Some relationship advice for CMS


Did you see the July 16 edition of "Mobility Matters," the bulletin that AAHomecare publishes to educate lawmakers and policymakers, among others, on the power mobility benefit?

It was a good one. In the bulletin, Dr. Jerald Winakur, clinical professor of medical humanities and ethics at the University of Texas Health Science Center in San Antonio, Texas, calls CMS to task for its "maddening" documentation requirements for power wheelchairs:

“I (perform) two or three ‘power mobility evaluations’ (for one patient). They take me most of an hour to see my patient, examine him or her, complete the redundant paperwork. I am also required to write a chart note in the patient’s medical record re-hashing the same information I have put on a form, rather than just putting the form in the patient record. Then there is all the work my staff has to do behind the scenes—several communications with the provider by phone. I could have seen two ill patients—ones that really needed my ministrations—in this same timeframe.”

But there was something else that Winakur said that really struck a chord with me:

"Worse than overly bureaucratic, the agency is cynical of its own mission, suspicious of those of us—physicians, hospitals, industry—who are trying our best to work within the very arbitrary rules spewed out in what appears to be a flailing, ill-conceived, short-term fix to save dollars— one year at a time—without regard to the big picture."

Winakur hit the nail on the head: At the root of all of this is the fact that CMS doesn't trust physicians or providers. On the one hand, I can't blame them. Type "Operation Wheeler Dealer" into our hme site engine, and you'll turn up dozens of stories about rampant wheelchair fraud in Texas in the early 2000s. On the other hand, it was none other than CMS that allowed these physicians and providers into the program in the first place.

At the outset, CMS probably trusted that physicians and providers would do right by the power mobility benefit. When a few bad guys proved them wrong, they started distrusting all physicians and providers, making prescribing and providing power wheelchairs more of a subjective than an objective process. The end result: Everyone's life is miserable, good and bad physicians and providers, and beneficiaries.

Here's the thing: At the end of the day, where does all of this get CMS?

It's like CMS is a person embarking on a new relationship who's been burnt by a previous relationship. They're setting up all these roadblocks to keep the person in their new relationship from straying.

Trust is a tricky thing, but any of us who are older than 16 know how well those kinds of tactics work.

Liz Beaulieu


[...] This post was mentioned on Twitter by Mike Moran, Liz Beaulieu. Liz Beaulieu said: Some relationship advice for CMS #hmenews. [...]

Good point, Liz. But it's a point that needs to be made to legislators as well. The career bureaucrats at CMS have way too much invested in self preservation to change. Congress needs to rein 'em in and hopefully will do so. And soon!

[...] featured a Q&A with Mark Schmeler on the documentation process for power wheelchairs (the last bulletin, you’ll remember, featured an interview with Dr. Jerald Winakur on the same topic). Schmeler, [...]