DME Stakeholders Condemn Trio of Media Reports

ATLANTA — In a week of bad press, three media heavyweights
took aim at the DME sector in stories industry stakeholders called
incomplete and misleading.

Springing off the debate about health care reform currently
engaging both houses of Congress and the president, CNN, The
Washington Post and The Wall Street Journal each
filed stories that took issue with the Medicare wheelchair benefit
(CNN), the oxygen benefit (The Wall Street Journal) and
the delay of competitive
bidding (The Washington Post).

The reports generated fiery responses from industry stakeholders
who, among other things, questioned the absence of relevant
facts.

CNN’s “One
wheelchair — one lesson of problems in heath care
reform,” by Drew Griffin with Kathleen Johnston, drew
particular steam from providers. The piece, which began airing July
20, focused on an Apria wheelchair patient who said her rented
wheelchair had cost taxpayers $1,200 over four years when it could
be bought on the Internet for $440. CNN reporters said they found
an even better deal than that: They purchased a wheelchair directly
from Apria for $349, they said.

In an almost immediate response to the piece, NRRTS uploaded a video on
YouTube featuring its executive director, Simon Margolis.

The story “presented a very one-sided look at a multi-faceted
problem,” Margolis said, noting that the piece did not include any
comments from industry representatives, nor did it discuss the
costs associated with providing equipment, such as delivery,
pick-up, service and adjustments to the wheelchair.

“There is also the cost of filing for Medicare payment and
billing the patient monthly, 13 separate times, for the copay.
These costs are not present in the cash price of the chair that
[the] undercover agent purchased,” he said.

“I think [the story] was slanted and distorted,” said Tim
Pederson, CEO of WestMed Rehab in Rapid City,
S.D. “They seem to be blaming the providers for the situation
instead of the government. We’re not the ones who came up with the
capped rental system.”

Michael Reinemer, vice president, communications and policy, for
the American
Association for Homecare, called the CNN piece “sophomoric and
laden with errors and misrepresentations.”

Ironically, AAHomecare had worked with reporters Griffin and
Johnston to provide industry facts for the piece.

“[AAHomecare] provided ample information to CNN about the costs
of providing equipment and services to Medicare beneficiaries in
their homes,” Reinemer said. “The association also presented
information about the controversial competitive bidding program
that Medicare implemented last year. However, CNN used a
combination of incorrect figures and cherry-picked facts to paint a
false picture of both topics.”

Reinemer said the story “perpetuated two myths that harm the
public’s understanding of the home medical equipment benefit in
Medicare.”

The first myth, he said, is that Medicare overpays for DME
because it can be purchased cheaper from the Internet. The two
cannot be equated, he said, because the Internet versions do not
include any services or maintenance.

“The costs of providing home medical equipment and services to
Medicare patients include delivery, often within hours of discharge
from a hospital, set-up, patient education, compliance and 24-hour
on-call service,” Reinemer pointed out.

The second myth, he said, is that HME providers “escaped the
price reductions that competitive bidding would have imposed.”

While Reinemer said the reporters and their producer knew the
competitive bidding program was delayed to address its flaws and
that the HME sector had paid for the delay by taking a 9.5 percent
reimbursement cut, that information was not included in the
story.

“CNN had this information but failed to mention it,” Reinemer
said. “Instead, CNN left its viewers with the impression that
providers of medical equipment escaped any negative impact because
of intervention by Congress. The stark reality is that hundreds of
home medical equipment providers are struggling and in some cases
failing as a result of the 9.5 percent cut, and a 27 percent total
cut for oxygen therapy in 2009, and even deeper cuts in
reimbursement for power wheelchairs in recent years.”

The story also did not note that competitive bidding would
exclude “as many as 80 percent of providers, even if they agreed to
the lower bid prices,” Reinemer said.

Lake Forest, Calif.-based Apria, which had also worked with CNN on the
piece, expressed serious concerns about it. A six-page rebuttal to
the report from Lisa Getson, Apria executive vice president,
government relations, said:

• The piece failed to mention that the patient is still subject
  to Medicare rules from 2005, important because reimbursement for
  her exact wheelchair was reduced beginning Jan. 1, 2006, Getson
  wrote. Also, she said, Apria has been reimbursed $960 for the chair
  by Medicare, not $1,200; the other 20 percent came from the
  patient’s private insurance.
• “CNN did not adequately research or tell the whole story about
  the limited services Internet vendors of DMEPOS equipment provide
  versus those that are required of local providers by the Medicare
  program,” Getson asserted, making her point with a chart comparing
  services that Medicare beneficiaries can expect from a local
  provider to those provided by Internet vendors.
• “CNN gave little coverage to the complex, time-consuming
  Medicare patient qualification, coverage guidelines and other
  paperwork requirements associated with serving Medicare
  beneficiaries, including those who require wheelchairs. The
  Internet vendors are not subject to these requirements and, in
  fact, state this on their Web sites,” Getson said in her
  letter.

Getson told CNN executives that Apria had “billed Medicare
appropriately under all existing regulations and Medicare paid
Apria under these rules.” She also pointed out that, while CNN
reported the patient said she had not been notified about an option
for Medicare to purchase her chair for her, Apria did indeed send a
letter to the patient in 2004 as required by Medicare “and she
consciously chose to continue the rental option.”

Both Getson and Reinemer asked CNN to print corrections and
clarifications.

But NRRTS’ Margolis said he agreed with CNN’s Griffin on one
point: “All wheelchairs for Medicare and other beneficiaries who
have long-term complex physical and functional needs should not be
rented. They should be purchased outright from Day 1. This is by
far the most cost-effective solution to the long-term needs for
Americans with disabilities who require complex mobility systems
… Congress should take heed of what Mr. Griffin has to say
about wasting money on wheelchair rental.”

(A provision in the House of Representatives’ health care reform
bill, currently under debate, would eliminate the first-month
purchase option for Groups 1 and 2 power wheelchairs.)

Newspaper Articles Take Jabs

Meanwhile, The Washington Post and The Wall Street
Journal added to the industry’s frustration with articles on
Friday.

The Post article, “Bush
Official Sees Peril in Health Plan,” by David S. Hilzenrath,
centered on comments from Michael Leavitt, former secretary of the
Department of Health and Human Services under President George W.
Bush.

Leavitt charged in the story that Congress authorized
competitive bidding for DMEPOS — “and then bowed to pressure
from the industry, putting a stop to the initiative just as it was
being implemented,” Hilzenrath wrote.

“In a system that’s run by the government, lobbyists and various
commercial interests, including doctors, hospitals, nurses, medical
equipment dealers and every other part of the system, use the
political process to restrict the capacity for change,” Leavitt was
quoted as saying.

AAHomecare’s Reinemer responded to Hilzenrath, saying the
article was “extremely misleading.” He pointed out that Congress
did not “stop” the competitive bidding program, rather, delayed it.
Again he noted the industry paid for the delay with a 9.5 percent
reimbursement cut.

“Congress delayed the program last year — it starts again
this year — because it was a badly designed and implemented
scheme that was going to put most of the providers out of business,
even if they agreed to new, lower bid prices,” Reinemer told
Hilzenrath.

About the 9.5 percent reimbursement cut, he added, “The
implication that the home medical sector weaseled out of a large
payment reduction through congressional intervention is absolutely
false.”

Laura Meckler’s article in The Wall Street Journal,
“Obama’s
Health Expert Gets Political,” focused on Peter Orszag,
director of the Office of Management and Budget, whom she describes
as “taken aback” when a House Democrat said her top priority was
winning higher payments for oxygen suppliers.

“Officials have been trying for years to cut payments to
suppliers of oxygen and other medical equipment, which critics say
are inflated,” Meckler wrote. “Yet when a new competitive bidding
process was set to take effect last year, industry supporters in
Congress were able to delay the plan. They are still fighting to
block changes.”

Reinemer, in a communication with Meckler, pointed out that she
had failed to mention the 9.5 percent reimbursement cut the
industry had taken to pay for the delay of competitive bidding.

“It’s discouraging to see no context or history or figures in
your discussion of oxygen and bidding if the topic is controlling
health care spending in Medicare,” he wrote.

The three reports illustrate how far the industry has to go to
gain the public’s and consumer press’ understanding of how it
operates, stakeholders said.

“I think that one of the things that we have failed to
communicate is the overhead that you have in a system where you
have to meet all the insurance and Medicare requirements and
regulations,” said Randy Wolfe, owner of Lambert’s
Healthcare, a 53-year-old Knoxville, Tenn.-based DME company
with three locations.

“We have to do a better job of describing to the average Joe
just how many layers of red tape we go through to do this
business,” he continued. “We have to show the enormous difference
between a cash transaction and an insurance transaction.”

Wolfe said the key to health reform is to take some of the cost
out of the delivery system. And much of that cost, he said, comes
from all the demands on the industry.

“They have created so many rules to manage us that they don’t
realize how excessive they have become,” he said, referring to
Medicare and insurance officials. “It creates overhead for us
… If I have to be Dr. Kildare and Dick Tracy and Perry Mason
to get our money, it’s going to cost, and it’s going to cost a
lot.”

In Wolfe’s view, the press consistently misses the main story.
“The comparison they are making [between the Medicare and Internet
prices] is not where the story is,” he said. “The story is the
overhead and the bureaucracy. It costs everybody too much
money.”

Wolfe, who is the chairman for the Stand Up for Homecare
committee for AAHomecare, believes the industry must do a better
job of educating the press.

“One of the things I want to look at this year is what our
messages are and how effective they are,” he said. “What the press
knows about us is so limited. We need to do a better job of
defining things and telling them how things work.”

It’s time, Wolfe said, to “build knowledge of our industry, the
good things we do, and explain some of this stuff and not be
reactive all the time. We have a great message, we have a great
industry.”

WestMed’s Pederson agreed the consumer media needs educating.
The CNN piece, he said, was, in fact, an indictment of the capped
rental system.

“That’s the point that needs to be driven [home] to the news
organizations,” he said. “Yes, this is a silly system, but we
didn’t create it. We just have to live with it.”

View the CNN segment.

View the NRRTS video response.