Reporter's notebook: Is there a dark side to the PMD demo?

Friday, June 19, 2015

In a letter to the editor published in the May issue of HME News, Scooter Store founder Doug Harrison questioned the success of Medicare’s PMD demo, pointing to a 69% decrease in utilization.

“Please watch out for prior authorizations coming to any other product categories,” wrote Harrison. “You might be lucky to have 31% of your claims survive. Is that enough for your business to survive?”

Which raised the question: Is the PMD demo hurting more than it’s helping? 

The short answer is no. 

“From what I hear, providers and consumer groups like the PMD demo because it doesn’t impede access for the people who really need equipment,” said Pete Rankin, government affairs manager for AAHomecare. “It’s just a more thorough vetting of beneficiaries.” 

While spending on PMDs in the original seven demo states fell from about $12 million in September 2012 to $3 million in June 2014, stakeholders say the drop in utilization has little to do with the demo. 

“Most of it is due to other challenges such as competitive bidding, the elimination of the purchase option, and an increase in audits,” said Seth Johnson, vice president of government affairs for Pride Mobility. 

Johnson is working with legislators to expand the demo in all 50 states.

In his letter, Harrison also states that, “the PMD demo allows Medicare to inflict all of the same ridiculous and sadistic ‘standards’ on all claims before they’re processed.” 

However, providers like Don Chrysler say they would rather fix a mistake upfront than be audited for technical mistakes after the equipment has been delivered. 

“We wish Medicare wouldn’t be so nitpicky about documentation, but if they’re going to be nitpicky, I’d rather know about it on the front end,” said Chrysler, owner of Amarillo, Texas-based National Home Health Care, who   responded to Harrison with his own letter to the editor in the June issue.