Monday, August 29, 2011
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.
Friday, August 26, 2011
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.
- 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.”
Friday, August 19, 2011
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
“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, firstname.lastname@example.org
Tilly Gambill, 703-535-1896, email@example.com
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.
- 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
Tuesday, August 16, 2011
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.
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.
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.
Monday, August 15, 2011
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, firstname.lastname@example.org; Tilly Gambill, 703-535-1896, email@example.com
Friday, August 12, 2011
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.
- 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.
Wednesday, August 10, 2011
- 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, firstname.lastname@example.org or (703) 535-1891.
Friday, August 5, 2011
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.
- 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.