Wall Street Journal Article on Medicare Bidding Examines Patient Worries about Quality

A March 19 article in the Wall Street Journal highlights worries expressed by patient advocacy groups, including Paralyzed Veterans of America and the United Spinal Association, about the Medicare "competitive" bidding program for home medical equipment.

The article quotes Tyler Wilson, President of the American Association for Homecare, who notes, "Competitive bidding is going to eliminate 90% of home-care providers. The result is going to be lower quality and lower access to care for seniors and people with disabilities."

The Journal states that an estimated 50% to 75% of the nation's 44 million Medicare beneficiaries use some type of durable medical equipment in any given year, but the savings from the bidding program "would be relatively small -- Medicare is expected to spend less than 2% of its roughly $500 billion budget this year on home medical equipment.”

Jerry Jones, a 49-year-old with severe pulmonary hypertension, observes “You get what you pay for.”

To read the full article or comment online, visit http://online.wsj.com/article/SB123741863094577953.html.

"Say Yes to Healthcare" Posts HME Ideas on Oxygen Reform

Discussions about the need for oxygen reform reach back to the middle of this decade, but the pattern of continuing oxygen cuts has made reform an increasingly urgent issue for HME companies. Oxygen patients and their providers need a Medicare policy that is fair and realistic. The time line for oxygen reimbursement should be based on medical necessity and align more closely than it does today with the true costs of providing the equipment and services integral to the benefit.

The reform plan outlined by the oxygen community would include a variety of changes to shift the benefit away from its current focus solely on equipment. Oxygen providers will be required to evaluate patients and participate in their care planning, provide beneficiary and caregiver education, supply 24-hour on-call service coverage and provide patient education and assistance.

To read more about an oxygen reform plan for the HME sector, visit http://healthcare-area.blogspot.com/2009/03/patient-centered-oxygen.html.

Obama Calls for End to Waste, Fraud and Abuse in Medicare

In his first address to a joint session of Congress, President Barack Obama declared that his administration would “root out the waste, fraud, and abuse in our Medicare program that doesn’t make our seniors any healthier.” The American Association for Homecare and its members applaud this goal and have developed a legislative solution specifically designed to help solve this growing problem. (See: www.aahomecare.org/stopfraud)

“Fraud in the HME sector is only a small portion of total Medicare losses to fraud, but by any yardstick, it is an unacceptable waste of taxpayers’ dollars and theft of resources that should go to the elderly and disabled,” says Tyler Wilson, president of the American Association for Homecare. “AAHomecare and its members are eager to work with President Obama, Congress and CMS to take tough new steps to prevent fraud and abuse in Medicare, and we are confident that this legislative action plan will provide an effective solution.”

U.S. Representatives See Need to Revise Oxygen Policy, Co-Sign Oxygen Letter

More than one hundred members of the U.S. House of Representatives co-signed a letter urging the Ways and Means and the Energy and Commerce Committees to urge CMS to revise post-36 month oxygen payment policies to address serious shortcomings that are creating hardships for both oxygen patients and providers of these services.

The bipartisan letter, signed by 123 members in the House, also explained that home oxygen providers are not just suppliers of equipment but rather front-line caregivers as well. The letter states:

CMS’ final rule, published on October 30, 2008, addressing the treatment of oxygen therapy post 36 months, established very limited payment levels and unreasonable obligations that are impeding the provision of quality care to Medicare beneficiaries on home oxygen therapy. These policies require the original home oxygen provider to continue to provide, without any payment, unscheduled service and maintenance visits, 24-hour emergency care, equipment repairs, and oxygen supplies and accessories for a two year period following the rental cap. The rule also establishes inadequate payment levels for scheduled maintenance and service equal to one visit every six months at a payment rate of approximately $30 per visit.

The American Association for Homecare would like to thank the Representatives who realized the importance of changing this policy and agreed to co-sign this letter. For more information, please visit www.aahomecare.org.

HME Stakeholders Address Medicare Fraud With Legislative Plan

During the American Association for Homecare (AAHomecare) Washington fly-in on February 11, HME stakeholders urged Congress and the Centers for Medicare & Medicaid Services (CMS) to adopt a Medicare Anti-Fraud Legislative Plan developed by AAHomecare. The legislative action plan outlines tough, effective measures to stop waste, fraud and abuse in Medicare’s home medical equipment sector.

Modern Healthcare explained that the “plan calls for mandatory site inspections of all new medical-equipment providers and companies seeking renewal of their CMS contracts; establishing more rigorous quality standards for providers; increasing penalties and fines for billing fraud; and requiring post-payment audit reviews of all new medical-equipment contractors.” To read their report of this plan visit, http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090210/REG/302109930&nocache=1.

Congressional Quarterly Healthbeat News also reported on the legislative plan, quoting president of AAHomecare Tyler Wilson, as saying, “the anti-fraud plan is the group’s attempt to help reduce Medicare fraud, which costs the $430 billion program as much $60 billion a year. DME accounts for $10 billion of Medicare spending and fraud in that sector accounts for less than $1 billion of that amount. “That has us concerned as it should have everyone concerned.”