Life after CMNs: 'It's total chaos'

YARMOUTH, Maine - In the weeks after the switch from CMNs to doctor's prescriptions for power mobility devices, rehab providers found themselves spending more time educating physicians and less time providing equipment. "It's total chaos," said Don Whitney, operations manager for Inland Medical and Rehab in Spokane, Wash., in early November. "Up until 10/25, I was delivering power [wheelchairs and scooters] every day. I haven't delivered one since, and I don't foresee that I'll deliver any in the next couple of weeks." A day-in-the-life of a rehab provider post-Oct. 25 includes numerous phone calls, e-mails and faxes to physicians to inform them of what's needed under CMS's interim final rule: a face-to-face exam, a prescription, medical records. In some cases, the equipment has already been ordered but now rehab providers and physicians must go back and fill in gaps to meet the new criteria. Whitney is even educating physicians on how they can bill the $21 and change for their services, he said. Although CMS claims it has educated physicians, numerous rehab providers said not one physician they work with knew anything about the changes, other than the information they had provided them. "We're always the bearer of bad news," Whitney said. "It's frustrating." Jim Travis, president of Buffalo Wheelchair in West Seneca, N.Y., knew more than most what was coming. Six months ago, he requested medical records for a sample of 50 power wheelchair orders just to see what he'd get. "First of all, they didn't want to send all of their medical records, because it's so expensive," he said. "They also weren't willing to go through the records and find something related to the patient's ability to ambulate. From some places, we wouldn't get anything at all. From others, we got 50 pages." The inability of physicians to include information on ambulation, which is "the whole premise" of the new documentation requirements, is "absurd," Travis said. The bottom line: "We've accepted this, and we have a plan in place, but how does the rule work in practice?" Travis asked. So far, not so well. Despite visits with rehab facilities to give mini-presentations on the rule, Travis described the weeks following 10/25 as "putting out a lot of fires." In addition to physicians, rehab providers are finding themselves educating beneficiaries, who aren't always happy to hear about the new rule. "It's befuddling to beneficiaries," said Dan Lipka, an ATS with Miller's Sales and Rental in Akron, Ohio. "We ask them if they've seen a doctor, and we tell them it's possible they may have to see a PT or OT. We tell them we're requiring this, this and this, and they hang up on us. They say, 'Why do I have to do all this stuff? I'll just call someone else.'" Some rehab providers are so confused that they don't even feel comfortable educating physicians and beneficiaries - or even their own staffs, said Michael Hamilton, executive director of the Alabama and Georgia state DME associations. "I can't remember a rule change as convoluted as this one," he said. "The doctors are not going to have confidence in suppliers or the system when they see how jerked around suppliers have been getting. It's unfortunate, because doctors are going to take it out on us, because we're the closest and easiest target." While the going has been tough in the weeks post-10/25, in the long run, requirements like the face-to-face examination will help ensure beneficiaries receive appropriate equipment, Lipka said. "Although these are big changes for suppliers, they're not all necessarily bad," he said.