Will 2015 be the year providers and practitioners play together?

Friday, February 20, 2015

We were inspired by Rick Rector’s “Hold on a little longer” editorial in the January issue of HME News, and we would like to submit our collective thoughts about what’s in store for DME providers in 2015. Our list is colorful, largely because it currently exists as a spider diagram on a white board. We really enjoyed this brainstorming exercise and we were once again reminded that there’s always a place for dry erase markers, white boards and diagonal writing.

But I digress.

I’m sharing our spider graph here, but I think you might prefer to hear specific details as they relate to one or more of the “opportunities” we have identified. One of our brightest blue scribbles says, “Providers and practitioners will learn how to play in the sandbox together.” 

We believe that in 2015 more practitioners will embrace DME documentation solutions brought to them by providers. It all starts with one brave soldier deciding not be discouraged by the mean gatekeeper and instead showing the king of the castle how easy it can be to produce accurate face-to-face notes and seven-element orders. 

The plight to obtain accurate documentation from practitioners has been burdensome for providers and frequently described as the ping-pong effect. Historically, paperwork goes back and forth between the two entities several times before it is complete. The prior authorization demonstration for power mobility devices prompted a sense of urgency for physicians and providers to work together to ensure that medical necessity is accurately identified and documented the first time. The 69% decrease in beneficiaries receiving a power mobility device between September 2012 and June 2014 is not insignificant. Peggy Walker explained in her article “mistakes vs. fraud” that few providers in the DME industry intentionally bill for items they did not provide, or are providing items that are not truly medically necessary. However, fraudulent providers do exist and, while they are the exception, they have not helped portray a trustworthy and reputable image of DME providers. Trust has been one of the biggest hurdles providers have had to overcome when attempting to educate physicians about Medicare’s coverage criteria for DME. That, and the fact that the best documentation solutions are standardized online tools that require the physician to try something new. We can’t blame them for not wanting to add one more thing to their plate and many physicians are choosing not to prescribe PMDs as a result. It is believed that the 69% decline in PMDs in the seven original demo states is largely a result of this. We believe the wheel is turning. There are now viable tools for physicians to use that take the uncertainty out of face-to-face documentation.

Standardized online documentation tools have bridged the gap between physicians and providers. These tools provide all parties with the opportunity to play by the rules and work together to help the patients get and keep equipment they qualify for. Our programmers are committed to building the algorithms that incorporate the coverage criteria and take the guesswork out of the face-to-face documentation requirements. In 2015, we will see even more providers and physicians gravitating toward solutions that meet the stiffer documentation scrutiny. 

This year, we have a team going to provider locations all around the nation to see firsthand how they are succeeding in obtaining accurate documentation from their referral sources. We will post what we learn on twitter and the news section of our website.

Thank you for the opportunity to respond to Rick’s question.

Katherine Sims handles marketing and public relations for dmeevalumate.com. She can be reached at katherine@dmeevalumate.com.