CMS addresses a touchy subject, HMEs take offense

Friday, June 30, 2006

WASHINGTON - CMS touched an industry nerve recently when officials said that "many" of the 44 beneficiaries polled by Medicare considered their HME providers "no more than" delivery people.
"It was insulting," said Cliff Woolard, president of Home Med-Equip in Concord, Calif. "It's absurd."
CMS's announcement of the poll results--which some considered a gratuitous and unfounded dig--came during a two-day meeting in May with its Program Advisory and Oversight Committee (PAOC) on competitive bidding.
Attorney Asela Cuervo, who represents AAHomecare on the PAOC, dismissed the poll as unreliable--based on a tiny sample and not statistically valid. What's more, she added, in past CMS surveys, beneficiaries have given their providers very high marks.
Nevertheless, the survey does highlight the tension that exists between regulators/lawmakers and the industry over whether HMEs are service providers or product providers, said attorney Neil Caesar, president of the Health Law Center in Greenville, N.C.
"CMS's communication of this admittedly small-sample survey suggests that we may not have done a good job or a sufficiently good job demonstrating--not yelling and proclaiming--that we are a service industry," Caesar said.
If the industry does not convince lawmakers and regulators of that soon, the result will be further reimbursement cuts, as everything (delivery, service, maintenance, billing, etc.) except the product is devalued, he added.
"Who knows: maybe CMS's long-term vision is a bunch of retail stores that customers come to, and no such thing as a (DME) house call," Caesar said. "Or, if there is a house call, it will be for a separate determination of medical necessity and separate reimbursement."
Whatever CMS officials think, even providing something as basic as a walker or commode involves a service component, Woolard said.
"Even for those items, we show the patient how to properly use it--when to replace the tips of the walker, advise them if they have throw rugs in their home," he said. "And when you move to higher-end products like oxygen or CPAP, tube feeding or nebulizers, the level of patient support and instruction is far beyond that of a delivery person. Otherwise, I think a lot of people in this industry would just start shipping things."
Scott Scobey, president of Low Country Mobility in Savannah, Ga., said he understands why some beneficiaries might view providers as little more than delivery people, especially when it comes to commodes and other items that, unlike respiratory therapy and high-tech rehab, have an intense and obvious service component.
"If you look at a DME delivering a hospital bed and a furniture store delivering a sofa, the patient sees pretty much the same thing," Scobey said. "But the DME is liable for the documentation being correct and bears financial responsibility if it isn't there. This is an inherent risk that the patient doesn't see."