Aiming for the lymphedema bulls-eye

Monday, March 31, 2003

COLMAR, Pa. - Mary Ellen Doran learned the hard way how not to build a good lymphedema pump business.
Several years ago, she got hit with a double whammy. Managed care company Aetna stop paying her, and Medicare discovered she built a $2-million-a-year business in lymphedema pumps by helping doctors prepare letters documenting medical necessity.

“The physician would read it, make changes, we’d rewrite it and he’d sign it,” said Doran, who at the time thought she was doing nothing wrong.

Medicare officials, who don’t look kindly on this practice, thought different and hit her with an audit.

Doran eventually filed for bankruptcy and shut the company down.

Now she’s back, helping her husband run two-year-old Medical Cabinet Supply and looking to significantly boost the company’s $250,000-a-year lymphedema pump business. The company began advertising earlier this year for sales reps, intending to hire eight by year’s end and station them throughout the Midwest and Mid Atlantic.

Medical Cabinet also handles wound care and diabetes supply, but its biggest push will be to increase its more lucrative pump business, Doran said.

“If she is being conservative and makes sure she has evidence of medical necessity before billing, I’d be her biggest fan,” said Jeff Baird, a healthcare attorney with Brown & Fortunato in Amarillo, Texas. “Pumps are still a hot fraud-and-abuse item from the standpoint of the DMERCs, OIG and CMS. There are certain products that will always have a bulls-eye on them and lymphedema pumps are one.”

The sure-fire way to get lymphedema pumps covered - and refute any audit - is to secure from the prescribing physician contemporaneous progress notes, Baird said,

That’s exactly what Vicki Jones, founder of the Women’s Health Boutique, does.

“We tell the doctor that we need you to document in your office notes that you want her to have it and you are going to do these other therapies first to see if they work,” Jones said. “When they have those documents in their notes, and Xerox off the notes for us, that’s wonderful.”

Doran’s taken note.

“We get reimbursed, but believe me, we don’t write letters anymore,” she said. “We have an extensive way of qualifying patients. Our customer service reps are calling patients, doctors, PTs, collecting all the data, making sure we have everything required before we bring out a pump.”

There’s good reason for Doran’s enthusiasm for lymphedema pumps. When you couple the notorious fraud and abuse charges that have engulfed pumps over the years with tighter Medicare coverage and payment policies, many providers have shunned this niche. That’s created a need. In that need, Doran sees a business opportunity.

“I agree,” Baird said. “If you are doing it right.” HME