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."