Industry: More Clarity, More Time Needed on Power Mobility Rule

–“The new rule presents a series of
major issues, which must be resolved by significant changes to the
rule and additional clarification,” said Cara Bachenheimer, vice
president, government relations for Elyria, Ohio-based Invacare
Corp. “For example, providers require very clear guidance regarding
the types of information that physicians are to chart in their
progress notes; this rule provides physicians no guidance
whatsoever, and providers will have a difficult time making an
assessment of whether the information provided is sufficient. The
30-day time frame is simply unrealistic. We are hopeful that CMS
will listen seriously to concerns from all
stakeholders–prescribing physicians, other clinicians and
providers and consumers, before implementing a final rule.”

–“I am concerned about the CMN issue,” said John Gallagher,
vice president of government relations for Waterloo, Iowa-based
VGM. “On the one hand, doing away with the CMN is a good thing. On
the other hand, the devil remains in the details. Is the doctor’s
prescription all that will be required? Or will the dealer still be
required to be responsible for the same floating data stream as
before?”

–“Like everyone else, we are digesting the information in the
interim rule. We acknowledge CMS’ efforts to ensure that suppliers
receive needed documentation. However, much more information is
needed to truly implement the NCD and the face-to-face interim
rule. We hope this information will be included in the [local
coverage determinations], and we hope this will be released very
soon,” said Rita Hostak, vice president, government relations for
Longmont, Colo.-based Sunrise Medical.

–“I am concerned that it is going to be difficult for providers
to ensure that the patient qualifies and can obtain the physician
notes they need for medical necessity,” said Jane Bunch, vice
president of HME consulting for Atlanta-based CareCentric.
“Regardless if CMS decides to reimburse physicians for their time
to complete this documentation, what guarantees do we as providers
have in knowing we are not going to have to return the
reimbursement in a post-payment audit? It is leaving the door wide
open for issues in the future.”

–Because a supplier only needs to submit a prescription with
claims, “It seems like it may open up the door for fraud and
abuse,” said Darren Tarleton, president and CEO of Stockbridge,
Ga.-based Mobility Warehouse. “It’s going to make it much easier
for me as a dealer to serve the patient and get equipment to them
in a much more timely manner. With the current process, there is a
lot of waiting. There are times that we’ve never been able to get a
CMN back from the doctor. Sometimes it has taken three to four
months. As far as the patient is concerned, it’s going to be much
better for them.”

–“I don’t think it’s going to work. I think they’re dreaming,”
said Tom Lambert, president of Redding, Calif.-based Maximum
Comfort, who won a battle with the government earlier this year
when a U.S. district judge ruled that a CMN is enough for DME
reimbursement (HomeCare
Monday, March 21). The provider has been in litigation over
the issue for years, and said he is not sure how the new policy
might affect the government’s current appeal of the court case. “It
kind of blows me away. I think we’re going to have to wait and see
… I know for us, one of the problems with requiring clinicians’
notes was that we’re not qualified to read these notes and detect
medical necessity. When I started in 1989, all we had was a
doctor’s prescription. Maybe that’s where we’re headed–back to the
horse and buggy days.”

–“Now we have a pretty good idea of what information is needed
from a physician in order to determine medical necessity–but
pretty good is not good enough,” said Dan Meuser, president of
Exeter, Pa.-based Pride USA. “Providers need a list, if you will,
of what information [CMS] wants. … We can manage through this
change, but there are still questions, and the time frame is
absolutely unrealistic. There is not a provider I can talk to–from
the most sophisticated to the smallest mom-and-pop–that feels they
can be prepared and ready by Jan. 1, or for this new
prescription-information program by Oct. 25. It can’t be done.”

–“It seems to completely eliminate the role of the therapist in
documenting an assessment, which is our primary concern as
therapists who have been invested in these procedures our whole
careers. [CMS] thinks this will limit fraud in the program, but we
believe the result is going to be gravely restricted access for
patients. If the physician is responsible, in many cases, we don’t
feel that is realistic [for them to gather documentation], even if
they provide them an extra $21. Physicians don’t write letters of
medical necessity now,” said Barbara Crane, assistant professor of
physical therapy at the University of Hartford (Conn.). Crain also
co-chairs the Clinician Task Force, part of a clinical-focused
group formed last year called the Coalition to Modernize Medical
Coverage of Mobility.

–“It looks like they are putting a lot of responsibility on
physicians, who don’t have the training or the time. All sorts of
technical questions that need to be answered aren’t in the doctor’s
area of expertise. CMS needs to more clearly define what the
physician is responsible for and what he or she can outsource to
other people. That is going to be critical. … Without some
standard form the physician can complete, it’s going to make it
difficult to make sure all this information is going to be captured
in the way CMS wants. If there was something that said, ‘Here are
some basic questions you need to answer,’ then clients could work
with their referrals,” said Don Clayback, senior vice president of
networks for Lubbock, Texas-based The Med Group.

–According to a statement from the Restore Access to Mobility
Partnership, “While the physician role is critical, the new rule
places undue and inappropriate responsibilities on them … Doctors
may not be well versed on the range of mobility assistive equipment
options, the factors involved in determining the right equipment
for patients or how to correctly document their evaluations. This
situation is compounded by the lack of any comprehensive effort by
CMS to educate the physicians on their expanded role in this
process.” What’s more, the industry coalition said, “the magnitude
of the changes in the interim rule dictate that it will take
substantially longer than the stated Oct. 25 implementation date
for stakeholders to fully understand and be able to implement the
new rules.” The statement concluded that “it is a mistake to rush
into implementation of a rule that is flawed.” RAMP members include
the American Association for Homecare, Invacare Corp., The Med
Group, Mobility Products Unlimited, Pride Mobility and Sunrise
Medical.