In Brief

The word from Erika Williams, ombudsman for the National
Supplier Clearinghouse, is that the final rule on provider
standards could contain six to 10 more standards when it is
issued. When will that be? No one knows, Williams said at
last month’s Medtrade.

CMS has released an MLN Matters article (MM6270) on the 2009 Fee
Schedule Update for DMEPOS, including a 9.5 percent
reduction for items included in Round One of the competitive
bidding program—with the exception of HCPCS codes E1392,
K0738, E0441, E0442, E0443 and E0444. These six oxygen generating
portable equipment (OGPE) and oxygen contents codes will not be
affected by the 9.5 percent cut, CMS explains. Non-competitive bid
items will receive a 5 percent covered item update for 2009.

The rate of patients discharged from hospitals who still
needed home health care increased 53 percent (from 2 million to 4
million) between 1997 and 2006. According to the Agency for Healthcare
Research and Quality, there was a 30 percent increase (from 4
million to 5 million) in the rate of patients discharged to nursing
homes or rehab facilities during the same period. The increases
reflect the rising number of hospital patients who are acutely ill
or cannot take care of themselves after being discharged, AHRQ
said. Overall, hospital discharges for all conditions rose from
roughly 35 million to 40 million—a 14 percent increase.

Think your knowledge of Medicare guidelines is pretty
solid? You can test it out by taking a quiz on DME MAC Jurisdiction A’s Web site.
Officials assure providers that the quizzes are not a way of
determining if they are going to do an audit; they’re simply
designed for education.

The average daily rate for a private room in a nursing
home remained essentially unchanged from 2007 at $212,
while semi-private rates increased $2 to $191 this year, or $69,715
annually, according to a MetLife Market survey of 2008 nursing home
costs. The national average daily rate for a private room in an
Alzheimer’s unit is $219 ($79,935 annually) and $198 ($72,270
annually) for a semi-private room. The highest daily rates for
nursing homes are in Alaska, at $577 for a private room and $566
for a semi-private room. The lowest are in some areas of Louisiana,
where a private room averages $127 per day.

According to the American Geriatrics Society, a shortage of geriatricians could reach crisis
proportions as millions of baby boomers age. By 2030,
when the last of the baby boomers reaches the age of 65, the U.S.
population aged 65 and older will exceed 70 million, roughly twice
the number in 2000. This year life expectancy reached 78, a
national record high, setting the stage for more seniors than ever
and fewer physicians to care for them. There are currently 4.7
geriatricians for every 10,000 older adults in the United States,
but AGS said the government predicts by 2050, there will be 1.6
geriatricians for every 20,000 older adults.

The World Health Organization is hoping new wheelchair
guidelines will promote mobility and independence for people with
disabilities in “less-resourced” settings. The guidelines address the design, production,
supply and service delivery of manual wheelchairs, in particular
for long-term wheelchair users. According to WHO, the wheelchair is
one of the most commonly used assistive devices for enhancing the
personal mobility of people with disabilities. An estimated 1
percent of the world’s population, or just over 65 million people,
need a wheelchair. In most developing countries, WHO said, few of
those who need wheelchairs have access, production facilities are
insufficient and wheelchairs are often donated without the
necessary related services.

In 2007, diabetes cost the United States $218 billion
due to higher medical expenditures and lost productivity,
according to a report released Tuesday by Danish pharmaceutical
company Novo Nordisk, which manufactures insulin and diabetes
medications. Conducted by The Lewin Group, the research shows that
beyond the estimated $174 billion widely accepted as the cost of
diagnosed diabetes in 2007, an additional $18 billion was spent on
6.3 million people with undiagnosed diabetes; $25 billion for 57
million American adults with pre-diabetes; and $623 million for
180,000 pregnancies where gestational diabetes was diagnosed. “In
individuals with pre-diabetes, we observed a significant increase
in ambulatory visits for a wide variety of medical conditions,
including hypertension, endocrine, metabolic and kidney
complications,” said Tim Dall, vice president at The Lewin Group.
“Additionally, the data show that during the two years before
diagnosis people exhibit an increase in ambulatory and
hospital-based care for diabetes-related complications.”

What’s in an image? If it is DME, it’s bad news, according to
Steven T. Behm of the Edelman Company, a public relations firm that has
studied the industry. Since the beginning of the year, 800
stories, most about fraud and abuse in the industry, have appeared
across the country, three times as many as last year, Behm
said last month at Medtrade.

In a move expanding its partnerships with health plans,
The Scooter Store recently announced agreements with
17 insurance companies to provide power wheelchairs and scooters to
nearly 7 million people. To date, the New Branufels,
Texas-based provider has more than 125 partnerships with health
plans that cover in excess of 160 million people. Some of the
company’s new contracts, which include Medicare Advantage plans and
Medicaid programs, now offer power wheelchairs and scooters to
3,900,000 health plan members in Ohio, 600,000 in Northeastern
Pennsylvania, 700,000 in Washington, 565,000 in Michigan and
340,000 in New York. Other contracts provide coverage for an
additional 475,000 members in states such as New Mexico, Oklahoma,
Minnesota and Texas.

Last week, CMS reported its 2007 national composite error
rates for Medicaid and the State Children’s Health Insurance
Program. The agency reported $32.7 billion in improper Medicaid payments for
FY 2007, or about 10.5 percent of all Medicaid payments, with an
$18.6 billion federal share. For SCHIP, the rate is 14.7 percent,
or $1.2 billion, with a federal share of $800 million. CMS said the
vast majority of Medicaid and SCHIP errors are due to inadequate
documentation; providers either did not submit information to
support their claims or did not submit additional data when
requested. Other errors are due to services provided to
beneficiaries who were not eligible for either program or who were
not eligible for the services rendered. Due to “aggressive efforts
to reduce payment errors,” CMS also said the Medicare
fee-for-service rate has declined from about 14 percent in 1996 to
the 2008 rate of 3.6 percent.