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.