Selected Tag: Medicare

A Happy Ending?

July 19th, 2010
HME Happy Ending

A feather in Medicare’s cap for rooting out more fraud. No matter how the publicity angle appears, this is good news for the HME industry.

You’re thinking, “Brian’s finally gone over the edge,” right? Maybe. (Of course, maybe you’d been thinking that for quite some time!)

For at least two reasons, I believe this is positive for legitimate HME providers.

#1 – You didn’t participate in this fraudulent activity, did you? So how can you be held responsible? Don’t fret over what you can’t control. We can’t control whether someone else decides to commit federal crimes.

#2 – Medicare did its job by uncovering these crimes using the current tools available to it. Rather than continuing to tighten the screws on law-abiding, beneficiary-serving HME providers, CMS went after the bad guys. And it worked.

If CMS continues this strategy, other bad guys may decide that bilking Medicare isn’t as profitable as they’d hoped. The result is that more of the Medicare budget will go toward the beneficiaries who deserve a certain level of care.

CMS looks good for its stewardship over our tax dollars. Real HME providers look good for continuing to lawfully provide the products, services and intangibles that you provide every day. Now, that story has potential for a mutual happy ending.

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Still a Major Threat – Part 2

February 17th, 2010

Hopefully, you’ve had an opportunity to read Part 1 of Todd Tyson’s guest post regarding national competitive bidding. Let’s continue with Part 2:

“What does this mean for Medicare beneficiaries? Limited access, no choice, substandard equipment and services. What good can come from low bid providers being awarded contracts with Medicare? Savings sure, but at what cost? Extended hospital stays, patients’ safety concerns, restricted number of providers, elimination of 90% of small business providers.

“HME is the most cost-effective and slowest-growing portion of Medicare spending according to the most recent National Health Expenditures data from CMS. HME accounts for less than 1.5% of the Medicare budget; and, CMS hopes to expand CB to physicians, hospitals and other health care providers in order to cut costs and ration health care to seniors and people with disabilities.

“CB will likely increase spending because it will shift cost from Medicare Part B (Home) to Part A (Hospital). Longer hospital stays and cost shifting from home to the institutional setting will surely follow service disruption and limited access for beneficiaries. Currently under Medicare, a day of oxygen therapy costs less than $7 per day while a day in the hospital costs more than $5500.

“Home care is the most cost effective way to treat most patients; and, home is where most people would rather be. HME is one solution to rising health care costs; but, once again the Federal government has put our Medicare beneficiaries at risk in order to eliminate providers, because they cannot control costs, fraud or abuse in the system. Once again they want to say that providers are the crooks when they [the Feds] are the ones that issued the provider a supplier number and are responsible for policing the behavior.

“There are numerous home care heroes that are out at all hours of the day and night providing in-home services so that patients can live independently in their homes where they prefer to be. These heroes appear at a moment’s notice ready to discharge you from the hospital, follow you home to install equipment, educate/instruct patients and caregivers on proper use, and then leave only to provide 24 hour, 7 day per week on-call services and follow-up to those that need it. Congress is clueless about the services component involved with HME and only reimburses for the equipment. HME is so much more than that and deserves the recognition that HME is the solution and NOT the problem.

“Crook or Caregiver? You be the judge! Call your representatives and ask them to protect HME by sponsoring HR3790 to repeal Medicare Competitive Bidding.”

Thanks to Todd for his contribution. He’s touched on several valid points. Please comment if you have anything to add.

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Still a Major Threat to Home Care Viability

February 15th, 2010

Just for the record, we received more snow; but, compared to last week, we’ve barely felt Round Three of February’s worst. The real storm that threatens home care as we know it is national competitive bidding.

A well-respected HME provider and ten-year CAU client, Todd Tyson, recently authored his thoughts regarding the recurring NCB nightmare and what you can do about it. Here’s Part 1:

“Atlanta will soon begin the bidding process for the second round of Competitive Bidding (CB) for Medicare Home Medical Equipment (HME) slated to begin in Atlanta in 2011. CB was part of the Medicare Modernization Act (MMA) of 2003 that most of us recognize as the prescription drug bill which mandates that Medicare bid for home medical equipment and services. CB was originally supposed to begin in 10 Metropolitan Service Area (MSAs) in 2009 and expand to 80 more in 2010 including Atlanta however the program was so fatally flawed that Congress passed the Medicare Improvement for Patients and Providers Act (MIPPA) to postpone the implementation until 2010 so that the Centers for Medicare and Medicaid Services (CMS) could fix the problems inherent in the MMA.

“Sadly CMS has decided to move forward again with CB in 9 MSAs without any real improvement to the initial plan or process. The first round of bidding awarded contracts to providers that were not appropriately qualified or licensed to satisfy the regulatory requirements established by CMS supplier standards. Many winning bidders had never provided the services that they bid for and were awarded. Most did not have the credit necessary to fund the business and the growth required to satisfy the capacity that they were legally obligated to provide. One manufacturer was even quoted as saying that of the 380 winning bidders he would not extend credit to, more than 50% and several of the other 50% were already on credit hold.

“The original bid process was to yield a 27% saving to Medicare HME only because non-qualified underfunded bidders bid way below Medicare allowed fees. Some local providers bid low for fear that they would be barred from participation and other non-local providers bid even lower in order to eliminate local providers and gain new markets. No one truly understands why providers were willing to low ball bids, but the reality of the contracts was unsustainable for most bid winners.

“What does this mean for Medicare beneficiaries?” We’ll find out next time as we continue with Todd’s guest post. Meanwhile, you’re welcome to add your opinion to the conversation.

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No More Uncollected Deductibles

January 20th, 2010

Deductible season. If you’re using the Medicare IVR to check a patient’s deductible level, or even if you’re using an online service, we can make your life easier.

How long does it take you to get the eligibility/deductible information you need? With Web Edition HME Software, you’ll get every detail on your screen within a few seconds!

Maybe you can already do that using another online method. Well, here are three areas where Web Edition’s built-in eligibility software leaves the others in the dust:

+ No telephone, no modem, no time lost in a maze of phone or online menus. You never need to leave your Web Edition HME software.

+ When you’re regularly checking deductible amounts, you don’t want to waste time re-keying all of the same required patient information into other software. We allow you to select a patient from your existing Web Edition customer file, click the Check Eligibility button, and the results display as an easy-to-read PDF in a new browser tab. You can save the PDF locally, print it locally, or …

+ Team your Web Edition HME software with our built-in Document Imaging and the eligibility/deductible results will automatically drop into the patient’s electronic file!

Online instant Medicare eligibility and deductible results are included with your Web Edition HME software at no additional charge. Contact me if you’d like to see how easy it is.

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The “Enough” Line

November 16th, 2009

I’ve never witnessed a time in this country where hard work, dedication, and caring for fellow Americans became disincentives. Yet that’s the course that CMS has taken with DMEPOS.

We’re already weary with the culprits: national competitive bidding, additional paperwork, PECOS, surety bonds, mandatory accreditation. Then there’s another little disincentive called reimbursement cuts.

Where’s the HME provider’s line in the sand? How much more can we take before we shout, “Enough?”

Sadly, many providers have declared, “Enough.” They’ve either left the Medicare program or dropped out of the business altogether.

Either way, too many beneficiaries will be left without providers. Senior citizens must scramble to find a new source for luxury items such as oxygen.

Where will it all end? At this point, there’s no news in sight that will reverse the trend toward less service and fewer providers.

Will voting seniors need to join HME providers with a consistent message? If so, what will that message need to convey?

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One Fewer HME Supplier

September 28th, 2009

I spoke with a representative from a pharmacy-based HME supplier today. After months of waiting for pharmacies to become exempt from the latest DMEPOS standards, they’ve decided to shutter their HME business.

This wasn’t one of our clients, but another HME software vendor will lose a customer. Local HME-experienced employees may lose jobs.

Here’s something that’s even more disturbing: think of the 80-year-old diabetic patient, who’s been getting supplies from this provider for many years. “I’m sorry, Ms. Patient, but you’ll either have to drive to the next town or place an order on the Internet.”

I understand that there may be octogenarians who are mobile enough to enjoy that occasional round trip to the next town. Others may relish the opportunity to login to DiabeticSupplies-R-Us to place an order.

Do you believe they represent the majority of Medicare beneficiaries? How do you think they’ll react to this “downsizing of their local providers” trend?

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Countdown to First Day of Reckoning

September 24th, 2009

Remember how much fun it was to make life-changing decisions while playing Milton Bradley Company’s (now Hasbro Inc.’s) Game of Life? In your little convertible, you’re happily winding along the various three-dimensional paths. All of a sudden, you have the biggest decision of all to make on the Day of Reckoning:

  • retire to the Millionaire Acres mansion; or,
  • take a 10:1 gamble to win the game outright. If you don’t spin the correct number, you end up on the Poor Farm.

For HME suppliers, two Days of Reckoning are upon us, with a third devastating Day of Reckoning lurking closely behind. The first, and most daunting deadline, is the mandatory accreditation deadline of October 1, 2009.

Some HME providers said, “Thanks, but no thanks” and decided to forgo Medicare business after the deadline. Others put a “For Sale” sign on their business, not only when the value of an HME business is down, but also in the worst overall economic downturn since the Great Depression. Still others, after years of serving local patients, will shutter their doors and move to a new life chapter.

The HME providers that opted to play the game, then discovered that they need to meet the second deadline. Have a surety bond in place by October 2, 2009, or else “game over.”

The coup de grace of this little life drama is competitive bidding. It’s still lurking out there and ramping up for another Round One deployment.

We all know that life isn’t fair; but, as you’re well aware, it isn’t easy to hit a moving target either — especially when all the target does is take without any give. Sprinkle in continually shrinking reimbursement and mounting administrative paperwork to create a perfect life storm.

Getting lost in all of this “Let’s stop Medicare fraud and abuse” mantra is the beneficiary. Who will remain to serve the patient?

Sadly, I can’t determine any winners in this game. I’m hoping that providers can take the beneficiary’s story to Congress. I still hope HME providers can approach Congress with a united voice.

The message could be as simple as, “This is how cost-effective a Medicare patient’s recovery at home can be. Here are the fiscal savings in black and white; here are the benefits for the patient. If you can’t see beyond politics as usual, we, as one, will all make a life-changing decision to go ‘play a different game.’”

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All is Quiet

June 3rd, 2009

Have you heard anything? If you have, please let me know, because all is quiet in my Inbox.

This week represents our industry’s big push in Washington, DC. AA Homecare offers details on its’ home page.

Hopefully, we’ll all see some positive news by the time you read this post. Truly, I expected daily updates from our media friends. Of course, in their defense, I always set a goal to communicate daily while traveling, but realistically, it just doesn’t happen.

I look forward to reading about the impact this week’s efforts will have on our lawmakers. In concert with your grassroots efforts and the raw savings that home care provides, our brand of health care should once again become a large percentage of the solution in the eyes of our government.

In light of current budgetary challenges, the fiscal state of Medicare, and the pressure from all taxpayers, I don’t believe Congress can continue to take the most expensive route. Do you?

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Half Full? Half Empty?

May 12th, 2009

I heard a brief health care reform interview on my way into the office this morning. Then a colleague referred me to this article. (Photo by Keith Reifsnyder)

Regarding the first subject: isn’t it great how the AMA, health insurance companies, pharmaceutical companies, and hospital interests all want to play nice? The key phrase I kept hearing was, “reduce the annual increases.” Where I learned math, that isn’t enough of a break to cover 50 million uninsured.

Two phrases on the “half full” side were “reduce unnecessary tests” and “reduce the length of hospital stays.” At least they admit they order unnecessary tests. That’s a start. The best news is the second phrase regarding “reducing the length of hospital stays.”

This seems to be a win-win-win for insurance companies (less cost), beneficiaries (recover at home), and HME providers (equipment and supplies for the beneficiaries to recover at home). The hospitals are left holding the bag unless they can fill those empty beds or run a tighter economic ship.

The “half empty” side of the article represents the sad shape of both Social Security and Medicare, although all of us poor working saps (at least in the private sector) keep pouring payroll deductions into both programs. Since fewer of us are paying into the programs, there’s less to go around. And that’s before we factor in the poor financial returns in this economy. We seem to be spiraling into an abyss.

On the “half full” front, HME providers will be introduced to 78 million baby boomers over the next several years. Again, the direction this is headed leads toward recovery and maintaining health at home.

John Shirvinsky, Executive Director of PAMS, boiled health care reform down to dollars and cents in a recent Letter to the Editor in the Harrisburg Patriot-News last Sunday. John writes, “Consider a patient with respiratory issues such as COPD. According to 2007 data, a day in the hospital will cost $5,920; a day in a nursing home will cost $191; but, a day of oxygen therapy in the home will cost only $7.62.”

We’re all well aware of our elected officials following their own agendas, even when it comes to seemingly easy fiscal decisions. However, these dollar figures are universal in US health care and cannot lie. It’s black and white. No exceptions.

As long as oxygen capping reform is still in our future, (a topic for another day), that combination of figures produces more than a half full glass for beneficiaries, those of us paying into the program, and the HME vertical. Remember, new day, new jet.

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