Issue link: https://read.dmtmag.com/i/45026
16 Editorial F YOU'RE LIKE ME, and you fol- low the Medicare Market Marker on our Databank page each month (partly because I have to put it together, but mostly because I find it interesting), you probably raised an eyebrow while reviewing the last few issues. For K0823, your standard power wheel- chair, the number of allowed beneficia- ries has spiked. In Region C (why haven't we changed that to Jurisdiction C, by the way), that number increased from 5,411 (February) to 9,498 (March) to 12,525 (April). This month: 16,748 (May). See for yourself on page 46. Wow, right? But before you get the wrong idea. Let me rephrase that: Before CMS gets the wrong idea, let's think about this. Is there some- thing that happened in January that would cause the number of allowed beneficiaries for K0823 to skyrocket? Well, starting Jan. 1, the first-month purchase option was eliminated for all stan- dard power wheelchairs. That means they're 13-month capped rental items. That means, as I understand it, pro- viders must bill Medicare for each month a beneficiary is using a stan- dard power wheelchair up to 13 months. And that means that same beneficiary is counted each month, instead of, when there was a first-month purchase option, only once at the time of purchase. Hopefully, you noticed the disclaimer that we've added to the K0823 graph. Let me WWW.HMENEWS.COM / NOVEMBER 2011 / HME NEWS Behind the numbers I LIZ BEAULIEU the top 10: ■ Lincare: $768,992,664.25 ■ ■ ■ Liberty Medical Supply: $413,452,040.96 Apria Healthcare: $363,338,898.14 Accredo Health Group: $297,071,641.75 ■ KCI USA: $175,169,539.48 ■ Lincare Pharmacy Services: $173,265,531.59 ■ Walgreen: $162,534,861.98 ■ ■ ■ DEGC Enterprises (U.S.): $159,606,461.96 Braden Partners: $101,216,185.32 Hanger Prosthetics & Orthotics: $94,266,353.21 HME LETTER TO THE EDITOR H Hail the French AVING LIVED and traveled in both France and other parts of Europe for several years, I believe that what we Ameri- cans think of as "cutting edge" reform and tools have been in place overseas for decades (See "CMS takes new approach to fraud," HME News, August 2011). Our government must very quickly revamp the current archaic system of Medicare and reimbursement. American private insur- ance companies are gouging the public with little coverage and huge premiums, which continue to rise without any effective government oversight. There's a lot we can learn from the French. The French system is not what most Americans imagine, says historian Paul Dutton at Northern Arizona Univer- sity, author of "Differential Diagnoses: A Comparative History of Health Care Prob- lems and Solutions in the United States and France." "Americans assume that if it's in Europe, which France is, that it's socialized medicine," he says. "The French don't con- sider their system socialized. In fact, they detest socialized medicine. For the French, that's the British, that's the Canadians. It's not the French system." France relies on both private insurance and government insurance, and people generally get their insurance through their employer. The advantage is that everyone in France has healthcare coverage. Unlike in Britain and Canada, there are no waiting lists to get elective surgery or see a special- ist, Dutton says. He says the French want pretty much the same thing as Americans: choice and more choice. The French national insurance program is funded by payroll and income taxes. Phy- sicians have a choice to work outside this system, serving patients who are willing to pay out of pocket. When someone goes to see a physi- cian, the national insurance program pays 70% of the cost. Most of the other 30% is paid by supplemental private insurance, which almost everyone has. It's affordable, and much of it gets paid for by a person's employer. Despite what appears to be a costly sys- tem, data suggest that the United States spends more than twice on healthcare per capita than most Western European countries. The system that CMS is talking about as "cutting edge," being the introduction of a swipe card for each beneficiary, has been used in Europe in one form or the other for decades. I sure wish that we get such a system in place real soon. Wouldn't it be wonderful for beneficiaries and medical providers alike to simply swipe the card and access the CMS or private insurance databases, establish benefits and eligibility, dispense the necessary service/product and get paid promptly? Each medical provider will be responsible for keeping the neces- sary physician order forms, etc. CMS can perform random audits to ensure that fraud and abuse are kept to a minimum. I'm afraid that if we don't act fast, we will see the number of medical providers across the country cut in half in less than five years. The beneficiaries, mainly the elderly needing the most care, will be the ones paying the price. HME – Med Fadel, CEO, BetaMED, Inc., Bryan, Texas rephrase that: Hopefully, CMS noticed the disclaimer. It says: On Jan. 1, 2011, standard power wheelchairs, includ- ing K0823, became 13-month capped rental items, meaning what was billed once is now billed as many as 13 times. I'm going to keep an eye on this, and I'm sure CMS will, too, but as far as I can tell, there's no need to investigate further. Case closed. TOP PROVIDERS In our December issue, we'll publish our 2011 State of the Industry report. Part of that report: the top 100 suppliers of DMEPOS by amount allowed for 2010. You'll have to wait until December for the entire list, but here's a sneak preview of PUBLISHER Rick Rector rrector@hmenews.com EDITOR Liz Beaulieu ebeaulieu@hmenews.com MANAGING EDITOR Theresa Flaherty tflaherty@hmenews.com ASSOCIATE EDITOR Elizabeth Deprey edeprey@hmenews.com CONTRIBUTING EDITORS John Andrews Jennifer Keirn EDITORIAL DIRECTOR Brook Taliaferro EDITORIAL & ADVERTISING OFFICE 106 Lafayette Street PO Box 998 Yarmouth, ME 04096 207-846-0600 (fax) 207-846-0657 ADVERTISING ACCOUNT MANAGER Jo-Ellen Reed jreed@hmenews.com ADVERTISING COORDINATOR Heather Pagano hpagano@hmenews.com MIDWEST SALES OFFICE Steven Loerch 847-498-4520 (fax) 847-498-5911 PRODUCTION DIRECTOR Glen Halliday ghalliday@unitedpublications.com REPRINTS For reprint information on orders of 500 copies or more, please call David Einziger at PARS 212-221-9595 x.407, david.einziger@parsintl.com ART CREDITS Steve Meyers: cartoon SUBSCRIPTION INFORMATION www.hmenews.com/subscribe HME News PO Box 1742 Lowell, MA 01853-1742 978-671-0449 Publishers of specialized business newspapers including HME News, Security Systems News and Security Director News. Producers of the HME News Business Summit. PRESIDENT & CEO J.G. Taliaferro, Jr. VICE PRESIDENT Rick Rector