New regs do a number on rehab dealers

Saturday, June 30, 2007

YARMOUTH, Maine - Rehab provider Tim Pedersen would like to hire additional staff and implement a document imaging system. Tyrrell Hunter wants to become a better manager.
Instead, in the past year, rehab providers have spent countless resources and hours implementing new codes, coverage criteria and pricing for power mobility devices and educating their referral sources on the changes. Add to that CMS's decision to include complex rehab in national competitive bidding, and they fear they won't have time for anything but keeping their heads above water.
"We've put off all major capital purchases," said Pedersen, CEO of WestMed Rehab in Rapid City, S.D., and vice chairman of AAHomecare's rehab committee. "These are things that would make us better and more efficient, but we can't make the investment when we don't know what's going to happen."
Rehab providers have always had battles to fight, but 2005 and 2006 brought "an unprecedented number of changes," agreed Cara Bachenheimer, beginning with CMS's decision in 2005 to require face-to-face evaluations, and replace certificates of medical necessity with prescriptions and physician notes.
"And new issues keep appearing," said Bachenheimer, vice president of government relations for Invacare.
Still ahead: CMS plans to revamp the manual wheelchair benefit, and release final codes and testing requirements for PMDs.All these changes are slowly wearing on rehab providers. Paul Bergantino, president of ATG Rehab in Newington, Conn., estimates that his company's 330 employees have spent some 7,000 hours on Medicare issues in the past year.
"How do you justify that?" he asked. "Imagine if we had spent half that time on something productive."
The sheer number of changes has forced rehab providers to bump some issues, such as clarifying documentation requirements, down their priority lists to make room for more ominous issues, such as exempting complex rehab from NCB.
"(Clarifying documentation requirements) would have been the big fight in previous years," Bergantino said.
Rehab providers must prioritize issues based on their impact on the industry and beneficiaries, sources say. Another thing to consider: Whether providers can succeed in their goal.
"We have a room full of issues, and we have to triage the most urgent ones," said Don Clayback, who heads up The MED Group's National Rehab Network. "There are only so many hours in the day, and everyone's doing the best they can."
Between hosting in-services for referral sources and lobbying legislators and disability groups, Hunter, president of Majors Mobility in Topsham, Maine, tries to find an hour here and there to do "a more thorough job on different management tasks."
"I feel like I've been responding to all of these changes rather than being proactive with my business," she said. "It doesn't seem right."