Letters to the Editor

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Friday, September 30, 2005

CMS'S PLAN OPENS CAN OF WORMS

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Editor's note: The following letter addresses CMS's proposal to do away with the CMN for power wheelchairs and instead require a physician's prescription, plus require the provider to keep the physician's progress notes on file.
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If a physician is paid to complete a medical evaluation and determines medical necessity for a power mobility device, and ultimately Medicare either denies the claim or recoups monies on a post pay audit, is the physician professionally liable for doing an incomplete and/or sub-standard review of the patient's needs? Would the physician, in the event of denial, be required to return the $21.60 fee, since the responsibility of documenting medical need was incomplete? Does a physician receive money for evaluations if he/she determines medical necessity does not exist and does not proceed with a written order?
This has opened up a whole can of worms.
- Bob Miller, President/CEO, Bach's Home Health Care Supply

ENTITLEMENT MENTALITY
Although I left the HME industry several years ago I have been following HME activity as a part of my over all work in health care.
Having been involved on the acute care side for some time, I can tell you that AAHomecare and its constituents do not have a prayer of coming up with the dollars it will take to get what they want when acute care providers, industry organizations, manufacturers and distributors have millions to spend on their causes. I really did not understand this until I was introduced to how the governments works after being called to testify before a Senate subcommittee hearing and hearings by the Department of Justice and Federal Trade Commission.
I think the bottom line for HME providers is what it was when I left. Until they accept the fact that Medicare is an entitlement program for senior citizens but not for HME companies, they just won't get anywhere, but they will be open to throwing their money to disorganized politics and bureaucracy rather than investing in strengthening their own operations. I think we are close to seeing major manufacturers such as Invacare and Sunrise being forced to disintermediate their HME provider customers in order to protect their own margins.
You are also right about proving value of homecare. It has not happened yet and most HMEs don't think they should have to because they are entitled to be paid based upon unsubstantiated but wonderful sounding marketing claims. If the Aprias of the industry, who have worked diligently on their logistics, are concerned, small providers who have done little to improve their cost of operations, should be paralyzed by fear. Maybe they are.
- Lynn James Everard, Consultant

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