Program (MPP), a reform of Medicare’s pricing system that is an alternative to the controversial bidding scheme for durable medical equipment and services.

“As it’s currently designed, Medicare’s bidding system reduces choice, access, and quality of care for seniors and people with disabilities who require home medical equipment and services,” said Tyler J. Wilson, president of the American Association for Homecare. “It also discourages competition and ultimately increases healthcare costs. Our proposal, the Market Pricing Program, corrects numerous flaws in the current bidding program and features a financially sustainable auction system.”

The bidding program implemented by the Centers for Medicare and Medicaid Services (CMS) has deep flaws, which were described in a letter to Congress signed by 244 top economists and auction experts. The current bidding system allows for non-binding bids – which encourage irresponsible bids and unsustainable prices and do nothing to ensure that winning bidders are actually qualified to provide the products and services to Medicare beneficiaries in the specified market areas. Since the bidding program was implemented on January 1, 2011, hundreds of Medicare patients have reported difficulty finding local equipment or service providers, delays in obtaining medically required equipment and services, and fewer choices when selecting equipment or providers.

The Market Pricing Program is based on recommendations by economists and auction experts in the field who have studied the current program. MPP features an auction system to establish market-based prices around the country and would require Medicare to make fundamental changes to ensure the long-term viability of the pricing program. Key components are:

• The Market Pricing Program is designed to achieve an accurate market price.
• Bids are binding for the bidders and cash deposits are required to ensure that only serious homecare providers participate.
• The bid price is based on the clearing price, not the median price of winners.
• The program includes the same equipment and services as the current bidding system and would be implemented across the country during the same timeframe.
• Two product categories per market area would be bid. Eight additional product categories in that same area would have prices reduced based on auctions conducted simultaneously in comparable geographic areas.
• Bid areas are smaller geographically than the currently used bidding units (metropolitan statistical areas) and are more homogeneous.
  

In addition to the 244 economists, more than two dozen consumer and disability groups, 165 members of Congress, and the National Federation of Independent Business oppose Medicare’s current competitive bidding system.

The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community that serve the medical needs of millions of Americans who require oxygen systems, wheelchairs, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.

The Holidays Highlight the Value of Home-Based Health Care

WASHINGTON, November 23, 2011 ------ Millions of Americans will be able to share Thanksgiving and other holidays with seniors and people with disabilities who are able to live safely and independently in the comfort of their own homes, thanks to home medical equipment, services, and supports.

Homecare also provides tremendous value to more than eight million Americans who require some type of care in the home, says the American Association for Homecare. Home medical equipment and services can be provided and maintained for just dollars a day, which is why homecare is a cost effective alternative to institutional care and is an important part of the solution to our nation’s healthcare financing challenge.

Facts about Homecare

• More than eight million Americans depend on medical equipment and services at home which treats conditions such as multiple sclerosis, Lou Gehrig’s disease, spinal cord injuries, severe lung disease such as chronic obstructive pulmonary disease (COPD), congestive heart failure, sleep apnea, and diabetes. Virtually every type of health care short of surgery can be successfully delivered in the home. Seniors and people with disabilities receive medically prescribed oxygen therapy, wheelchairs, hospital beds, drug infusion therapy, hospice care, walkers, and other medical services, supplies, and equipment at home.
  
  
• Americans would rather receive care at home according to surveys by AARP and other organizations. Moreover, a 2011 Harris Interactive survey about spending priorities for health care found that 79 percent of Americans believe the federal government should strengthen patient access to home medical equipment and services and 61 percent favor investment in community- or home-based care to improve cost-effective health care.
  
  
• Providers of home medical equipment and services help prevent ER visits and hospitalization and enable hospitals to discharge patients on a timely basis to post-acute care at home, which reduces length of hospital stays and lowers spending in the healthcare system. The home is the most cost-effective setting for many types of medical care including long-term care and is part of the solution for lowering health costs. In an October 20, 2010 New England Journal of Medicine article, Steven H. Landers, M.D., cites home oxygen as an example of advancement in portable medical technology and cites parenteral nutrition (tube feeding) and infusion as examples of home-based care that are cheaper than and as equally effective as institutional care.
  
  
• Home medical equipment providers serve as first responders to ensure that people receiving homecare are safe in emergencies such as Hurricane Irene or ice storms where power is lost for days at a time. A power outage can be deadly for a person who requires a ventilator or an oxygen concentrator that treats lung diseases or chronic heart failure. During a power outage or evacuation, having an adequate back-up supply of battery power or oxygen is essential to the health of the device users. In a catastrophic pandemic flu, home-based care will play a large role in treating flu victims since patients will quickly overwhelm hospitals.

The American Association for Homecare celebrates the thousands of dedicated professionals and family caregivers who provide the equipment, services, and supports that enable seniors and people living with disabilities to remain in the care setting that most prefer – their own homes.

The American Association for Homecare represents providers of durable medical equipment and services who meet the healthcare needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and mobility assistive technologies, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members provide homecare in all 50 states.

Contact:
Michael Reinemer, 703-535-1881, michaelr@aahomecare.org
Tilly Gambill, 703-535-1896, tillyg@aahomecare.org

Misleading Medicare Data on Improper Payments for Home Medical Equipment Paints False Picture

The American Association for Homecare expressed dismay today that the Centers for Medicare and Medicaid Services’ (CMS) calculated a 61 percent improper payment rate for the home medical equipment sector for 2011. The 61 percent improper payment rate is significantly higher than the overall Medicare fee-for-service error rate, which is 8.6 percent for 2011.

Even though the improper payment rate is not a calculation of fraud, the rate is misunderstood and it casts an unwarranted cloud over the entire home medical equipment sector.

“The 61 percent error rate is preposterous,” said Tyler Wilson, president of the American Association for Homecare. “More than anything, the improper payment rate for HME reflects badly on Medicare. It highlights the inconsistent guidance provided by CMS and the subjective audit reviews by the Agency’s contractors. Without significant changes to the medical review process, the millions of Medicare beneficiaries who require home medical equipment will not receive what their physicians order. The agency must better educate physicians about documentation requirements and help to improve compliance without placing needless burdens on providers of home medical equipment.”

The Association has worked with CMS to lower the error rate through greater consistency in audit requests, Medicare coverage criteria, and education of both home medical equipment providers and physicians. However, the Association’s recommendations to the agency for reducing the error rate have been ignored.

CMS is required by law to estimate and report the improper payment rate through a random sampling of claims conducted by the Comprehensive Error Rate Testing (CERT) audit contractor. The CERT contractor evaluates claims to determine whether they were properly paid according to Medicare coverage, coding, and billing rules.

The American Association for Homecare represents providers of durable medical equipment. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association’s members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org.

AAHomecare Supports Key Anti-Fraud Bill Introduced in House

The American Association for Homecare (AAHomecare) is pleased that Representative Peter Roskam (R-Ill.) introduced an important bill yesterday designed to reduce fraud and improper payments in Medicare.

The Fighting Fraud and Abuse to Save Taxpayer Dollars Act, or FAST Act, H.R. 3399, would strengthen Medicare by shifting Medicare's "pay-and-chase" payment system to one that is modeled after credit card industry fraud-prevention tactics, utilizing predictive modeling technology to prevent paying fraudulent Medicare claims. The legislation also contains a provision, supported by AAHomecare, which would require an electronic prior authorization process for standard power wheelchairs in Medicare. This provision requires physicians to use a clinical medical necessity template to document the medical need for a power wheelchair. The Association believes that this physician template is a critical tool needed to reduce improper payments due to documentation errors.

AAHomecare has long fought against Medicare fraud. The Association has worked with Congress and the Administration to implement a number of key components of its 13 point anti-fraud plan. Visit www.aahomecare.org/stopfraud to see the plan. Last year, AAHomecare supported H.R. 5546, introduced by Rep. Roskam, which would have improved the tools and resources available to prevent fraud and abuse in Medicare through the use of predictive modeling technologies.

The Association welcomes the opportunity to work with Rep. Roskam on this important bill as it moves through the legislative process.

Meet the Team: Dan Smith, Director of Membership Sales and Marketing

Dan Smith is the director of membership sales and marketing at AAHomecare. Dan joined the team in the summer of 2011.

Dan spends the majority of his time traveling state to state, listening to members, talking to prospects, and promoting the value of AAHomecare. He’s a seasoned veteran of the HME sector, bringing decades of experience to AAHomecare. From 1983 to 1991, he was a Rehabilitation Technology Supplier (RTS) for Advacare Medical, in Kansas City. From 1991 to 1997, he served as Regional Manager at Everest & Jennings. He also worked for The MED Group for twelve years, where he served as vice president of membership from 2002 to 2009.

Dan is a graduate of Kansas University and a huge JayHawk basketball fan.

Fun Facts
• Dan is an amateur herpetologist. He currently owns an 8-foot boa constrictor as a pet, and he has appeared twice on TV.

• Dan has been a national triathlete (swim, bike, run) for 15 years and competed all over the country, including the National Championships at Hilton Head Island, South Carolina, where 2000 national triathletes competed.

• Dan is a self-proclaimed expert on the Mexican/US border and Mexican Drug Cartels. He works out of the AAHomecare Western Regional Office (actually, his house) in Lubbock, Texas.

Meet the Team: Tilly Gambill, Manager of Marketing and Communications

Tilly Gambill is the manager of marketing and communications at AAHomecare. She joined the team in the summer of 2007.

Tilly manages a variety of advertising, marketing, grassroots, and public relations projects for the Association. Her sweet Southern charm and whole-hearted kindness are positive influences on an office otherwise full of city folk. As one of our resident social media gurus, Tilly has helped to establish and leverage the visibility of HME issues in emerging online media in addition to traditional communications channels.

Before joining the team, Tilly worked at Docs for Tots, a Washington-based advocacy network for physicians that champions the healthcare and social needs of children. She served as communications director there, leading media outreach and message framing efforts for the organization as well as work on print and electronic publications.

Tilly received her bachelor’s degree in Communications and History from Ouachita Baptist University in Arkansas, and her Master’s degree in Mass Communications from the Grady School of Journalism at the University of Georgia. (Go Bulldogs!)

Fun Facts

• Tilly has traveled across the world, literally, skiing the alps (she lived in Europe for 7 years), swimming in Dubai, and trekking past the Egyptian pyramids on camel-back.
  
  
• Tilly was taught how to field a baseball by Tommy Lasorda, her first job was scoring baseball games and she married an MLB Sirius XM executive producer – she and baseball cannot escape each other.
  
  
• Tilly was elected class president from the seventh grade to her junior year of high school, and student government president her senior year; her record is so squeaky clean that if/when the position is created, she can become the President of the Universe (Trust us, we've Googled her).

Homecare Champion Award Will Go to Tom Ryan of Homecare Concepts and Joe Lewarski of Invacare

In recognition of their outstanding service to the homecare community, Tom Ryan of Homecare Concepts and Joe Lewarski of Invacare Corporation will each receive the Homecare Champion Award from the American Association for Homecare next week at Medtrade.

The Homecare Champion Award honors members of the American Association for Homecare who have made exceptional contributions to the homecare community throughout their careers. A Homecare Champion has a longstanding record of service and he or she embodies a spirit of caring and generosity that is a hallmark of successful leaders in the home medical equipment sector.

Tyler J. Wilson, AAHomecare President and CEO, said, “During this time of challenge for the HME sector, it’s important to keep sight of the good deeds and great contributions of dedicated professionals in the homecare community.”

Ryan and Lewarski will be honored at the Stand Up for Homecare reception on Tuesday evening at Medtrade, October 25, 5:30 pm-7:00 pm, Maple Point – Hall B, Georgia World Congress Center, Atlanta, Ga.

Tom Ryan is president and CEO of Farmingdale, NY-based Homecare Concepts. He began work as a Respiratory Therapist during the 1970s and founded Homecare Concepts in 1988. He is also a founding member and former chairman of the New York Medical Equipment Providers Association (NYMEP). During his many years as an AAHomecare member, Ryan served two terms as chairman of the board.

“Tom’s entrepreneurial achievements, professionalism, concern for patients, high level of service, and his past and continuing leadership in both AAHomecare and NYMEP are among the many qualities that make him a fitting recipient of this award,” Wilson noted.

Joe Lewarski is vice president of clinical affairs at Invacare Corporation, based in Elyria, Ohio. Lewarski has worked in homecare for more than two decades and has authored more than two dozen scientific papers on pulmonary and respiratory topics in peer-reviewed publications. He has served as a volunteer on AAHomecare councils for many years, providing vital expertise on the clinical implications of regulations and legislation related to oxygen therapy, respiratory devices, and inhalation drugs.

“Joe’s clinical expertise and tireless service to the HME sector and AAHomecare have provided our whole community with a wealth of insight and information that has proved invaluable in our work on respiratory issues, including our successful effort to establish a significant dispensing fee for inhalation drugs in Medicare,” said Joel Marx, Chairman of AAHomecare’s Board and Chairman of Medical Service Company, based in Cleveland, Ohio. “We are pleased to honor both of these HME professionals who have generously volunteered countless hours to the Association and have strived on so many fronts to help improve the environment for homecare.”

More information about Ryan and Lewarski will be offered at the presentation of the awards at the Stand Up for Homecare reception on October 25.

Meet the Team: Gina Conlon, Executive Assistant and Office Manager

Gina Conlon is the executive assistant and office manager for the American Association for Homecare. She has been keeping the team on track since October 2006.

Gina works directly with Tyler as his executive assistant, and serves as mother to everyone else on the staff, more commonly known as the office manager. Many of you have spoken to her and received emails from her, and some of you have been lucky enough to actually meet her in person. Most of Gina’s duties involve organizing and nagging, of course all of it is necessary to make the well-oiled AAHomecare machine stay on track no matter what.

Gina graduated from George Mason University, in Fairfax, Virginia, with a BS in Early Childhood Education.

Fun Facts

1. Gina is the only native Washingtonian on the AAHomecare staff.
2. Gina knows the lost art of shorthand. Or at least she claims her meeting notes are in shorthand, it looks like Arabic to the untrained eye.
3. She worked for the CIA…click on this link at your own risk.

AAHomecare Calls on Joint Deficit Committee in Congress to Preserve Homecare Access for Millions of Americans

The American Association for Homecare urges the Joint Select Committee on Deficit Reduction not to include any additional budgetary spending cuts that will restrict access to home medical equipment and services in its recommendations to Congress. Over the years, homecare has broadened health care access for millions of Americans, while also producing cost-savings in the health care system by keeping seniors and people with disabilities out of costly hospitals and nursing homes.

“While we support the Committee’s efforts to reduce the deficit and contain rising health care costs, homecare is part of the solution, it’s not the problem,” said Tyler J. Wilson, president of the American Association for Homecare. “Homecare is a well-recognized form of cost-effective, post-acute and long-term care that has proven to reduce costs across the health care system.”

“Any additional cuts to the homecare sector will severely restrict access for the eight million seniors and people living with chronic conditions and disabilities who depend on care and services at home,” Wilson said. Over the past decade, home medical equipment and services have endured a series of deep, disproportionate budgetary cuts. Recently, the Medicare Payment Advisory Commission voted to repeal the Medicare Sustainable Growth Rate formula and partially offset the estimated $200 billion 10-year cost of the repeal through steep, disproportionate cuts to durable medical equipment reimbursements.

Durable medical equipment is a shrinking line in Medicare’s budget, representing less than less than 1.5 percent of total Medicare spending. Home medical equipment and services provide a cost-effective alternative to institutional care for both patients and the health care system. For instance, a full year of oxygen therapy at home under Medicare costs roughly $2,400 a year. Yet without access to the proper services and equipment, a home oxygen patient suffering an exacerbation of COPD can cost Medicare more than $5,000 per day in hospital expenses.

Durable Medical Equipment Is 1.4% of Total Medicare Spending--and Falling

Medicare Spending Chart: Durable Medical Equipment Is 1.4% of Total and Falling (NHE data)

Help preserve HME, tell lawmakers "No more cuts to homecare." Visit the AAHomecare Action Center today.

Meet the Team: Tim Hopkins, Manager of Web and Information Systems

Tim Hopkins is the manager of web and information systems at AAHomecare. He joined the team in January 2005.

Tim handles all things technology under the AAHomecare roof – from PCs and laptops to mobile devices – and manages the website as well. Some say that he is both the cause-of and solution-to all of AAHomecare's technological problems. A self-proclaimed PC chiropractor, email list whisperer and website duster-upper, Tim has used his knowledge of design, the web and social media to move the Association forward as “the interwebs” (his term) continue to evolve.

Tim received his bachelor’s degree in Information Science from Christopher Newport University, located in Newport News, Virginia.

Fun Facts

• Tim cofounded a live reading event in Alexandria, Virginia, called As Was Written, where poetry, prose and song writers perform their original work in front of a live audience.
  
  
• Tim learned sign language as a child from his parents, who both freelance as American Sign Language (ASL) interpreters.
  
  
• Tim is the quarterback of the two-time championship-winning Tailights flag football team in the Mid-Atlantic Flag Football Rec League.

Meet the Team: Jay Witter, Senior Director of Government Affairs

Jay Witter is the senior director of government affairs at AAHomecare. He joined the team in the Winter of 2008.

Jay brings sixteen years of legislative, political, and management experience to AAHomecare, which serves him well in advancing our legislative initiatives on Capitol Hill, as well as coordinating our political activities. His years working on Capitol Hill for several members of the House of Representatives provide valuable knowledge in the legislative and political processes, as well as helping cultivate invaluable relationships on The Hill that assist his lobbying for homecare issues on a daily basis.

Before joining AAHomecare, Jay worked as senior lobbyist for the United American Nurses (UAN), AFL-CIO, and oversaw the organization’s legislative, regulatory, and political policies, procedures and positions. During the 2008 presidential election, Jay worked with a majority of the candidates on pro-nurse policies and initiatives. He was also appointed to Obama’s Health Care Policy Committee, as well as organized a “Nurses for Obama” campaign. Before the UAN, he worked as VP of Government Relations at the American Chiropractic Association and successfully worked with ACA members for the passage of six specific chiropractic bills into law over the six years he worked at the Association.

Jay has a bachelor’s degree in Political Science from SUNY Courtland and Masters degree in Public Administration from George Mason University.

Fun Facts

• Jay, proudly, does not own a Facebook or Google+ page. His reasoning is foreign to those heavily reliant on social media: “I like to build relationships the old fashioned way.”
  
  
• Jay is a fan of all types of music, but claims that grunge music saved rock and roll in the early 1990's and has yet to return to that peak.
  
  
• Jay has been riding motorcycles for 25 years and currently owns a dirt bike and two street bikes, a 1979 Yamaha 750 Special and a 2011 Kawasaki Ninja ZX -10R (1000cc).
  

Harris Poll Finds Public Supports Increased Access to HME

Americans want the federal government to improve access to HME and invest in home and community based care. And given a number of choices for how to reduce Medicare spending, cutting homecare was their least favored alternative.

These are the results of a survey conducted last week of more than 2,000 adults in the U.S., conducted by Harris Interactive for AAHomecare. The survey was made possible by the Stand Up for Homecare Campaign.

Survey questions included:
“Where should the U.S. government invest the most money to improve health care and cost-effective delivery of care?”

• Community health clinics (37 percent);
• Patients’ homes (24 percent);
• Hospitals (23 percent); and
• Doctors’ offices (15 percent).

Given four choices for ways the government might cut Medicare spending to help reduce the budget deficit, respondents selected:

• Raising the premiums high income Medicare recipients have to pay (59 percent);
• Raising the age people start receiving Medicare benefits (24 percent);
• Cutting Medicare spending on home medical equipment such as oxygen, wheelchairs, and other equipment and services in their homes (9 percent); and
• Raising the premiums all Medicare recipients have to pay (9 percent).

Asked whether the federal government should “strengthen access to home medical equipment and services” given its potential to reduce hospital length of stay and healthcare costs, respondents replied:

• Agree (79 percent);
• Disagree (11 percent);
• Not Sure (9 percent).

We will be sharing these results with media and policymakers in Washington. Read the full data results.

Do You Know a Homecare Champion?

This Fall, the American Association for Homecare will honor the organization’s first Homecare Champion(s) by presenting an award that recognizes AAHomecare members who have made exceptional contributions to the HME sector. The recipient(s) will receive their honor at the Stand Up for Homecare reception that will take place during Medtrade on Tuesday evening, October 25, in Atlanta.

We are asking for nominations to help us identify those individuals who have had a significant impact on HME issues and who have helped to advance the business of the homecare community.

Some of the attributes to be considered in determining who might be deserving of recognition:

• Longstanding record of service within the homecare community;
• Embodiment of the spirit of caring and generosity which are the hallmarks of this profession;
• High personal integrity; and
• Membership in the American Association for Homecare and in one or more state organizations.

While the recognition of a Homecare Champion may relate in part to involvement in government affairs, this award is not predominately focused on federal or state government advocacy. We are seeking to honor people who have been involved in various aspects of the business of HME and the care that is an essential component. (Note – in February 2012 at the AAHomecare Washington Legislative Conference, we will also initiate an award that specifically recognizes leadership in advocacy and government affairs.)

The Homecare Champion recognition will be an ongoing award bestowed upon several deserving individuals every year at Medtrade and Medtrade Spring.

Submitting Nominations
All nominations must be submitted either by mail (address below), fax (703-836-6370) or email (suem@aahomecare.org) using the nomination form and must be received on or before 5:00 pm ET on Friday, September 30, 2011.

Anyone involved in the homecare community may submit a nomination.

Nominations should be submitted to:

Homecare Champion Award
Sue Mairena
American Association for Homecare
2011 Crystal Drive, Suite 725
Arlington, VA 22202

Questions about the Homecare Champion recognition and related inquiries should be directed to Sue Mairena at (703) 535-1890 or to suem@aahomecare.org.

Download the 2011 Homecare Champion Nomination Form

Expansion of Disastrous Medicare Bidding System Costing Jobs, Threatening Patient Care

Dozens of stakeholders from the Triangle’s home medical equipment (HME) industry brought homemade signs and rallied for jobs around the corner from where President Obama touted his jobs bill in North Carolina.

Organized by the North Carolina Association for Medical Equipment Services (NCAMES), the rally was designed to bring attention to the disastrous Medicare bidding system for HME.

Learn more at www.ncames.org.

The Realities of Wheelchairs and Medicare

Statement by Madonna Long

“The public would be better served if policymakers left their desks in Washington and met with us in our homes, where every day is a struggle.”

I have been in a wheelchair since being severely injured in a school bus accident as a teenager. For many people like me who live full lives with physical disabilities, the durable medical equipment provider who supplies mobility devices is one of the most trusted people in our lives. The equipment and service they provide keep us out of hospitals and nursing homes.

So it’s frustrating to see unfair accusations leveled at these providers. A small group of criminals who have posed as legitimate equipment providers have tainted the reputations of the many dedicated, hard-working wheelchair providers, like the ones I know. The bad guys, who are scamming the Medicare system, aren’t part of the durable medical equipment community; they are criminals who deserve to be locked up.

The media often focuses on the price that Medicare pays to provide power wheelchairs to its beneficiaries, but reporters frequently overlook the fact that the cost of mobility assistance is determined by a patient’s functional needs and the specific equipment and accessories required to address their unique physical conditions. Furthermore, the people who get power wheelchairs from Medicare don’t have them to cruise to the shopping mall. They can’t walk. The power wheelchair brings back their mobility. Oftentimes, it is the difference between living independently and being confined to a nursing home or other care facility.

It has been 30 years since I became a member of the wheelchair club. My life is no joyride. My manual wheelchair is a necessity. When I get out of bed in the morning, it helps me safely begin my day. I have to transfer from the bed to the wheelchair, and with one wrong move and I can fall to the floor, possibly injuring myself. The next challenge is getting dressed. It’s hard to accomplish when sitting in a wheelchair. Then, I must maneuver to the bathroom to groom and to the kitchen to prepare breakfast. None of this would be possible without a wheelchair. All of those tasks are even more difficult for those whose physical limitations require them to use a power wheelchair.

We do not choose to join the wheelchair club. But it’s our reality. We try not to whine about our circumstances because for many of us, it is just the way our life is.

Yet, we hear accusations that providers are delivering power wheelchairs to Medicare beneficiaries who don’t really need them. Nothing could be further from the truth. Data clearly shows that typical Medicare beneficiaries who receive power wheelchair prescriptions from their doctors are 70 years or older and suffer from chronic diseases, like COPD, diabetes, arthritis and heart disease. Their physicians have written the prescriptions because the patients need power mobility assistance so they can remain independent in their homes and groom, go to the bathroom, prepare food and do the other daily necessities of life when a walker or manual chair isn’t sufficient.

Wheelchairs are life-changing devices for the people who need them. It’s hard to understand why the federal government continues to add more and more barriers for Medicare beneficiaries to receive power wheelchairs. Over the years, policy changes ranging from reimbursement cuts, the so-called competitive bidding process, elimination of the first-month purchase option and other polices have made it difficult for suppliers to provide quality equipment and services. Surveys indicate that more and more home medical equipment providers are choosing not to sell power wheelchairs because of all the challenges presented by the government.

There must be more consideration of how these policies impact real people and families. As the number of providers decline, so does access to care and equipment, especially in rural areas where small businesses serve wheelchair users who are spread over vast areas.

It’s easy for bureaucrats to pronounce spending on power wheelchairs as “government waste,” even as the devices help to reduce overall healthcare costs and provide Medicare beneficiaries with the ability to live independently in their homes. The public would be better served if policymakers left their desks in Washington and met with us in our homes, where every day is a struggle. In all the congressional hearings on Medicare spending, rarely are the beneficiaries given a voice. What lawmakers would hear is passionate pleas for independence and dignity from some of the most vulnerable people in our society.

We may be overlooked. But we won’t go away. Mobility assistance allows us to embrace the spirit that our nation was built upon – it gives us freedom and independence.

Madonna Long, who has spent decades working on behalf of people living with disabilities, is a consumer advocate for Pride Mobility Products Corp.

Meet the Team: Gordon Barnes, In-House Consultant

Gordon Barnes is an in-house consultant at AAHomecare. He has worked for the team for several periods since 2007.

Gordon is best known as the Appointment Concierge to attendees of our annual Washington Legislative Conference – setting, confirming and managing hundreds of Capitol Hill appointments for conference attendees. (Put his skills to the test by joining us at the Legislative Conference in DC on Feb. 15-16) He also helps grow AAHomecare’s grassroots advocacy capacity and has a hand in several other communications projects and outreach activities.

Before joining AAHomecare, Gordon worked in public relations, grassroots and online communications roles for the DC-based PR firm Burson-Marsteller, the American Gas Association, the American Forest and Paper Association and the National Republican Congressional Committee.

He is a graduate of the University of Virginia, majoring in English.

Fun Facts

• Gordon lives in a townhouse in nearby Old Town Alexandria, Virginia, that was built in 1824, which he has been restoring for the better part of a decade. He does not particularly recommend this hobby for people who value their money or mental health.
  
  
• Speaking of often-frustrating hobbies: Gordon is a long-time Washington Redskins fan.
  
  
• Gordon attended the wedding of Wheel of Fortune grandee Pat Sajak (friend of bride’s family) and swears he is somewhere in the background in People magazine photos. He recalls that Vanna White seemed tiny in person.

Low Bids for Home-Based Care: A Threat to Independence

By Kelly Buckland, Executive Director
National Council on Independent Living

While there is much debate about controlling costs and improving quality in our healthcare system, you don’t hear much about one simple way to achieve both: preserve access to good home-based care and equipment.

Home medical equipment and services, such as wheelchairs, oxygen therapy, and other types of durable medical equipment, are essential to the safety, health, and independence of several million Medicare beneficiaries. Medicare covers seniors and people living with disabilities.

Like everyone else, people living with disabilities want to live independent and healthy lives. I know this because I am a person living with a disability. I have relied on my power wheelchair for mobility for more than 40 years, and I know the importance of having a well-functioning wheelchair that meets my physical needs and preserves my ability to live independently.

However, the agency that oversees Medicare, the Centers for Medicare and Medicaid Services (CMS), seems to have overlooked many of these basic facts when they designed a “competitive” bidding program for home medical equipment. This bidding program, which CMS claims works in the best interest of Medicare beneficiaries, actually does the exact opposite. As the executive director at the National Council on Independent Living, I feel it is important to highlight some of the troubling features of this program.

The bidding program applies to commonly used equipment and services, such as oxygen therapy, enteral nutrients (tube feeding), continuous positive air pressure (CPAP) and respiratory assistive devices, power wheelchairs, walkers, hospital beds and support surfaces, and mail-order diabetic supplies. By design, this bidding program dramatically limits the number of home medical providers allowed to provide the bid-upon equipment and supplies. This complicates and slows down the process of discharging people from a costly hospital stay to far less-expensive—and beneficiary -preferred--home-based services. The program also makes it harder to obtain required equipment and services. Ultimately, this steep reduction in providers also stifles rather than promotes competition.

The program began on January 1 in an initial round of nine metropolitan areas – Charlotte, Cincinnati, Cleveland, Dallas-Fort Worth, Kansas City, Miami, Orlando, Pittsburgh, and Riverside, California. It will spread to another 91 areas beginning later this year. However, in the first nine areas alone, hundreds of Medicare beneficiaries have already reported difficulty finding local equipment or a service provider, delays in obtaining medically required equipment and services, and reduced quality of care and products.

This is no surprise to those of us in the independent living community who have known about the numerous flaws in the CMS bidding system. Nor is it a surprise to the 167 economists and auction experts who called the design of the system inherently flawed because it encourages irresponsible bids and unsustainably low prices.

The solution is H.R. 1041, a bipartisan bill in Congress that would repeal this misguided and flawed bidding program. In addition to the National Council on Independent Living, many other advocacy organizations support this legislation. Those organizations include the ALS Association, the Brain Injury Association of America, the Christopher and Dana Reeve Foundation, the International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema and COPD Association, the National Spinal Cord Injury Association, and United Spinal Association, to name a few. The bill also has strong support from 150 Republicans and Democrats in Congress.

Everyone agrees that we need to contain healthcare costs. But we must also ensure that Americans with disabilities can continue to get the equipment and services they need in order to remain independent in the one setting that is both cost-effective and preferred – our own homes.

Meet the Team: Alex Bennewith, Senior Manager of Government Affairs

Alex Bennewith is the senior manager of government affairs for AAHomecare. She has been with the team for more than four years.

Alex advocates for members on legislative and regulatory affairs with Congress, the Centers for Medicare and Medicaid Services and the Food and Drug Administration. She also develops partnerships with disability and consumer advocacy organizations that work with us on competitive bidding and other homecare issues.

Alex went to Brandeis University for her undergraduate degree in politics and Latin, and obtained her master’s in public administration at American University. Before joining AAHomecare, Alex lobbied Congress for consumer groups and before that held business development and account management positions at public affairs businesses, lobbying firms and financial consulting companies.

Fun Facts

• Alex practices martial arts training with her husband, including boxing and muay thai.
• Legit et scribit linguas Latinam et Graecam. (Need a translator?)
  
• Alex likes to eat marmite sandwiches. Extra points to anyone who knows what that is!

Hurricane Irene Spurs Emergency Deliveries of Oxygen to Patients in Storm Path

From the Carolinas to New England, durable medical equipment providers spent much of the past three or four days preparing their customers for Hurricane Irene. Of particular concern to the companies are people who require supplemental medical oxygen, which is often supplied by an electric concentrator. During a power outage or evacuation, having an adequate back-up supply is essential to the health of the oxygen users, many of whom are Medicare beneficiaries.

Mark Richardson at Home MediService in Havre de Grace, Maryland, said his company received at least 58 Hurricane Irene-related calls over the weekend and the company made two dozen trips to visit oxygen users on Sunday alone. “Many of our patients were very impressed that their oxygen company would take the time to call them and make sure they had adequate back-up. Many were very thankful that we went out in that storm to make sure that they weren’t at risk.”

In Sandwich, Massachusetts a home medical equipment provider made numerous deliveries to home oxygen patients in the Cape Cod region over the past several days and providers in Ephrata, Pennsylvania put all delivery, clinical, and management staff on alert for the weekend and lined up gas and liquid oxygen supplies. A registered respiratory therapist and operations manager in Ephrata, said high winds and heavy rains produced power outages over the weekend and the company delivered extra oxygen supplies to 10 patients on Sunday.

Home medical equipment providers in other mid-Atlantic and New England states also helped patients beginning as early as Thursday, August 25, lining up extra supplies and contacting patients.

A provider of medical equipment in Matthews, North Carolina, said, “Although Hurricane Irene posed no real threat to the Charlotte area, we used this as an opportunity to kick our emergency preparedness plan into gear for a practice run. We called all of our oxygen patients to ensure that all their back up tanks were, in fact, full and that they had a plan in the event of an extended power outage. I look at this exercise as a win-win as our customers were very appreciative of our proactive efforts and we had the chance to practice our emergency plan. We were fortunate to have avoided Irene’s path.”

These are just some of types of extra steps taken by hundreds of durable medical equipment providers nationwide during emergencies -- whether caused by hurricanes, tornadoes, excessive heat, flooding, ice storms, or heavy snows. The companies receive no extra compensation from Medicare for providing emergency services. Companies responded with extra calls and visits during the July-August heat wave and during the flooding that struck Tennessee and neighboring states this Spring.

Meet the Team: Ashley Wyatt, Coordinator of Meetings and Education

Ashley Wyatt is the coordinator of meetings and education at AAHomecare. She joined the team in the Spring of 2009.

Ashley is in charge of recommending and coordinating educational events and teleconferences, as well as assuring that each trip to industry events (including Medtrade in October) goes as smoothly as possible, from the flight in to the flight out. She also spends time scouting potential event locations (she keeps recommending a “industry team building” trip to Hawaii, we keep saying no), making recommendations for upcoming shows, and works with our marketing team to promote our upcoming events (teleconferences, webinars, fly-ins).

Before joining AAHomecare, Ashley attended the University of Maryland University College full-time, where she’s currently two semesters away from a degree in Legal Studies.

Fun Facts

• Ashley is the only person in the office who could qualify as an “ice skating” expert – she took 6 years of instructional classes growing up, and knows what a “sit spin” and “axel” are without pointing at the TV during the Winter Olympics.
  
  
• Ashley is known to buy classic Disney DVDs on the day of release from the vault – but not for her two young children. She is the biggest fan in the house, touting her top 3 controversial picks, in order, as: “The Jungle Book,” “101 Dalmatians,” and “The Little Mermaid.”
  
  
• Ashley’s favorite food is pizza, and says that the best can be found in New York at Bocce’s Pizzeria – “It’s the best I have ever tasted, period.”

AAHomecare Corrects CMS Misinformation About Patient Medicare Bidding Complaints

In the article, Medicare Bid Process for Medical Supplies to Expand, U.S. Says, published in Bloomberg, Jeffery Young reports on competitive bidding saying, “The [CMS] agency received 45 complaints, contrasting with reports from suppliers and the American Association for Homecare of more than 500 from beneficiaries who couldn’t find a supplier, said Tyler Wilson, the Arlington, Virginia-based group’s chief executive officer.

Medicare officials are ‘dead wrong,’ Wilson said by telephone. ‘They’re mischaracterizing or turning a deaf ear to problems in this system,’ he said. Association members also are reporting stores going out of business, he said.”

Myths and Realities about Medicare’s Competitive Bidding Program for Home Medical Equipment and Services

As Medicare expands a controversial “competitive” bidding program for home medical equipment and services, economists, consumer groups, and members of Congress have gone on record to oppose that program citing reduced patient access to care, flaws in the program design, and impact on local jobs.

“There’s a reason why more than 30 patient advocacy groups, 244 economists and auction experts, and 145 members of Congress oppose this program: it undermines quality of care and it increases costs,” said Tyler J. Wilson, president of the American Association for Homecare. “Because of this bidding program, beneficiaries will spend more time in expensive institutions, rather than in the far more cost-effective setting for care – their own homes.”

New restrictions and unsustainable prices based on this controversial bidding system took effect on January 1, 2011 in nine of the largest metropolitan areas including Charlotte, Cincinnati, Cleveland, Dallas-Ft. Worth, Kansas City, Miami, Orlando, Pittsburgh, and Riverside, Calif. Another 91 areas throughout the U.S. will be subjected to the bidding program starting later in 2011. The bidding system affects providers and users of home medical equipment and services such as oxygen therapy, respiratory devices, hospital beds, wheelchairs, and other medically required equipment and supplies needed by seniors and people with disabilities in the Medicare system.

Proponents of the bidding system have conveyed misleading information that exaggerates the benefits and ignores the severe shortcomings of the program.

MYTH #1: Medicare overpays for home medical equipment and services, and the bidding system improves the method for setting reimbursement rates for that equipment and service.

REALITY: Proponents of the bidding system use out-of-date reimbursement rates and false comparisons of retail costs versus Medicare costs to argue their case. For many years, CMS has set reimbursement rates for home medical equipment through a fee schedule. Over the past decade, those reimbursement rates have dropped nearly 50 percent because of cuts mandated by Congress or imposed by CMS.

The costs of delivering, setting up, maintaining, and servicing medically required equipment in the home are obviously greater than the cost of merely acquiring the equipment. But Medicare does not recognize the costs of these services. So comparing the cost of the equipment to the larger cost of furnishing the full array of required equipment, supplies, and services is false and misleading.

Moreover, 167 experts, including two Nobel laureates and numerous economics professors from leading universities, have warned Congress that this bidding system will fail. The experts, who do not otherwise oppose competitive bidding to set Medicare prices, point out that the system has four fatal flaws:

• The bidders are not bound by their bids, which undermines the credibility of the process.

• Pricing rules encourage “low-ball bids” that will not allow for a sustainable process or a healthy pool of equipment suppliers.

• The bid design provides “strong incentives to distort bids away from costs.”

• There is a lack of transparency in the bid program that is “unacceptable in a government auction and is in sharp contrast to well-run government auctions.”

These concerns have been shared with the federal Centers for Medicare and Medicaid Services (CMS), which designed the bidding system. But the agency has dismissed the concerns.

A September 30, 2010 New York Times’ “Freakonomics” article by two of the 167 economists addresses the bidding issue. Yale University economist Ian Ayres and University of Maryland economist Peter Cramton, conclude: “The mystery is why the government has failed over a period of more than ten years to engage auction experts in the design and testing of the Medicare auctions…. We suspect the problem is that CMS initially did not realize that auction expertise was required, and once they spent millions of dollars developing the failed approach, they stuck with it rather than admit that mistakes were made.”

MYTH #2: The bidding program will make healthcare more cost-effective.

REALITY: The home is already a highly cost-effective setting for post-acute and long-term care. For many years, home medical equipment providers competed in Medicare on the basis of quality and service to facilitate the hospital discharge process and enable patients to receive cost-effective, high-quality care at home. As more people receive quality equipment and services at home, patients and taxpayers will spend less for hospital stays, emergency room visits, and nursing homes. Home medical equipment is an important part of the solution to the nation’s healthcare funding crisis. Home medical equipment represents approximately 1.5 percent of total Medicare spending. So while this bidding program would make even more severe cuts to reimbursement rates for home medical equipment, that will ultimately result in much higher spending in Medicare and Medicaid for hospital and nursing home stays and for physician and emergency treatments.

MYTH #3: The bidding program will eliminate fraud.

REALITY: CMS continues to describe the bidding program as an anti-fraud tool. In reality, it is a price-setting mechanism that has nothing to do with fraud prevention. In fact, the exact opposite is true, according to the 167 market experts who warned Congress that the CMS bidding program “will lead to a ‘race to the bottom’ fostering fraud and corruption.”

The real solution to keeping criminals out of Medicare is better screening, real-time claims audits, and better enforcement mechanisms for Medicare. Two years ago, the American Association for Homecare proposed to Congress an aggressive, 13-point legislative action plan to combat fraud, and many of those provisions have been included in legislation passed in Congress. Moreover, two important anti-fraud requirements for home medical equipment providers – accreditation and surety bonds – took effect nearly two years ago, in September 2009.

MYTH #4: Only the home medical equipment sector opposes the bidding system.

REALITY: In addition to the 167 economists and bidding experts who have expressed grave concerns about the bidding program, 30 consumer and patient advocacy organizations have called for a halt to the bidding system. Those groups include the ALS Association, the Brain Injury Association of America, the Christopher and Dana Reeve Foundation, the International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema and COPD Association, the National Council on Independent Living, the National Spinal Cord Injury Association, and United Spinal Association, among others.

These consumer groups support H.R. 1041, a bill in the U.S. House of Representatives that would eliminate the bidding program. The bipartisan bill has 145 cosponsors so far, including roughly equal proportions of Republicans and Democrats.

MYTH #5: The bidding system is good for Medicare beneficiaries.

REALITY: In January 2011, round one of the bid program was implemented in nine metropolitan areas. Since then, more than 500 patients, clinicians, and homecare providers have reported:

• Difficulty finding a local equipment or service provider;
• Delays in obtaining medically required equipment and services;
• Longer than necessary hospital stays due to trouble discharging patients to home-based care;
• Far fewer choices for patients when selecting equipment or providers;
• Reduced quality; and
• Confusing or incorrect information provided by Medicare.

CONTACTS: Michael Reinemer, 703-535-1881, michaelr@aahomecare.org
Tilly Gambill, 703-535-1896, tillyg@aahomecare.org

Meet the Team: Walt Gorski, Vice President of Government Affairs

Walt Gorski is the vice president of government affairs at AAHomecare. He joined the team in the Winter of 2006.

Walt oversees the government affairs team, coordinating strategies for legislative and regulatory positions, as well as lobbying Congress and the Centers for Medicare and Medicaid Services (CMS) on a vast array of issues impacting the homecare sector. His time spent tackling policy issues has placed him on a first-name basis with Lawrence Wilson, CMS director of chronic care policy group, and numerous high-ranking individuals in federal agencies and on Capitol Hill.

Before joining AAHomecare, Walt worked at the American Orthotic & Prosthetic Association (AOPA) for seven years as director of legislative and regulatory affairs, where he worked with current AAHomecare president, Tyler Wilson. Before that, he worked on the staff of the U.S. House of Representatives Ways and Means Subcommittee on Health.

Walt is a proud graduate of the University of Richmond.

Fun Facts

• Walt is an avid golfer – and occasionally gets the shakes when he goes a full week without spending time out on a course (golf withdrawal is real, according to the internet)
  
  
• Walt keeps in great shape by running to absolutely nowhere quite frequently – some people call it “jogging”
  
  
• Walt is a lifetime member of the Boston Red Sox Nation and -- here comes a shocker -- names Bill Buckner as his least favorite BoSox player of of all-time
  

No More Cuts to Home Medical Equipment in Deficit Reduction Legislation

The Budget Control Act of 2011 (BCA) requires the creation of a 12-member, bipartisan joint House-Senate committee to recommend cuts in federal spending, including Medicare. We strongly urge committee members not to include any further cuts to home medical equipment and services (HME) in their recommendations. HME (or durable medical equipment) has been targeted for significant payment reductions to reduce Medicare spending over the past seven years and cannot withstand additional cuts. Reducing HME payments will threaten the ability of the health care sector to save money by allowing patients to stay in their homes rather than in more costly settings like hospitals and nursing homes.

During the recent deficit reduction negotiations, conducted by the White House and congressional leaders, cuts to Medicare reimbursement for HME were included in the list of options. The list of cost-cutting targets included reductions to HME payments that totaled $5.4 billion over 10 years by making cuts to Medicaid HME payment rates by basing pay on competitive bidding rates and prepayment review for power wheelchairs.

We strongly oppose these two provisions because they will hamper access to quality home medical equipment and services. Further, these provisions will unnecessarily reduce the services that beneficiaries require:

Prepayment Review of Power Wheelchair Claims

• Require prepayment or earlier review for all power wheelchair claims.
• Allow the Centers for Medicare and Medicaid Services (CMS) to conduct prepayment or earlier review on power wheelchair claims to ensure they meet the existing criteria for coverage and, according to the proposal, reduce improper payments and prevent fraud.

Limited Medicaid Reimbursement of HME Based on Flawed Competitive Bidding Medicare Rates

• Limit federal reimbursement for a state’s aggregate Medicaid spending on certain HME services to what Medicare would have paid in the same state for the same services.

Position on Prepayment Review of Power Wheelchair Claims
Homecare providers make every effort to comply with complicated and subjective Medicare documentation rules and regulations. However, unlike other Medicare providers, HME providers are dependent not only on compliance with detailed policy requirements, but also on the level of detail and accuracy of documentation of medical necessity provided by physicians.

The Medicare documentation rules have become so complicated in an effort to stamp out fraud that compliance by legitimate providers has become extraordinarily difficult and are subject to Medicare contractor interpretation. The lack of clarity within the documentation policy is evidenced by Medicare contractors’ varied widespread audit results. Congress should work with the homecare community to formulate recommendations for early review of documentation, and develop clear and concise rules so that physicians, therapists as well as claim reviewers understand what documentation is required for the provision of a power wheelchair.

While the HME sector opposes “pre-payment” review for power wheelchairs, AAHomecare has an alternative proposal that moves Medicare away from its current pay-and-chase system to one that provides for real-time documentation analysis.

Position on Limiting Medicaid Reimbursement of HME based on Flawed Medicare Competitive Bidding Rates
The Administration and congressional budget negotiators considered a proposal that would reduce Medicaid payment rates for competitively bid items to the Medicare rates set by bidding. This proposal has two fundamental flaws. First, it is unclear whether the bidding program is sustainable over the longer term. Independent studies called for by Congress to evaluate the program’s effectiveness have not been completed. Therefore, applying these Medicare payment rates before these studies are complete would be premature and potentially harmful to seniors and persons with disabilities.

Also, Medicaid programs are structured very differently from Medicare. Many states discount their payment rates by a certain percentage off the Medicare rate. For example, a state Medicaid program may pay 80 percent of the Medicare payment rate for items and services. In addition, other states waive the 20 percent beneficiary co-payment because Medicaid patients cannot afford co-payments. Still other states combine these two provisions (i.e., the 20 percent reduction off the Medicare payment rate and waive the 20 percent beneficiary copayment amount). Therefore, if this provision were enacted by Congress, many state Medicaid payment rates would be up to 40 percent below the Medicare payment rates established by competitive bidding. Homecare providers will simply not be able to furnish items and services at such payment rates and be unable to accept and treat Medicaid patients if this proposal is adopted.

We urge Congress to oppose any further cuts to homecare.

HHS Inspector General Report on Power Wheelchair Use in Medicare Triggers Misleading News Coverage

Properly Prescribed, Power Wheelchairs Prevent Falls and Keep Thousands of Seniors and People with Disabilities Safe and Independent at Home, Lowering Healthcare Costs for Taxpayers

A July 2011 report by the U.S. Department of Health and Human Services Office of Inspector General (OIG) about power wheelchair usage in Medicare back in 2007 has resulted in misleading articles published in several media outlets, including USA Today.

The findings section at the front of the OIG report, “Most Power Wheelchairs in the Medicare Program Did Not Meet Medical Necessity Guidelines,” begins with the statement, “Sixty-one percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 were medically unnecessary or had claims that lacked sufficient documentation to determine medical necessity.”

This suggests that most power wheelchairs provided in 2007 were not medically necessary. But a reader would only have to finish the paragraph to discover that the OIG report found the wheelchairs were not medically necessary in only two percent of the cases, out of the 375 sample claims the OIG reviewed. In those two percent of claims, the OIG found that manual wheelchairs or scooters would have been more appropriate for the Medicare beneficiary. In seven percent of the claims, the OIG said “beneficiaries should have received a different type of power wheelchair than was provided.” And 52 percent of the claims were “insufficiently documented to determine whether the power wheelchairs were medically necessary.”

In other words, in most cases examined in the study, the OIG could not determine whether or not the wheelchairs were medically necessary – in their sample of four-year-old data, which does not reflect current regulations or reimbursement rates.

Yet, last month, USA Today published a July 13 news article about “medical scooter fraud” that stated, “Medicare’s inspector general also showed that 61% of the motorized wheelchairs provided to Medicare recipients in the first half of 2007 went to people who didn’t qualify for them….” An August 11 editorial in the South Florida Sun-Sentinel used the same OIG statistic to conclude that “about $100 million was wasted.” Neither statement is supported by the OIG report, which uncovered a number of cases where the beneficiary should have received “a more expensive power wheelchair.”

Tyler Wilson, president of the American Association for Homecare, said, “It’s disappointing but not surprising that the OIG report led to distorted news coverage. The American Association for Homecare has zero tolerance for waste and fraud, and we have lobbied for stronger anti-fraud measures for Medicare for years. But policymakers must not forget that properly prescribed, power wheelchairs help prevent falls and keep thousands of seniors and people with disabilities safe and independent at home, which lowers healthcare costs for taxpayers.”

“The OIG report ignores the real problem with Medicare’s system for reviewing claims which is the government’s failure to adopt an effective documentation process for determining a beneficiary’s medical necessity for a power wheelchair,” said Wilson. “Physicians, providers, clinicians, and consumer advocates have repeatedly warned Congress and the Centers for Medicare and Medicaid Services (CMS) that the current documentation process is confusing, inefficient and subjective.”

Home medical equipment providers are concerned that neither the media nor government investigators are focusing on the fact that 52 percent of the claims that the OIG reviewed had insufficient information for the investigators to determine whether or not a Medicare patient had a medical need for a power wheelchair.

“This is the statistic that puts the real problem in perspective,” said Georgie Blackburn, who is vice president at BLACKBURN’S, a home medical equipment provider in Tarentum, Pa. She added that the 2007 period reviewed by the OIG was just after CMS revised documentation rules, but failed to properly educate physicians and providers on the changes.

“The bottom line is that providers file extensive paperwork with their reimbursement claims so they can be repaid for the power wheelchairs that they have already purchased from manufacturers and delivered to Medicare beneficiaries,” she said. “We badly want to provide CMS with all the information they need to process claims so our businesses can stay open. If information is missing, it’s because their guidelines are confusing physicians and providers.”

One of the major problems is that providers have to depend on physicians to supply patient medical information. Blackburn said that CMS has failed to supply physicians with a tool or template to document the patient medical information that is now being required. When the information isn’t available to be reviewed, she said the claim falls into the insufficient information category and the providers are wrongly blamed.

“Physicians are used to documenting patient medical history for their purposes, not for what CMS is looking for to document medical necessity,” she said. “CMS needs to work with physicians and providers to develop a policy that works for all the stakeholders.”


The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community who serve the medical needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and assistive technologies, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.

CONTACTS: Michael Reinemer, 703-535-1881, michaelr@aahomecare.org; Tilly Gambill, 703-535-1896, tillyg@aahomecare.org

Meet the Team: Melva Mazur, Senior Director of Membership

Melva Mazur is the senior director of membership at AAHomecare. She joined the team in the Fall of 1993.

As the longest-serving member of the staff, Melva has worked in nearly every department since her first day on the job. Her experience ranges from government relations to education to her current department, membership. Melva is a walking encyclopedia of member information, based on her duty as keeper of the AAHomecare member database.

Melva received her bachelor’s degree at Towson University. Before she joined AAHomecare, she worked as a teacher and a baker for several years – and is a certified foodie, through and through.

Fun Facts

• Melva has lived in two foreign countries – Japan and Germany – and visited over 30 others.
  
  
• Melva is the only person in the office who has spent the night in an ice hotel (on purpose) – Hotel de Glace in Quebec.
  
  
• Melva is a longtime collector of Japanese arts and crafts, with items from the Meiji era to the present.
  

Medical Supplies Council Pushes Full Agenda

AAHomecare’s Medical Supplies Council focuses on HME policy issues that affect audit, payment and coverage issues related to diabetes, wound care and incontinence issues. The Council has worked on the following issues: ostomy claim denials, surgical dressings policy coverage, negative pressure wound therapy (NPWT) accreditation standards and the issue of inadequate documentation from physicians in the diabetes space.

• Most recently regarding NPWT, AAHomecare and Council members have met with the White House, the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration and members of Congress on the need to establish accreditation standards for NPWT and have received unanimous support for this initiative. The Association continues to work closely with other NPWT stakeholders including the Advanced Medical Technology Association and the Alliance for Wound Care Stakeholders. The Association has also worked closely with members of Congress on Congressional sign-on letters to CMS supporting NPWT standards and AAHomecare continues to work closely with those offices. In early August, House and Senate Congressional sign-on letters were sent to CMS Administrator Berwick urging the agency to implement accreditation standards for NPWT providers.
• In the ostomy space, AAHomecare and council members have been reviewing the ostomy supplies policy regarding concerns about patient claims of denials for ostomy orders. The Association sent a letter at the end of July to all DME MAC medical directors and to medical specialists at CMS calling for a review of the ostomy supplies policy asking for greater flexibility with claims, taking into consideration the medical need of ostomy patients especially when the “usual maximum amount” is insufficient. AAHomecare worked closely with the United Ostomy Associations of America, on this initiative, who endorsed our letter.
• On the issue of diabetes, the Association is working with Council members to review educational materials for prescribing diabetes supplies and has proposed recommendations to address concerns with physicians’ inadequate documentation. These recommendations will be submitted to all DME MAC medical directors.
• As far as surgical dressings policy is concerned, council members are collecting data on affected Medicare beneficiaries regarding the types of surgical dressings that are used in order to effect change with the DME MAC medical directors so as to eliminate restrictions on current policy coverage.
• Managed Care/Insurance Coverage/State Issues: The Medical Supplies Council also monitors Medicare, Medicaid, managed care and other insurance coverage issues and reviews cases where medical supplies and related services and accessories are not appropriately reimbursed. Medical Supplies Council members are actively engaged on state issues and AAHomecare updates council members regularly on state Medicaid reimbursement and state competitive bidding news affecting the medical supplies sector.

The Council is chaired by Raymond Kreiger, Vice President, Contracts and Pricing with Byram Healthcare and the Council’s vice chair is Laura McIlvaine, Vice President, Government Affairs, Shield Healthcare.

“AAHomecare updates the council on pertinent issues in the medical supplies space. The council reviews a legislative and/or regulatory strategy for moving forward on any given issue from competitive bidding and audit matters to specific reimbursement and coding and coverage issues which is why council membership is a valuable way to address matters that are of concern to council members.” said Kreiger.

For more information about the Medical Supplies Council contact Alex Bennewith, alexb@aahomecare.org or (703) 535-1891.

Meet the Team: Stacey Harms, Manager of Government Affairs

Stacey Harms is the manager of government affairs at AAHomecare. She joined the team in the spring of 2005.

As a member of the government relations team, Stacey attends Capitol Hill visits and lobbies for homecare issues, both regulatory and legislative. She is the resident expert on obscure regulatory policy, poring through several hundred page CMS documents upon their release and drafting detailed position papers on any given cause within the association. Stacey keeps a constant “ear to the ground” in Washington, given her many contacts (many of whom she considers friends) – as evidenced by her Blackberry usage data each month.

Stacey received a bachelors and masters degree in journalism in 2004 and 2005, respectively, from Northwestern University's Medill School of Journalism. She has covered a wide-range of issues, including healthcare, politics, bull riding and sports.

Fun Facts

• Stacey is a sharp shooter – she has attended many boot-wearing events where she gets to show off her shotgun skills – rooted in the ten years she lived in Oklahoma.
  
  
• Stacey is a proud member of the Junior League of Washington, an organization of women committed to promoting voluntarism, developing the potential of women, and improving communities through the effective action and leadership of trained volunteers.
  
  
• Stacey once danced on stage with George Clinton at a Parliament Funkadelic concert.
  

Meet the Team: Sue Mairena, Chief Operations Officer

Sue Mairena is the chief operating officer (COO) of AAHomecare. She joined the team in the summer of 2003.

Sue has more than 25 years of financial and managerial experience in a variety of industries.

As COO, Sue manages AAHomecare's day-to-day operations, human resources, accounting, monthly financials and yearly audit, tax return and budget. In addition, each year she evaluates the Association's existing structure, and makes recommendations to the President and Executive Committee.

Sue is a certified public accountant (CPA). Up until she joined AAHomecare in 2003, she served as Supervisor of Accounting Outsourcing for Raffa and Associates, P.C., in Washington, D.C. In this role, her clients included The Washington National Cathedral and the American Dental Education Association, both large non-profit organizations in our nation's capitol. Mairena also served as Vice President of Finance and Administration for Bantu, Inc., a Web-based instant communications company in Washington, D.C.

Fun Facts

• Sue has an affinity for music from the 80’s, with the moves to prove it. Her fond memories include “dancing like crazy to the tunes of” Paula Abdul, Bananarama, Fine Young Cannibals, Gloria Estefan, Kool & The Gang, Michael Jackson, Sheila E and Vanessa.
  
  
• Sue is a certified French fry connoisseur – and touts Dogfish Head Alehouse as having the best!
  
  
• Sue is a decorator at heart – in her next life she will accessorize your home and outfits for every occasion. “Deck the halls with boughs of holly” is taken to a new level at Sue’s house, always a warm and welcoming place.

More Support for H.R. 1041

While Congressional support for H.R. 1041 continues to grow, with 143 co-sponsors currently on board, AAHomecare also continues to generate support from patient advocacy, consumer, and healthcare groups across the country, including this recent message from the California Federation for Independent Living Centers. That message, as well as the complete list of groups supporting H.R. 1041 may be useful in your efforts to educate similar groups your area about competitive bidding, and enlist their support for H.R. 1041.

Meet the Team: Tyler Wilson, President and CEO

Tyler J. Wilson is the president and CEO of AAHomecare. He joined the team in Fall 2006, with his first week on the job taking him to Medtrade.

Working with the AAHomecare board of directors (a mix of large and small HME providers and manufacturers), Tyler leads the team in developing and implementing organization strategies on the Hill and at CMS, with the homecare industry’s best interests always the top priority.

Tyler is an attorney with an undergraduate degree in economics from Georgetown University. He has spent the last decade serving as chief executive of organizations that advocate for better policies under Medicare Part B. Among other positions in Washington DC, Wilson served as an attorney for legislative and regulatory affairs at the U.S. Chamber of Commerce.

Fun Facts

• Tyler can reference show tunes from as early as the 1940s with Cole Porter and, more recently, Stephen Sondheim being two of his favorites. He’s a great teammate in trivia games.
  
  
• Among the AAHomecare staff, only Tyler will eat anchovies.
  
  
• Tyler collects presidential campaign memorabilia, with his earliest items being from the election of 1896.