The problem is....

I am just a lowly contracts manager, but I have been working for and with the nation's largest provider's of homecare services, including respiratory. I respect others opinions and comments on competitive bidding and having Polk County as one of my coverage areas, remain familiar with the "trial." Here in my opinion on the issues that need to be addresses. There is a lack of communication between physician/hospital, respiratory manufacturer's and respiratory providers. Dr. Tom Petty, insists (and is correct) that technology changes and the providers have access to this "new and latest technology." The greatest challenge is that manufacturers, such as ResMed and Respironics, keep coming out with more and more high-tech services constantly, which makes our equipment inventory, in a sense, obsolete. It is clear that individuals outside of the provider network do not understand the small net revenue that is finally obtained after you account forthe CMN, constant monitoring, doctor's orders and rechecking for qualifying through overnight or spot check oximetry. You will notice that there is one HCPCS code for CPAP. What happens when the doctor orders a C-Flex that costs $100 more or an Auto-Pap, all of which fall under the same code. Worse yet Medicare covers about one-third of the true cost of a CPAP mask. Yes, the industry leaders create better and better (so they say) ambulatory systems. However, you would have to have a great deal of capital and rid your warehouses of hundreds of concentrators and cylinders. It is my humble opinion that it is not the fault necessarily of the homecare companies as much as it is the manufacturer's telling providers and physicians that the CPAP that came out last year is bulky and not practical and everyone needs to switch to the newer, smaller and more efficient equipment. This is a continuous process with no end in sight. Each week we get orders for the latest mask, the latest concentrator and the latest conserving device, and we are not even an Apria (whom I used to work for out west). When does it stop. The physicians get called upon by the reps from the manufacturers, and they order the latest in technology. How can a company with small revenues (come visit and I will show you how difficult it is to collect from the MCOs and members) with all the documention requirements, maintenance, delivery, upkeep, and accessories, keep up? -- Russell J. Held RN, CCM, BHCA is vice president of sales at LifeCare Solutions East in DeBary, Fla.