Thursday, September 30, 2004

Editor, HME News

At every turn this early autumn, there’s a major issue brewing for the tankard of every HME provider.

If you’re a rehab supplier, the question marks on your operations are flying like ack-ack. Your codes are in flux, and there’s no telling what kind of sense CMS will ultimately make of this very serious issue. On the facing page, Rita Hostak writes of the “bright line” that CMS is trying to draw between basic, or consumer wheelchairs and higher-tech, rehab wheelchairs. Hostak and NCART have trouble with the bright line, believing that the munificent shades of gray in wheelchair user’s conditions warrant a less simplistic code-set.

The rehab supplier’s worries don’t end at the code set. You (and your DMEPOS brethren) are worrying also about whether CMS is really going to mandate a face-to-face physician visit for the prescription of every wheelchair and DMEPOS item. Seems to make sense on the surface, but as Dan Lipka points out in a commentary, this requirement is accompanied by a hydra’s head of new problems.

The jury is still out on medical coverage guidelines for power wheelchairs, of course. The Wheelchair Work Group led by Sean Tunis at CMS is muddling through that mess at the moment. And just how responsible will the HME supplier be for what the physician writes or does not write in his chart notes?

Rehab suppliers who provide K0011 power wheelchairs wish the FEHBP-based cuts slated for Jan. 1 were all they had to fret over since those cuts will reduce reimbursement by a mere three to four percent - for them. HME providers should be so lucky. They’re looking at significant cuts (see story) to a what’s what list of their bread-and-butter products, including hospital beds, pressure mattresses and nebulizers. Even Rep. Bill Thomas, R-Calif, who has promised the farthest-reaching changes for the industry with his call in the MMA for competitive bidding, is going somewhat to bat for the HME industry on this issue (see story) by asking CMS to make sure that FEHBP data is good data, which it ain’t.

(Seems to me Thomas should have checked the data before he let it rip in the MMA as a way to recoup some of the dough he was giving up by agreeing to postpone competitive bidding until 2007. But maybe that’s just me asking too much of a legislator.)

And then there’s oxygen, the wildest wild card of all. Wall Street, which could care less about power wheelchairs, is very interested in the size of the cut the OIG is going to suggest. That OIG report was supposed to be out by now. It wasn’t by the time we went to press last month.

So there’s all this going on at the moment, and we haven’t even talked about competitive bidding yet, or did we? By the time you read this, CMS probably will have announced the 12-15 members of the Program Advisory Oversight Committee, who will begin to develop the modus operandi for competitive bidding. In which case, should that come to fruition, you’ll need the aforementioned tankard and all the brew it can hold.