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.
Monday, August 29, 2011
Friday, August 26, 2011
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.”
Friday, August 19, 2011
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.”
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
“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
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