Yes to standards

Sunday, June 30, 2002

It's interesting that your editorial in the June issue was "Let's raise industry standards" and the lead article deals with ethics. Do we think legislators, governmental officials, insurance carriers, news media, physicians and those that can get into the HME business with $300.00 are blind? They all think the HME industry is the pot of gold at the end of the rainbow. I think those outside our industry view us as having "no honor among thieves." Have we given the FBI the ammunition to believe that one in 10 DMEPOS providers are crooks?

I agree with your statement "Let's raise the standards." We all suffer because of the fraud and abuse issues, ethics, living on the edge of the rules and whatever else goes on that is perceived negative about our industry. It is no wonder that we become easy targets for CMS, Congress, the FBI, etc.

As an industry we should concentrate on earning the respect of those that view the HME industry from the outside looking in and raising the "standards" to a level that will earn respect for the service we provide.

-  Hal Freehling Jr., MA, RRT is v.p. of support services of O.E. Meyer in Sandusky, Ohio

No to more standards
I've just finished reading your column in the June issue, "Let's raise industry standards." Not too many years ago accreditation was going to clean up the industry. During that time the seven or eight HME companies that were active in my area all were accredited. That's not the case today. In that same period half of the respiratory therapists were laid off from those companies. Accreditation and staff RTs doesn't mean anything to Medicare. Private insurance requires it but Medicare doesn't. Accreditation raised standards for HME companies.

It's not a matter of new tougher standards or a college education for DME owners. It's a matter of enforcement. Medicare needs to enforce the standards and regulations that are already in place. And about competitive bidding being a fraud and abuse provision - it may be presented in those terms, but at its core, it's a tool to reduce payments. The government cannot get past the discrepancy in Medicare vs. VA contracts.

My fear is your approach of layering on one more set of standards for legitimate HME companies to suffer under will cost us more than we can bear. If Medicare were given the choice of higher standards or make the cut, they will take both. So be careful what you ask for, it's my company we're talking about.

-  Mark Zelezen is president of Hess Healthcare Services in Bethlehem, Pa.

Loan closets not fair
Regarding "OIG gives advice on loan closets" in the June issue, the OIG's attidude on this issue will do more harm for the DME industry than it will meet the needs of the patient. If DME #1 has a loan closet in a doctor's office and DME #2 does not, which provider do you think the doctor will choose? 

In a perfect world, the patient would have the freedom to choose but, if the patient chooses DME #2 and the equipment is not stored in a closet from this DME provider, what is the doctor to do?  Should he, in the best interest of the patient, loan the patient equipment from the closet which belongs to DME #1, or call DME #2 and let the patient wait on the equipment to be delivered?

This scenario exists day to day in this industry. It is a very competitive field, and if this is to be considered "normal practice", then doctors will be faced with the decision of which DME provider will store equipment and which will not. This in my opinion, will cause many DME providers to bid, overtly or covertly, for the space in the loan closet. Providers who will not pay for the space, will not receive any patients from the doctors. 

There are doctors'offices in every city who will only refer patients to DME companies that will supply them the personnel or equipment to actually perform the test that will qualify the patient for oxygen. So why should the use of a loan closet be any less a reason to sway a doctor to use a particular DME closet?

  -  Thomas Harvill is president of Riverside Medical in Savannah, Tenn.

The fiddle and the banjo
About your article last month "Lincare's sales efforts spark debate," we know all about this. We're three people, running a DME in a little small town in Missouri. Two days ago, after Lincare came into one of our patient's homes and did a sleep study, that patient phoned and asked us to pick up our equipment. He said the Lincare rep told him our equipment was antique. It was not. It had just been rebuilt in October. Lincare put their equipment on him, but we don't know where they got his O2 test results because we know his doctor never gave them. We're fifteen minutes away from Mr. Hummer. Lincare is 50 miles away. To them, he's just a number. They don't know he plays the fidddle and banjo like you never saw. We take ours to heart. We send cards when they die. We go to the funerals. Maybe that's why we don't make any money.

- Julie Means is office manager of Barton County Homecare in Lamar, Mo.

Richter's wrong
I recently read the article titled "Analyst: HME prospects have never looked better" (May 15, 2002). In this article Todd Richter (managing director, group head of Bank of America's healthcare equity research) says Apria and Lincare were enormous winners in the demonstration projects in Polk County and San Antonio. That's false. Apria and Lincare were not awarded the bid in San Antonio. Lincare gained entry to the demonstration [in Polk County] by acquisition. Apria is not a demonstration provider in San Antonio. Both of these companies have a very small presence in the SanAntonio market and very little market share. Mr. Richter needs to completely retract his statements, restate the facts and explain his motivation to the SEC.

I am appalled that a homecare publication such as HME News would even bother publishing remarks from such an uninformed source. We should have learned something from disasters like Enron. I feel it is the responsibility of HME News to respond to this letter for the benefit of all homecare providers.

- Eric Cherry is v.p. of Southern medical in San Antonio, Texas.

Editors note: Although Mr. Cherry is correct to point out that Apria is not a competitive bidding demonstration provider in either San Antonio or Polk County, and that Lincare is not a provider in San Antonio, a CMS source has confirmed that Lincare has garnered a majority of the oxygen business in Polk County. HME News became acquainted with Mr. Richter during his participation in a panel discussion at AAHomecare's annual Leadership Conference in February.

Dissing the discounter
I am really disappointed that your magazine, which advocates for mobility equipment companies, would promote Mobility Express. They have [come into] the market with low pricing to drive out competitors. They have diminished the value of POVs and advertise with questionable practices. I have been in this industry for over 10 years, and every manufacturer I have ever aligned myself with believes in offering discounts or loss leaders to acquire new customers, but never do they promote such discounting. You never see doctors, or therapists offer huge discounts for their services.

-  Carey J. Britton, A.T.S., is a member of RESNA and NRRTS.

Unfair position
Re "Aggressive audits rankle providers" (HME News, May 15, 2002), as a result of the DMERCs'increasingly arbitrary standards for documentation of "medical necessity," claims are being denied or payments recouped in cases where the need for the equipment is clearly documented but where the DMERC objects to the form of the documentation.

A statement by Dr. Paul Metzger, Region C Medical Director, published in the Spring 2002 Advisory says that medical necessity is demonstrated by physician progress notes and that other documentation such as physician letters, detailed written orders, or other written statements obtained by the supplier will not be sufficient in the absence of adequate physician progress notes.

By adopting a position that only the physician's progress notes will provide evidence of medical necessity, the DMERCs have mandated that a supplier providing equipment or supplies to a Medicare beneficiary without first reviewing and assessing the adequacy of the physician's progress notes runs the risk of having such revenues subject to recoupment regardless of the other steps taken by the supplier to document medical necessity.

It is not uncommon for physicians to fail to respond to requests for copies of progress notes in conjunction with a DMERC audit, since such failure has no financial impact on the physician. However, it has enormous financial consequences for the supplier, who remains at risk for physician conduct over which the supplier has no control. For this reason, it is patently unfair for the DMERCs to take the position that the physician's progress notes are so far superior to all other forms of documentation that no other form will suffice.

- Lisa K. Smith an attorney with Brown & Fortunato in Amarillo, Texas.