Dr. Hoover returns to Cigna

Sunday, January 6, 2008

NASHVILLE, Tenn. – Dr. Robert Hoover returns to Cigna Government Services as Jurisdiction C medical director this month, just about two and a half years after he left that position to become Sunrise Medical’s senior vice president of global clinical services.

“It’s an opportunity to come back with a fairly large body of knowledge about how the industry works, and to be able to educate CMS and my medical director colleagues on some of the issues plaguing the medical equipment suppliers out there,” Hoover said recently.

The opportunity to rejoin Cigna appealed to him for a couple of reasons, Hoover said. It allows him to travel less, spend more time with this family and return to a position that he enjoyed. His official start date at Cigna is Jan. 14.

So much has changed since Hoover left Cigna for Sunrise (the DMERCs became MACs, for example, and Cigna now oversees Jurisdiction C, not D), that it all resembles a bureaucratic game of musical chairs. Suffice it to say that as medical director, Hoover will oversee coding and coverage, technology evaluation, provider education, and pre-payment and post-payment reviews.

During his previous stint with Cigna, Hoover was generally liked and respected by the HME industry, which viewed him as progressive and supportive but resolute in his decisions. In a recent interview, Hoover had this to say about his return to the Medicare contractor.

HME News: Will your experience at Sunrise make you a better medical director the second time around?
Robert Hoover: I think so. Because of my role at Sunrise, I’ve kept up with the things going on at CMS, but I’ve also been out in the provider community, listening to things they say and the problems that they have and the things that work and don’t work. I also did a large amount of physician education and have heard various things from them about the program, what needs to change and what they like about it. Being able to bring that knowledge back to CMS, the contractor system and to other medical directors will ultimately benefit providers in all regions.

HME: For example?
Hoover: Issues related to new power wheelchair policies. We’ve seen Jurisdiction A and B doing some widespread probes that have resulted in very high denial rates, and I think a lot of that is related to physician knowledge of the policy and what they need to do to document that.

HME: Does your experience at Sunrise make you more sympathetic to the challenges providers face?
Hoover: I think I feel more knowledgeable about what happens in the day-to-day workings of a provider. Whether that translates into sympathy or not, at least I have the knowledge of what will ultimately benefit the provider community.

HME News: Did you develop a more positive opinion of the HME industry while working at Sunrise?
Hoover: I don't think I ever had a negative view of providers. I always tried to be open, listen and be accommodating when I could. When the situation made sense and regulations and policy allowed me to be flexible, I tried to do that. I didn’t feel that the whole industry was a bunch of crooks. I’ve always felt that the bulk of providers are trying to do things the right way and that it’s a small number that tarnish the industry.