All hell's breaking loose

The NRRTS listserv in March lit up with posts about complex rehab products being sold on Walmart's website. The group's members posted comment after comment about how manufacturers shouldn't be selling these products to online companies who sell direct to consumers. In this case, Walmart, through a company called CSN Stores.

For most of the stakeholders involved in this chatter, it doesn't matter whether or not or how said online company bills Medicare. CSN Stores told a stakeholder who inquired that, "The wheelchair would have to be paid for out of pocket and then Medicare would refund your money. We do require a prescription from a doctor and an approval code. We can find the insurance approval code for you."

They say it shouldn't be happening--period.

Providers are on high alert for manufacturers selling not just complex rehab but other HME direct to consumers. We've hardly shied away from these stories. We've written about New England providers turning up the heat on Invacare and we've polled our readers on what they'd do if their manufacturer started selling direct to consumers. In a nutshell, they said all hell would break loose.

Since then we've gotten e-mails from providers about Medline selling medical supplies direct to consumers. Word got around to Medline officials, too, who crafted a response. They said for disposable supplies provided to patients through home health agency contracts, they try to continue to provide supplies to those patients even after the HHA is out of the picture for continuity of care. They also say they don't provide and aren't accredited to provide DME like wheelchairs through home health agencies, so those referrals go directly to providers.

I think this is a complicated issue, and for complex rehab, anyway, when stakeholders get a separate benefit, most of it will become a moot point. Or that's the idea, anyway, and I think it's a good one.

But I also think that most of the providers on high alert are looking behind their backs at what others are doing (manufacturers or their competitors), when they should be looking forward at what they're going to do. When it comes to health care, all bets are off, whether you're a manufacturer, a provider, a home health agency, a hospital.

All hell is breaking loose.