PMD stakeholders battle new demo

Thursday, December 15, 2011

WASHINGTON - With a new demonstration project calling for prepay reviews and prior authorizations for power mobility devices (PMDs) just weeks away, stakeholders are pulling out all the stops to delay it or get rid of it altogether.

"I really do think we're in a good position to get a change prior to implementation," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "It's just a matter of how significant those changes are."

Industry efforts have included a bipartisan "Dear Colleague" letter, signed by 22 lawmakers, sent to CMS Administrator Marilyn Tavenner on Dec. 15 by Reps. Henry Cuellar, D-Texas, and Lamar Smith, R-Texas. The letter encourages CMS to halt the demo, set to begin in seven states on Jan. 1, to allow for a notice and comment period. Their reasoning: The demo, while intended to prevent fraud and abuse, will have unintended consequences, including "potential threats to businesses, jobs and seniors' access to care."

Additionally, AAHomecare officials met with CMS officials recently to discuss, among other things, their concerns with the demo and its implementation. State associations and consumer organizations have been speaking up, as well, stakeholders say.

"There has been a significant influx of calls into CMS trying to drill down as to what their intent is with this, what the scope of it is, and conveying the significant concerns," said Julie Piriano, director of rehab industry affairs at Pride Mobility Products

All of these efforts are paying off with CMS, stakeholders say.

"We are hearing from our allies on Capital Hill that CMS is indicating a willingness now to make some changes," Johnson said.



I do not know how to say this tactfully. The attitude our industry is taking is ludicrous. This program would be good for everyone including patients, dealers and Medicare. We are idiots for fighting every proposed program that comes down the pike. This program will improve so many areas. From fraud and abuse to patients getting improper equipment.<br />
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We could have taken a positive attitude towards this in exchange for rectifying other programs and legislation, but no, we had to fight about this program also.<br />
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We better become part of the solution and stop fighting everything proposed. We missed a golden opportunity and the opportunity has now passed.<br />

Joel, I am not going to try to be tactful. You do not have a clue about this subject. A 3-9 month 100% prepayment audit will run all of the small power mobilty providers out of the market because it will be a huge cash flow hit. Payment on 3-9 months of their production will be delayed for 6-30 months until they can get in front of an ALJ judge who will look at medical necessity. This is how you go bankrupt winning an audit. If you had any relevant experience on this subject then just maybe you would know what you are talking about.

Actually the idea of moving to a PA system is a great idea. It would help our industry and take a lot of the risk out of the equation. But the extended 100% prepayment audit in this current environment is an industry killer. Only the large nationals with strong liquidity positions can hope to survive. This isn&#39;t about fraud or proving medical necessity or providing value to the taxpayers or the beneficiaries. This is about a stark cash flow strain that few small providers can hope to endure.