Industry gets temporary reprieve from PMD demo

Thursday, December 29, 2011

WASHINGTON - Just days before it was set to start, CMS hit the brakes on its power mobility device demonstration project. 

CMS on Dec. 29 stated that it will delay the demo, which was set to start Jan. 1, "until further notice" and that it will give the industry at least a 30-day notice before the next start date. 

"We worked closely (with CMS) to have them understand the impact that this proposal would have on power mobility providers and patients," said Walt Gorski, vice president of government affairs for AAHomecare. Gorski said awareness efforts in the physician and consumer communities also helped generate the grassroots efforts needed to delay the program. 

CMS also announced that it would delay its recovery audit prepayment demo, which was set to begin Jan. 1 in 11 states.

CMS stated it would use the additional time to consider the comments and suggestions Medicare received regarding both programs.

Rehab stakeholders say they hope to use that time to refine the PMD demonstration project so that it works for providers, consumers and CMS. 

"We still have some work to do," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "This delay provides the industry and other stakeholders the opportunity to work with Medicare and make sure that when they do roll out a demonstration, they do it in an appropriate manner."

Among the industry's goals: bypass the prepay review phase, which would create serious cash flow issues for providers and access issues for patients; and work with CMS to alter the prior authorization process to allow providers to submit the required documentation and to allow physicians to use templates, Johnson said.




Bypassing the prepay review phase would be an excellent idea. All that would do is limit access to chairs provided by national companies with deeper pockets. Allowing physicians to use templates is an excellent idea. Anyone who thinks the average primary care physician bothers knowing the LCD requirements for powerchairs is delusional. But I do hope they don&#39;t allow the providers to submit for PAs. I really think unwarranted utilization will go down if the physicans are allowed to initiate the process.<br />
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At the end of the day we want as many chairs on people doctors feel are qualified as possible and as few on unqualified people as possible too. And putting the determination firmly in the hands of physicians who do not profit off of the chairs is a good start. At least it&#39;s a better means of balancing the competing needs than anything else I can think of.

No what that would do is limit access. Like you said physicians don&#39;t care about the LCDs what makes you think they would go out of their way to complete this paperwork. It takes NUMEROUS phone calls to get them to do paperwork for PMD. Im in support of PMD but we have to be involved in process somehow if not all your patients will go national companies who have unlimited to market to these physicians. You will no longer see ads targeting patients, you will see a bunch of TV ADS targeting physicians.

Tons of people are denied access because of their physician&#39;s apathy but that really can&#39;t be fixed. I still say the best way to prevent over utilization is to have the physicians initiate any process of assessing the patient. If the question doesn&#39;t pop up in the doctor&#39;s mind first, then it should not happen.

I agree that the decision to order should start with the physician. Powerchairs are a cheaper alternative than 100 days in a skilled nursing facility, early nursing home admittance or hospitalization and therapy costs associated with falls. And if we utilize power mobility devices when a doctor thinks it&#39;s appropriate then the taxpayers will likely see a strong cost mitigation benefit. But if we let providers initiate the process then I think we increase the rate of claims that are of less value to the taxpayers.<br />
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Along those lines I would ban all print, radio, mail and television advertising for powerchairs. Some doctors would order a chair the patient may or may not need if the patient harrasses them about it long enough.