Medicare crackdown rattles staff

Wednesday, March 31, 2004

YARMOUTH, Maine - When Steve Awtry learned in October that CMS had asked his employer, Home Health Options, to repay $157,000, his jaw dropped. His eyes lit up. He couldn’t believe it.
Les Defelice

“Two and a half employees and we get a $157,000 bill?” said Awtry, who works part time and handles a variety of duties. “It was earth shattering. I thought that was it.”

It wasn’t. Owner Russ McLellan put his wedding on hold because of the uncertainty, but he managed to hold the business together and has begun fighting CMS’s charge that he billed improperly for 36 K0011 power chairs.

With the Medicare Modernization Act promising deep cuts for DME reimbursement, and CMS doing everything it can to rein in power chair utilization, these are uncertain times for business owners. But they are equally difficult for staff, who desire secure employment. One HME owner said that following passage of the MMA he felt pretty sure his employees had begun updating their resumes.

“Make no mistake - this is not a time for some of the silly games and ‘fun’ stuff that is often offered to motivate staff,” said business consultant Vince Crew. “These are serious times, serious issues. They require serious intervention. These aren’t hobbies, but people’s livelihoods we’re dealing with.”

At the RRT Group in Lynbrook, N.Y., employees were a “little freaked out” when Congress passed the MMA. To counter that nervousness, top management sat down with staff and explained what the legislation meant for the company.

“We said we need to tighten our belts and be a little more diversified,” said Vice President Ed Walsh. “We also explained that this is only going to affect Medicare, which is about 30% of our business. Are we going to take a hit? Sure. But compared to the big guys we are taking a smaller hit.”

At DeFelice Care in Wheeling, W.V., employees expressed concern over the cutbacks included in the MMA, but they also had a good idea of what the company needed to do to succeed and remain profitable, said owner Les DeFelice.

“We are going to get through this by improving our processes, lowering our mistakes and with our usual commitment to the customer,” DeFelice said. “These are things we wanted to do anyway, with or without the legislation. I don’t see our people being unnecessarily (upset) because we are doing the best we can to prepare for it.”

At Home Health Options, owner Russ McLellan countered his employees fears and worries by being “real positive,” said Awtry.

“He said we would get through this and that our case was strong,” Awtry said. “We’re not committing fraud, and once we started digging into the files, I got more confident. I said, ‘We’ve got a point here.’”