Thursday, January 31, 2002

Playing to the doc's strengths

Q: If most physicians know as little about Medicare's home health rules as indicated in a recent OIG report, is there any hope physicians will master the Medicare HME/CMN requirements?
A. For the majority, probably not. Why should physicians master the Medicare HME rules? Much of what occurs in the home is between the patient, the supplier and the equipment. After the order, do Medicare's tasks for a physician really assist the delivery of care?

At a basic level, physicians are trained to make decisions under intense pressure, without second guessing themselves. Physicians analyze a patient's medical condition and then apply medical procedures and techniques that experience and training tell them will bring the body's responses back into the "normal" range. They treat the patient in front of them, issue orders and move on. Medicare's medical necessity determinations and CMN requirements inherently are an exercise in reconsideration and second-guessing that a physician cannot help but find distasteful.

Another issue is that Medicare's requirements are designed for Medicare's payment purposes, not to support the way health care at home is delivered. Medicare insists on using a physician for purposes and in roles that physicians are not typically trained for or given incentives to undertake. The OIG report's clearest message is that physicians fear legal liability and are angry at being given additional work without adequate compensation.

Medicare should not be looking for ways to overcome physician resistance to learning its Byzantine homecare rules - the leopard can't change his spots. What is needed is a system that allows physicians to participate in those ways that play to a physician's strengths - assessment and orders - and allows HME suppliers to play to their strengths, without fear of reprisal.

Michael DeCarlo is a Washington, D.C., healthcare attorney. Reach him at 202-775-4736 or