MED respiratory czar does her homework

Sunday, December 31, 2006

LUBBOCK, Texas - The MED Group now counts 95 members in its five-year-old National Respiratory Network, with more than 400 locations around the country. In late October, Kelly Riley stepped in as the group's new director, replacing Jackie McClure who moved on after three years as the group's leader.
As Riley stares into the murky depths of 2007, where competitive bidding is to kick off in 10 cities, one thing is clear: "There are some metrics you need to be ready," said Riley. "You need to have the best pricing, the ability to gather information, and then good information to even allow you to enter the bid process."
Good information is what Riley's all about. Days after CMS issued its 416-page final rule on capped rental for home oxygen Nov. 1, she had digested the document and dispatched the ins and outs of the news to members in an e-conference.
One week later, she plunged again, this time into an advisory opinion that spelled out the rules for oximetry testing and the role that HMEs may or may not play. After consultation with industry attorneys Jeff Baird and Lisa Smith at Brown & Fortunato, she hurried up a briefing for network members who were scrambling for news about what this meant for their business.
"We've got to be very, very responsive," said Riley. "Members know they can count on the network and MED to be there and take all of the data that we get from various sources, sift through it, glean the importance and produce a palatable and easy-to-read type of thing." These are heady days for networks, MED especially, with more members reaching out for solidarity in the face of ongoing uncertainty. "In fact, for 2007 we are developing an updated comprehensive program on how to be successful in these two markets (respiratory and rehab)," said Don Clayback, senior vice president of networks at MED. MED is now re-evaluating both the respiratory and rehab markets with an eye on the key success factors, policies and procedures, business measures and product formularies. "These will help members better deal with NCB and the other business challenges that lie ahead," he said. MED's rehab network numbers 125 distinct members. Though not as well known as her predecessors at the respiratory network--McClure and Joe Lewarski--Riley does come from a clinical background. She is a respiratory therapist and a former MED member, who most recently served as COO at At Home Medical of Ponca City. Before that, she worked as an area coordinator for Primedica, with oversight for eight HME locations. Riley can't say for sure where the network comes down on the issue of modality specific reimbursement for home oxygen. She's still sifting through the depths of that challenge. Nor is there all the desired certainty with regard to best practices in an age of capped rental for home oxygen. Like most suppliers, Riley and her network are addressing the various challenges posed by the new paradigm. For example, do you transfer title of oxygen equipment to a patient who still owes a big co-payment? CMS says you do, Riley said.
"We've got to develop some tools," she said. "What is the best way to go after private pay collection. It's a whole different world, collecting from an elderly beneficiary who may or may not have the money, versus trying to collect revenues from Medicare and Medicaid."