PWCs: We have questions ... and we have answers

Monday, May 31, 2004

If you were trying to solve a major problem, why wouldn’t you accept an offer of knowledgeable assistance? If you had incurred significant damage that could have been minimized if only you had listened to others, why wouldn’t you listen now? If you were looking to improve a system that all agreed needed strengthening, why wouldn’t you actively include all key players from the start? These are some of the questions our industry needs to continue to ask CMS and Congress regarding the Medicare power wheelchair crisis.

CMS speaks of a partnership with its suppliers. If there is a desire for a true partnership, then ethical and committed HME industry representatives need to be more actively included and listened to. A partnership is not one-sided. It’s people working together to achieve a common objective. As Stephen Covey said in his The Seven Habits of Highly Effective People, “begin with the end in mind. How about this as an objective: A Medicare mobility benefit that contains clear requirements and regulations and enables legitimate Medicare beneficiaries to obtain appropriate medical equipment from qualified Medicare providers. Hopefully that’s something everyone could agree to.

It’s certainly what our industry wants. We must all work together to eliminate fraud and abuse and make it impossible for criminals and unethical providers to operate in the Medicare arena. The industry is willing and able to move forward. But every day that goes by in the current environment of unnecessary restrictions and uncertainty, Medicare beneficiaries are being hurt.We need to move faster.

The industry stands ready with answers. Our industry associations, along with individual suppliers and manufacturers, have supplied information, testimony and specific recommendations. The focus of this sharing is on fighting fraud and abuse while at the same time preserving the power wheelchair benefit for Medicare beneficiaries. Specific recommendations include the creation of a fraud task force, clearly defined coverage and documentation requirements, new codes to address the levels of power mobility technology, company accreditation requirements, certification requirements for individuals that provide complex mobility equipment, specific advertising guidelines, and an enhanced fraud and abuse reporting system.

As we move forward, here are some points for us to continue to communicate to CMS and Congress:

- No one (except the criminals) likes fraud and abuse. Efforts to combat it will be much more successful with all of us uniting and working together.

- Industry representatives were one of the first to raise the flag pointing to the fraudulent billing in Texas. Suppliers were happy to see that finally there was action taken, but ethical suppliers and needy Medicare beneficiaries were, and continue to be, penalized.

- There must be recognition of the difference between increased expenditures due to legitimate reasons, such as demographic and technological changes, and those due to outright criminal activity. It’s a critical concept in the goal of protecting appropriate Medicare beneficiary access.

- Bad statistics and comparisons result in bad decisions. Let’s all agree to gather relevant and valid numbers and use them in a constructive manner.

- Listening sessions and meetings are great as long as they lead to improvements; provide informal and formal forums for real two-way communication. Include the industry at the start of policy and process development. We’re on the front lines and can be valuable allies.

CMS’s just released power wheelchair initiative addresses three areas: coverage, payment, and supplier standards. The announcement includes certain issues that need to be discussed further, but Dr. McClellan states: “With this new initiative, and with input and feedback from suppliers and beneficiaries, we are going to do even more to make sure that Medicare funds are spent on patients who need them, and that beneficiaries with disabilities are getting the high-quality, modern services they deserve” (emphasis added).

Each of us in the industry must build on this opportunity for input and drive home to CMS and our Congressional representatives that we are here to help. Don’t keep us in the back of the room, to do so only hurts beneficiaries and the Medicare Program. Ethical and committed suppliers are part of the solution, not the problem. There needs to be an increase in real constructive dialogue and action.

Bottom line, we want to work together to protect and clearly define the Medicare mobility benefit so we can get back to doing what our industry is all about…improving the quality of life for the individuals with illnesses and disabilities in our communities.

Don Clayback is vice president of networks for The MED Group. Contact him at 716-835-1728 or