Face-to-face requirement could bite providers

Thursday, April 29, 2010

WASHINGTON - A little-understood requirement that calls for Medicare beneficiaries to have a face-to-face visit with a physician could place unfair burdens on HME providers, say industry watchers.

Included in the recently enacted health care reform legislation, the provision states that for durable medical equipment, a physician, physician assistant, nurse practitioner or clinical nurse specialist must have seen the patient during the six-month period preceding the order.

"We feel it should be left to the discretion of CMS whether to require a face-to-face," said Walt Gorski, vice president of government relations for AAHomecare. "We also feel very strongly that not every prescription needs to have an interface with a physician or clinician."

For instance, he said, will a face-to-face visit be necessary for a wheelchair repair or "every test strip?"

"If you think a 52% CERT error rate (is high), wait until there is a face-to-face requirement for all items," said Gorski.

One area of particular concern: getting the required documentation.

"The supplier will have to dig a lot to get information from the doctor about when the last visit was and they will have to have documentation in their files," said health care attorney Asela Cuervo. "The administrative burden could outweigh any benefit the provision might provide."

Some worry access could be impeded by the requirement.

"We are in a rural state where a lot of people have issues getting to the doctor," said Terry Flatt, president of Des Moines, Iowa-based Hammer Medical Supply. "There has got to be ongoing communication for everything, but not necessarily face to face."

At any rate, it will be up to the provider to determine if the six-month requirement has been met, said Wayne Stanfield, president and CEO of the National Association of Independent Medical Equipment Suppliers.

"The physician could call and order a walker that may have resulted from a phone call from a patient that the physician hasn't seen for eight months," he said. "The provider isn't going to know that unless they ask. They are going to have to have protocols that require them to ask the date last seen."

Provider Jim Greatorex isn't too concerned. The president of Portland, Maine-based Black Bear Medical says 90% of his orders already meet the requirement.

"We get prescriptions faxed in all day long from people that have just seen their physician," he said. "If it's a renewal for a supply order, I think it's foolish."