Why 'Round Zero' Was Zapped

The HME industry achieved a rare victory on Dec. 29 with Medicare’s last-minute delay of a demonstration project requiring prepayment reviews of power mobility devices in seven states. Experts say the delay was the product of many factors, and predicted that the the reprieve would be temporary.

“It’s coming,’’ said James Herren, a consultant and executive director of the Association for Tennessee Home Oxygen & Medical Equipment Services. “Be prepared.”

In fact, at press time, officials announced a new timetable and restructuring for the project. 

Herren, a former employee of a Durable Medical Equipment Medicare Administrative Contractor (DME MAC), said a key concern for Medicare was raised by contractors who would have been inundated with paperwork generated by the prepayment review demonstration. They lacked capacity to deal with the project—called “Round Zero” by some in the HME industry—and they told Medicare that it was a serious problem, he said.

Seth Johnson, vice president of government affairs for Pride Mobility Products Corp., was among HME advocates who fought the demonstration project, and he said Medicare appeared to be in disarray as the project advanced.

“I think there was a big disconnect within the agency,’’ he said. “I think what may have happened is a certain wing of the agency said they want to cut down on fraud and abuse, and said, ‘This is how we’re going to do it.’ The problem is they didn’t run it through the proper channels to make sure all the I’s were dotted and the T’s were crossed. … It just didn’t make sense. We’d have meetings with Medicare, and one official would say this is the way it’s going to work, and then you’d talk to somebody else, and they’d say, ‘Oh no, no.’ It would almost be the complete opposite. It appears the agency wasn’t prepared to announce the PMD demo when they did, and that caught up with them.”

Johnson noted other factors that contributed to Medicare’s decision to delay the project, including:

Unified opposition: “I really think that when the industry is unified and sticks together and is able to not only get providers actively involved but also various consumers who would be impacted—along with the clinicians and physician groups—that tends to be the right recipe for a successful effort. There was a lot of coordination between AAHomecare, NCART and the members of those organizations.”