Hoover Returns to Role as Medical Director for Cigna

ATLANTA–After more than two years in HME’s private sector, Dr.
Robert Hoover will reassume his role as a Cigna Government Services
medical director when he takes over those duties for Jurisdiction C
on Jan. 14.

Hoover left his position as medical director for the
Cigna-administered Region D DMERC in 2005 to join Sunrise Medical
as senior vice president of global clinical services, subsequently
becoming chief medical officer for Somerset, Pa.-based DeVilbiss
Healthcare when Sunrise split its mobility and respiratory
operations last year.

Hoover said he had enjoyed his time with Sunrise and DeVilbiss,
but called it “a fantastic opportunity when Cigna approached me
about returning as the Jurisdiction C medical director.” Following
a year-long tug of war with Palmetto GBA to become the government’s
new Jurisdiction C DME MAC, Cigna was awarded the contract and took
over full operations for the region in June 2007. (See
HomeCare Monday, Jan. 29, 2007.)

In a HomeCare Q&A with Hoover conducted last week,
he outlined the work that lies ahead of him and gave his thoughts
on some of the industry’s most pressing issues.

HomeCare: Why are you leaving DeVilbiss for
Cigna?
Hoover: Although I’ve enjoyed my time with Sunrise
and DeVilbiss, there was a significant amount of travel associated
with the global responsibilities. Family considerations came into
play along with the desire to return to my duties as a medical
director. And yes, I did miss working with my colleagues both at
Cigna and the other contractors.

When I was at Cigna and responsible for Region D, I felt that
our team did a good job of building relationships with providers,
physicians and beneficiaries. Personally, I tried to be open-minded
and listen to providers and their issues. While I couldn’t always
accommodate their requests, I believe the provider community
believed that I was accessible and was willing to work
collaboratively with them. I’d like to continue that same policy
for providers in Region C.

I feel confident that DeVilbiss will continue to grow in my
absence … They’ve got a fantastic product portfolio including
iFill, Pulmo-Aide and IntelliPAP that will support their continued
success in the marketplace. It has truly been a pleasure to be part
of their growth and I wish them the best in the future.

HomeCare: Has your time “on the other side” of HME given
you a new perspective of this industry and its
needs?
Hoover: I think I have a better appreciation for
the day-to-day “struggles” of the typical HME provider. I’ve always
felt that the majority of providers were hard-working, honest and
dedicated to rendering the best care possible for their patients.
My time at Sunrise and the interactions I’ve had with our customers
and others in the industry have simply confirmed by beliefs.

One of the main things that I’ve experienced is the age-old
issue of physician education about HME and Medicare’s policies.
I’ve traveled around the country over the past two years and spoken
to physicians and HME providers and it’s clear that many of
Medicare’s policies are poorly understood by physicians. I think
the root cause can be traced, in part, to the contractors and the
Centers for Medicare & Medicaid Services who don’t have a
sustained educational effort directed specifically towards
physicians and DMEPOS.

For example, the DME MAC contractors aren’t funded to do
physician education, only HME provider education. However, I think
much of the “blame” falls on physicians who simply aren’t
interested or more likely, don’t have the time, to learn the HME
policies. Unfortunately, the fallout for the failure of physicians
to document properly lands on the HME provider who’s held
responsible for the claim and supporting documentation.

HomeCare: What are the most pressing problems that you
see for the HME industry coming up this year? What are the most
pressing issues you will have to deal with as medical
director?
Hoover: 2008 will continue to be a challenging
year for the HME industry. While respiratory providers dodged a cut
in oxygen equipment reimbursement at the end of 2007, Congress only
provided a temporary patch for the Medicare program and will have
to revisit funding issues in early 2008. That reimbursement
uncertainty is hanging over the industry creating a lot of
nervousness which translates into decreased sales. Competitive
bidding will also be a significant force in 2008 with the
announcement of Round 1 contracted suppliers (and fee schedule) and
the beginning of Round 2.

As the medical director for Region C, one of the main issues
will be improving the Comprehensive Error Rate Testing (CERT)
program scores. Cigna was quite successful in Region D in bringing
down the CERT error rate through intensive education and targeted
claim reviews. Region C has consistently ranked high in the CERT
program among the four DME MAC contractors so making improvements
in that metric will be a top goal.

In addition to provider and physician education, I will also be
looking at any new policies that might need to be developed to help
providers improve their claim submission accuracy. I view policies
as an educational tool since they tell the provider community
exactly how to submit claims properly and with the appropriate
documentation. Policy revisions and/or new policy development will
be a focus upon my return to Region C.

HomeCare: Is there anything in particular you hope to
focus on/change/improve as medical director for
Cigna?
Hoover: I’m a big proponent of education, as you
can guess from my previous responses. Unfortunately, education
takes a while to have an impact versus targeted claim review. I
feel we were very balanced in our approach in Region D with a good
mix of education and claim review. My preference is education since
claim review, whether pre- or post-payment, is labor intensive. It
involves a lot of resources in terms of claim processing, nurse
review time and in some cases, appeals workload. I’d like to get to
know my provider community in Region C by working with the Region C
provider council and encourage their collaboration in any
educational efforts we initiate. Again, I prefer an open-door
policy and look forward to working with this new region.

HomeCare: Regarding competitive bidding, do you feel
that complex rehab should be included?
Hoover: True complex rehabilitation equipment
should not be included in competitive bidding; however, part of the
issue is how “complex rehab” is defined.

There are clearly patients who require very customized equipment
and accessories, and it’s inappropriate to “commoditize” that
equipment. Moreover, patients requiring complex rehab equipment are
by definition, complex patients. They require more time and effort
on the part of the rehab professional to fit the patient with the
proper equipment and accessories. Couple that with a Medicare fee
schedule that is already “lean” on the complex rehab end of the
spectrum and I don’t think Medicare will see the savings envisioned
for this group of products.

HomeCare: Regarding the recent preliminary decision on
home sleep testing, and assuming the final will be essentially the
same, what kinds of opportunities do you see for HME
providers?
Hoover: Home sleep testing will raise awareness of
OSA, both in the physician and beneficiary community. Managed care
will piggyback on the Medicare policy and we’ll ultimately see more
patients with access to diagnosis and treatment. As we learn more
about the impact of OSA on other diseases like heart disease,
stroke and diabetes, having greater access to diagnostic tools and
treatment options will benefit both patients and the health care
system.

HomeCare: Do you see a better way that the industry and
government can work together to better serve Medicare
beneficiaries?
Hoover: The HME industry gets a black eye every
time a report of fraud gets published in the trade or lay press.
For the past two years I’ve heard stories from providers about
“this guy” or “that guy” who are defrauding the Medicare system.
It’s clear to me that providers know who the “bad guys” are in
their communities.

Unfortunately, I can count (without taking my shoes off) the
number of providers that contacted me in the seven years I spent as
Region D’s medical director with credible leads on fraudulent
providers. This industry must adopt a “Community Watch” mentality
and actively report providers that are stealing money from Medicare
and its beneficiaries. At the same time, CMS, its contractors and
law enforcement must also respond promptly and with follow-up when
providers generate fraud leads. There’s nothing more disheartening
that doing your job as a provider and reporting a fraudulent dealer
only to have no action taken by enforcement authorities.

Finally, and this may be the most important aspect of this
point, the trade and lay press must give recognition to the
providers that initiated the reporting. I’m not suggesting specific
names of the people reporting but it should be made clear that when
an investigation is concluded and reported in the press, the HME
industry get a share of the credit for being the “good
guys.”