Medicare Bill Provisions Threaten HME
At press time, the tentative Senate and House compromise on a prescription drug benefit to Medicare recipients included many provisions that could cause problems for HME providers, including a rate cut for some inventory staples, competitive bidding starting in 2007 for the nation’s 10 largest cities and expanding to the 80 largest cities by 2009, future mandatory accreditation, increased review of power wheelchair claims, and cuts to Medicare Part B drug payments. However, all was not lost, said the American Association for Homecare (AAHomecare) and other industry advocates.

Kay Cox

“It is not over by a long shot,” said Kay Cox, AAHomecare’s president and CEO, after the association released the details it had received about the agreement. “AAHomecare still considers this an open bill and there are many, many moving pieces right now. And until the bill is signed by the president, there will still be time to make changes to this legislation.”

AAHomecare had tried to avoid competitive bidding by advocating substituting it with a 7-year freeze in the DME payment increases that correct the prices for inflation. However, the Medicare bill, as agreed to at press time, did not replace competitive bidding with a freeze. Instead it used the freeze as a cost-saving mechanism for 5 years and then planned to institute competitive bidding—a situation Cox said was absolutely unacceptable.

The other area of concern for industry advocates was a proposal added to the bill by House Ways and Means Chairman Bill Thomas (R-Calif). This proposal would reduce reimbursement for five popular items and services by comparing the Medicare payments for them with the Federal Employees Health Benefits Program (FEHBP) payments for the same items and services. The tentative list of these items included oxygen, wheelchairs, nebulizers, diabetic supplies, and hospital beds/air mattresses.

“It is a reimbursement decrease of what we think is approximately 10% and it is the bread and butter of your typical DME provider, and that is a huge chunk,” said Cara Bachenheimer, JD, vice president of government relations for Invacare Corp, Elyria, Ohio. “So that is our number one priority. We had been working on staving off competitive bidding as long as possible in the hope of eventually being able to get rid of that in the next couple of years, but the FEHBP pricing has really risen to the top of the list.”

With the powerful senior citizen group AARP, physician groups, the prescription drug industry, President Bush, and key Republicans in Congress lining up to support the bill, industry advocates hoped to be able to alter the text before it was voted on by both houses of Congress. If that became impossible, the strategy would be to try to stop the bill from being passed altogether.

This goal did seem possible because while the bill had powerful proponents, it had equally powerful detractors. Many key Democrats, including Senator Edward Kennedy (D-Mass), had expressed their open dislike for the bill’s provisions to privatize parts of Medicare, as had some ultraconservative Republicans who opposed those same provisions for not going far enough. Because the original Medicare bill approved by the House passed by just one vote, AAHomecare said this opposition from the left and the far right could mean that the compromise bill would have only a 50/50 chance of passing.

For more information on the status of this bill and its provisions, please visit Dealer/Provider online at www.hhcdealer.com and click on “December News.”

NRRTS Refutes Alleged “Attacks”

In response to reported attacks on the reputation of the National Registry of Rehabilitation Technology Suppliers (NRRTS), the registry’s board of directors and staff last month released a public statement. The purported attacks occurred at a “number of public forums where industry colleagues assembled,” according to the NRRTS response, and ostensibly included accusations of promoting clandestine efforts to exclude individuals from doing business.

“Nothing could be further from the truth,” the statement reads. “For example, when the organizers of the original consumer protection legislation in Tennessee first proposed their plan, it only recognized the National Registry of Rehabilitation Technology Suppliers or the NRRTS CRTS® credential. The NRRTS board unanimously requested this overly restrictive language be expanded to include the RESNA ATS and ATP credentials. Without such an inclusion, NRRTS would not support the draft proposal.”

NRRTS also says the unspecified critics claim its standard to achieve inclusion is easier than the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) Assistive Technology Supplier examination.

“NRRTS believes these criteria are different; not necessarily easier or harder. Passing a written test (the RESNA criteria) measures basic knowledge, not actual practice (one of several NRRTS criteria),” the statement says. “The NRRTS’ CRTS® is a stronger credential, because it combines knowledge and experience.”

Dan Lipka, president of NRRTS, did not wish to focus on who is behind the attacks, but called the comments “unfortunate and inappropriate.”

“I also do not wish to speculate as to the motivation of the attacks,” Lipka says. “I can say that they have become more public and more intense with the recent efforts by some states to enact consumer protection regulations.”

Scooter Store Hires Palmetto Med Director, Gets FBI Visit
The Scooter Store, New Braunfels, Tex, which is being investigated by the FBI as part of a Centers for Medicare and Medicaid Services (CMS) crackdown on billing fraud, recently welcomed the previous DMERC Region C medical director to its management team.

Paul Metzger, MD, who in October retired from 8 years at the Region C DMERC—Palmetto GBA—started as Scooter Store vice president of government relations and chief medical director on November 10.

“We have always felt that in all our dealings with that DMERC that [Metzger] has been very fair and upfront. He definitely is someone who has a tremendous amount of experience in the DME industry, having been the medical director for many years; he was also around when the CMNs were developed,” says Tim Zipp, executive vice president of government relations for the Scooter Store, based in New Braunfels, Tex. “He is a physician and understands that perspective, so we really think he’s going to be able to help us develop our physician relationships.”

Metzger resigned from Palmetto after the power wheelchair fraud scandal in Harris County, Texas, and the FBI visits to 24 Scooter Store sales representatives.

According to Zipp, the Scooter Store approached Metzger about the position after he announced his intended departure from the DMERC job and Metzger’s decision to leave was unrelated.

“Metzger is a man of high standards, and I don’t think him leaving has anything at all to do with what happened in Harris County,” Zipp says.

Margaret McGuckin, executive vice president of marketing at the Scooter Store, says that she was not surprised by the FBI investigation because the Scooter Store is the largest power wheelchair provider in the industry.
“We’re very supportive of what [CMS] is doing. There are inconveniences for all providers, like [the moratorium on] new supplier numbers, but we are supportive of anything that can be done to eliminate fraud,” she says.