HME Garners Lots of Press — Good and Bad — This Month

ATLANTA — Home medical equipment stakeholders have been
fending off slings and arrows cast by the press for the last month,
but an article appearing in the Wall Street Journal
regarding the effect of oxygen rules on patients provided some
solace last week.

Amy Merrick’s “Oxygen Rules Pinching Patients” painted a stark
picture of the challenges facing oxygen patients under the 36-month
rental cap implemented in January and, as of Oct. 1 and 2,
respectively, mandatory accreditation and surety bonds.

“New Medicare rules designed to reduce waste and fraud in
medical-equipment reimbursements are driving some home oxygen
suppliers out of business and leaving patients scrambling to find
new providers,” Merrick wrote in her Nov. 24 article.

While CMS says it is paying too much for oxygen equipment and
the payments for the first three years should cover the next two
years as well, Merrick pointed out that “suppliers say those
calculations don’t account for how much it actually costs to
provide services, such as delivering oxygen tanks.”

The result, she said, is that some companies “are balking at
accepting new patients who are near or have already reached the
three-year limit on full payments.”

Nurse and case manager Barbara Renzullo, who works at
Massachusetts General Hospital in Boston, told Merrick the new
oxygen rules are “penny wise and pound foolish.” She cited an
instance in which a terminally ill patient who wanted to move from
Massachusetts to Virginia to live with her daughter could not find
a Virginia oxygen provider who would take her on. She spent extra
days in the hospital until a Massachusetts provider mailed an
oxygen concentrator, Renzullo told Merrick.

While stakeholders applauded Merrick’s balanced story, they were
not so happy about a slew of derogatory reports that appeared in
several other publications. Among the most recent was a Reuters
piece transmitted Wednesday to member news organizations.

“Cancer of fraud permeates U.S. healthcare
system,” trumpeted the headline. Noting that “Medicare has paid
as much as $92 million from 2000 to 2007 for medical services or
equipment ordered or prescribed by doctors who were dead at the
time,” Reuters writer Tom Brown focused most of his article on
Florida.

“Hardly a week goes by without authorities in Florida reporting
another arrest, indictment or conviction for Medicare fraud, which
has replaced the drug trade as the crime of choice among many
criminals,” Brown wrote. “The cases often involve
multimillion-dollar schemes featuring bogus suppliers of
wheelchairs, or other so-called durable medical equipment devices,
and sham infusion therapies for the treatment of HIV and AIDS
patients.”

An estimate by the National Healthcare Anti-Fraud Association
sets the country’s losses to health care fraud at $60 billion, or
about 3 percent of its total health care expenditures, Brown wrote,
but he added that Reuters considers that figure “conservative.”

• In an article about the acquisition cost of a wheelchair and the
  average reimbursement from CMS that appeared in November’s AARP
  Bulletin, the association called the difference “a threat to
  Medicare.”

  That elicited a response from Michael Reinemer, vice president,
  communications and policy for the American Association for
  Homecare, who pointed out that the purchase cost of a wheelchair
  does not include a number of essential services, namely delivery,
  set up, fitting, maintenance, etc.

  Reinemer also took issue with AARP’s assertion that an HME lobby
  has prevented cost-cutting measures, saying that “in fact,
  reimbursement rates for durable medical equipment, including
  wheelchairs, were cut substantially in the Medicare Modernization
  Act of 2003 and the Medicare Improvements for Patients and
  Providers Act of 2008 and rates have been subject to a freeze for
  the last five years.”

• The attacks continued on Nov. 9, when Poynter Online, a
  product of the Poynter Institute, which caters to journalists, ran
  an article on Medicare fraud. That appeared to paint all HME
  providers as crooks.

  “DMEs are so-called pharmacies or medical supply companies.
  [Fraudulent ones] literally open for 30 to 60 days, get a list of
  patients and their Medicare numbers and then bill like crazy,” the
  article said. “They send in their bills for artificial arms and
  legs, wheelchairs, breathing machines, medicine, etc. But none of
  this is ever bought and sold; Medicare just pays for these
  items.”

  That drew Reinemer’s ire. “We are extremely distressed that you
  suggest all providers in this sector are, by definition,
  criminals,” he wrote, adding that while the article might be
  alluding to “fly-by-night operators … you make no mention of
  the honest providers.”

• That wasn’t the last of the bad news. Alex Leary, writing a blog
  for the Nov. 19 issue of the St. Petersburg (Fla.) Times,
  questioned what Rep. Kendrick Meek’s problem was with competitive bidding. Meek has
  sponsored H.R. 3790, which would eliminate DMEPOS competitive
  bidding. Leary quoted the Center for Public Integrity as saying
  that “federal investigators have long complained that the equipment
  business is a hotbed of Medicare abuse.”

  Reinemer fired back with a swift reply. “This is breath-taking
  in its shallowness and absence of context and balance — even
  for a political blog,” he wrote. “First of all, the Meek bill would
  require cuts to the Medicare durable medical equipment
  reimbursement rates in order to offset the savings that this train
  wreck of a bidding program would have reaped. Wouldn’t that be
  worth mentioning?”

  He enumerated several of the organizations that support Meek’s
  bill, noted that Leary had confused two separate issues (combating
  fraud and accurate price setting in Medicare) and emphasized that
  competitive bidding was a “price-setting mechanism, not an
  anti-fraud program. The bid program, as designed by Medicare,
  deliberately reduced the number of equipment providers
  (competitors) by 90 percent.”

  As well, Reinemer pointed out, the industry itself is zealous
  about deterring fraud and in fact supports anti-fraud
  legislation.

• He got the chance to explain the point again when on Nov. 25,
  Carol Gentry of Health News Florida wrote an editorial
  that Reinemer called “a smear of durable medical equipment
  advocates, suggesting in your article today that we tolerate
  fraud.”

  He shot back once again, noting in a response that AAHomecare
  has not only endorsed an anti-fraud measure introduced by Sen.
  George LeMieux, R-Fla. — which calls for better screening of
  providers before enrollment — “but we are on record urging
  Congress to go ever farther than the LeMieux bill and adopt our
  entire 13-point
  plan, which would increase penalties for fraud, mandate more
  site inspections and get more resources to federal fraud fighters,
  among other steps.”