Illegalities

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Monday, May 31, 2004

Editor, HME News

If it weren’t for the Abu Ghraib photos, and before that the Bob Woodward book, and before that the Richard Clarke book, the story of Tom Scully’s decision to keep Congress in the dark about the true cost of the Medicare prescription drug bill might have assumed center stage for more than three minutes.

On May 3, the Congressional Research Service, a highly respected, non-partisan arm of the Library of Congress, concluded that the Bush Administration appeared to break the law by ordering its chief actuary, Richard S. Foster, to withhold his financial analysis of the drug bill from Congress.

Foster said his boss, Tom Scully, threatened to fire him if he told lawmakers the bill would cost more than $500 billion, which we now know to be true. Many fiscal conservatives said they would not have voted for a drug bill that cost more than $400 billion.

This prescription drug bill is bad news for the HME industry, a missed opportunity for seniors, a coup for special interests and a blow to any pretense that a public good might trump partisan politics. Why didn’t Scully let Foster divulge his numbers? Because that disclosure would have turned the tide against the drug bill. It’s as simple as that. Or maybe not. The DHHS is leading an inquiry (they won’t say investigation) into the affair, but nobody I know is holding his breath. Revelations of wrong-doing these days don’t carry much in the way of consequence. (To wit, how many CMS or DMERC officials got sacked for the recent $100 million wheeler dealer fiasco?)

Still, there’s good news to report. COPD is getting more attention from a new Congressional Caucus. Medicare’s oxygen business is robust. In 2003, according to recently tabulated CMS numbers, Medicare paid $1.57 billion in reimbursement for oxygen concentrators and $109 million for stationary liquid.

As well, thanks to agitation by a sleep doc in San Diego, CMS is going to take another look at real reimbursement for in-home diagnosis of OSA - real because Medicare does have a code for in-home diagnosis, and they will pay on that code, but that diagnosis doesn’t work as a qualifier for CPAP therapy. For that, you need a facility-based polysomnography.

Dr. Terence Davidson wants to change that. His critics are lambasting him for his connections to industry. He sits on ResMed’s medical advisory board, for which, he said, he is paid a “pittance.” They’re criticizing the effort to get Medicare to pay for in-home studies because no large organization is backing the initiative.

But the reluctance of the American Academy of Sleep Medicine, the American Thoracic Society and the American College of Chest Physicians to sign off on in-home diagnosis may simply be a function of money. If you sanction home diagnosis, then you are going to kill cash cows for sleep labs and sleep docs all over America. Right? Or do we believe that physicians and the organizations that represent them are immune to their own special interest? That they are somehow higher?

If you believe that, you probably also believe that Tom Scully scuttled Foster’s cost analysis for the greater good of all Americans.

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