Stakeholders Call Meeting with CMS’ Weems a Positive First Step

WASHINGTON–In a meeting arranged by Sen. Arlen Specter, R-Pa.,
representatives from the American Association for Homecare and
other industry stakeholders talked with CMS Acting Administrator
Kerry Weems on Tuesday, opening up a dialogue on industry concerns
that several participants called a positive first step.

According to several of those at the meeting, Weems seemed
receptive to concerns they raised about Medicare fraud, competitive
bidding, power mobility issues and threats to home oxygen. Although
Weems indicated that he thought CMS was on the right track with
competitive bidding, attendees said, he also expressed willingness
to review any information the industry could provide on possible
access problems or the need to exclude complex rehab from the
program.

“That will be provided to him as follow-up,” said Seth Johnson,
vice president of government affairs, Pride Mobility Products
Corp., Exeter, Pa.

Overall, Johnson said, it was a “very good initial meeting. He
really kept the door open on his willingness to work with us on all
the issues that we raised with him.”

“The mood was very collegial,” added Eric Sokol, executive
director of the Washington-based Power Mobility Coalition. “Not a
lot of new ground was forged, but it was certainly the
establishment of the beginning of a dialogue, and there seemed to
be reception on both sides and a willingness to listen.”

Don Clayback, senior vice president of networks for The Med
Group, Lubbock, Texas, said he “thought it was a good meeting,”
considering it was the initial meeting with an acting administrator
“who is familiar with our industry but is also dealing with a lot
of other issues, too.”

“We talked about our frustration that CMS has not taken more
measures to strengthen program integrity in Medicare and to stem
fraud at the front-end,” Tyler Wilson, AAHomecare president,
commented. “We told the Administrator that we want to collaborate
to prevent fraud from happening in the first place.”

Wilson noted that the fraud and abuse CMS encountered in Florida
earlier this year could have been prevented by site visits from the
National Supplier Clearinghouse or from accrediting bodies. Wilson
said the meeting was positive and that Weems acknowledged that
fraud is not coming from mainstream providers in the HME
industry.

According to an AAHomecare report of the meeting, the group made
several specific recommendations to Weems with respect to program
integrity:

–CMS should immediately announce a final date by which all home
care providers in Medicare must be accredited.
–Quality standards should be further strengthened. AAHomecare
recommended more stringent standards than those finalized by CMS
last year. The second draft of standards now being developed by CMS
should raise the bar for all product categories identified in the
three appendices.
–CMS should instruct staff who oversee the Medicare DME program to
spend a day with an HME provider to see how the current system
works in the real world.
–On power wheelchair issues, the association stated that new power
mobility device codes and coverage policy have reduced Medicare
spending by 27 percent. The reduction in payment rates and new
coverage policy appear to have substantially decreased utilization
of the benefit. PMD utilization is currently trending more than 30
percent below the CMS estimates of 243,000 reimbursed PMDs in 2007,
resulting in an estimated 49-51 percent reduction in total spending
for PMDs this year. The group expressed concern that the PMD policy
is harming patient access to power wheelchairs.

Specific recommendations to Weems regarding power mobility
included the following:

–Exclude product categories for standard and complex power
rehabilitative power wheelchairs and accessories from the first
round of Medicare competitive bidding.
–Create PMD policy documentation requirements and issue updated
education and training for physicians and suppliers. Clearer and
more practical documentation requirements must be developed and
communicated from CMS to physicians/clinicians and suppliers.
–Work with industry stakeholders to provide much needed clarity,
guidance and education about the Medicare documentation
requirements.

AAHomecare also pressed for a closer examination of
service-related components of oxygen therapy and said it is pleased
that CMS is not opposed to a repeal of the transfer of ownership of
oxygen equipment to the beneficiary after 36 months.

Others participating in the meeting included Alan Landauer of
Landauer Metropolitan, AAHomecare chairman; Georgie Blackburn from
Blackburn’s Physicians Pharmacy, AAHomecare treasurer; and provider
Don Bates from Fuller Rehabilitation in Ringgold, Ga.