Second Study to Challenge Proposed Respiratory Drug Dispensing Fee Cut
In its proposed 2006 physician fee schedule released on August 1, CMS announced that the 2006 dispensing fee for home inhalation drug therapy “will likely be lower than the 2005 level,” causing concern that the fee will drop below the current level of $57. Determined to oppose any cuts, AAHomecare has again commissioned Muse & Associates to conduct a similar study to that of last year. AAHomecare is urging providers who receive a survey/questionnaire from Muse & Associates to fill it out and return it quickly, as the public comment period regarding the proposal ends September 30. “We welcome the opportunity to provide CMS with information about the cost of dispensing this critical therapy and look forward to a close dialogue in the weeks ahead,” says Cox. “The fee must account for the numerous, specific costs involved in dispensing this therapy. Any cut in the fee would make it harder to provide the therapy to Medicare beneficiaries in the most cost-effective setting, which is in their homes.”

In last year’s study, findings emphasized that the 2005 Medicare reimbursement formula based on average sales price (ASP) would under-reimburse the actual cost of providing two key drug therapies by $68.10 per monthly supply. AAHomecare shared with the GAO and CMS information about the patient-management, pharmacy, compounding, delivery, and administrative costs of providing these drug therapies and argued the therapies cannot be provided to Medicare patients at the ASP formula without a substantial dispensing fee.

“We are very worried about the dispensing fee—that only after 6 months CMS would consider a reduction in the fee when we are not aware of any additional studies that would support this action,” says Kay Cox, president and CEO of AAHomecare. “Void of any new data, AAHomecare believes that it is premature for CMS to reduce the dispensing fee when data suggests that it should be higher based on the 2004 comprehensive Muse & Associates study of 109 pharmacies.”

Senators Ask CMS for Clarity on Mobility Documentation
In a letter dated August 5, Pennsylvania’s two Republican Senators, Rick Santorum and Arlen Specter, asked CMS to provide clear, detailed documentation instructions for mobility equipment. Their letter stated, “providers regularly encounter inconsistencies within the four DMERC regions on how documentation is interpreted.”

Noting that DMERCs put extreme emphasis on physicians’ chart notes, which often lack the specificity DMERCs require, the Senators’ letter suggested that “evaluations from other health care clinicians or letters of medical necessity from the patient’s ordering practitioner should be considered part of the medical record and used by claims processors in the event of an audit.” The revised CMS wheelchair certificate of medical necessity, power operated vehicle policy, and final face-to-face examination rules are all expected soon. The Senators requested clarity “so that little is left to subjective interpretation by the DMERC claims processors.”

Invacare Reduces Staff
Making adjustments for recent lower than anticipated earnings, Invacare Corp, Elyria, Ohio, completed its first round of layoffs, reducing its staff by 36 at corporate headquarters in a series of layoffs that are expected to total 230. According to a recent sales and earnings press release statement by A. Malachi Mixon III, chairman and CEO of Invacare, the staff decrease is part of cost reduction and profit improvement actions that also include “outsourcing improvements utilizing the company’s China manufacturing capability and third parties, shifting substantial resources from product development to manufacturing cost reduction activities and product rationalization, reducing freight exposure through freight auctions and changing the freight policy, general expense reductions, and exiting four facilities. As a result of these actions, the company anticipates recognizing a $3 million to $5 million charge in the third quarter of this year. These initial actions are expected to result in annualized savings of $20 million as Invacare enters 2006.”

PAOC Meeting Scheduled for September 26-27
The next meeting of the CMS Program Advisory and Oversight Committee (PAOC) on competitive bidding will be held September 26 and 27, 2005, in Baltimore. This meeting provides an important opportunity to demonstrate concern about competitive bidding.

Ad Hoc Committee AAHomecare created an ad hoc committee to focus on specific threats and remedies for small home care providers under restrictive contracting (competitive bidding). Committee members include: • Kay Cox • Tom Ryan • Georgetta Blackburn • James Clark • Asela M. Cuervo • Ramon Darcey • Karyn Estrella • John Gallagher • George Kucka • Tim Pederson • Jeff Wills • Jeff Woodham

Accreditation Central at Medtrade
Accreditation Central, located just off the trade show floor this year at Medtrade Atlanta, is an AAHomecare event designed to get you ready for compliance with the Medicare Modernization Act of 2003 (MMA). The MMA’s mandate requiring all HME providers be accredited is quickly approaching. Which organization is best for your company? What are their distinguishing characteristics? How do you even begin the accreditation process? Accreditation Central will provide attendees with an interactive forum for deciding which accrediting organization is right for them. Sponsored by the American Association for Homecare, Accreditation Central will feature representatives from a variety of accreditation organizations.

Murderball Killing Audiences
The much talked about documentary Murderball is now playing in theaters across the United States. Winner of the Audience Award at the Sundance Film Festival, the R-rated documentary on paralympians who compete in the blood-and-guts sport of wheelchair rugby puts a new spin on the world of ability and mobility. The film has gotten rave reviews from the major national daily newspapers and four stars from Roger Ebert, and a recent Sunday New York Times Magazine ran a fashion spread featuring the athletes posing in their battled-scarred chairs.

The October 2005 issue of Dealer/Provider will feature a special Murderball analysis and review by industry veteran David T. Williams. Check out www.Murderballmovie.com for dates and locations.

Sixth Annual LTOT Consensus Conference
Today, some Baby Boomers and younger Americans enjoy hitting a trendy oxygen bar for a quick health high. But in the not-too-distant future, millions will need long-term oxygen therapy to get enough air to function. An estimated 15 million Americans have been diagnosed with chronic obstructive pulmonary disease, and approximately 10% require home oxygen therapy to treat chronically low oxygen levels in the blood.

Doctors, clinicians, patients, and other experts in long-term oxygen therapy (LTOT) will tackle these and a host of issues in Denver during the Sixth Oxygen Consensus Conference on August 25 to 28. The invitation-only group will discuss problems confronting LTOT patients and develop action plans for addressing the issues. The previous consensus conferences between 1986 and 2000 stimulated development of oxygen standards and other therapy improvements.

AAHomecare will be among the participating stakeholder organizations representing home care providers. AAHomecare hopes the conference, collaboration, and outreach efforts will produce several key outcomes including:

• better awareness in the consumer and medical communities about the options and the complexities of oxygen therapy;
• earlier testing for low blood oxygen since early treatment helps provide for healthier outcomes; and
• greater patient access to long-term oxygen therapy through stronger Medicare and Medicaid policies to support the benefit.

AAHomecare’s Web site at www.aahomecare.org and the conference site at www.ltotnet.org contain details about the conference, facts and figures for oxygen therapy, and a list of five myths and realities about LTOT.