Ostomy access in question

Wednesday, March 31, 2004

WASHINGTON - After finally adjusting to a much-revised HCPCS code set, the United Ostomy Association may soon be advocating for more coding changes.

This past winter, the UOA conducted three surveys, one in conjuction with AAHomecare, of patients and providers to determine if reimbursement and access had improved since the codes were revamped a year ago.

“We are just testing the waters and looking for additional information about whether patients truly are getting good access or if access has improved since the work we did last year,” said Linda Aukett, chairwoman of UOA’s government affairs committee.

Aukett said UOA hopes to use the results as evidence to approach CMS with further changes to the ostomy supply code set.

“There are a couple more codes that we feel really need to be looked at, and we are looking at our options for an approach,” she said.

The UOA has focused on reimbursement issues to combat a growing trend of providers refusing assignment or discontinuing their ostomy product lines.

“Our estimate is that about two-thirds of all people in the country with a stoma rely on Medicare,” said Aukett. “This puts significant pressure on a dealer. If they are not being well reimbursed for two-thirds of their ostomy business, chances are they are going to have to get out of the business.”

The first two surveys released went to UOA members and providers known to the organization. The third was completed in conjunction with AAHomecare and was distributed to its members.

“The UOA is a patient’s group that is very important to AAHomecare - an importnant coalition partner,” said Asela Cuervo, AAHomecare’s senior vice president of government relations. “Access is an important issue to these patients, so it is important for us to be able to support them.”