Issue link: https://read.dmtmag.com/i/48253
News 4 HME NEWS / DECEMBER 2011 / WWW.HMENEWS.COM NEW STUDY HME saves billions 'The return is so much greater than the dollars CMS is trying to save' BY JOHN ANDREWS, Contributing Editor ATLANTA – A new study that shows how the HME industry can save Medicare billions of dollars should have CMS, Congress and the general public intrigued and excited, its chief analyst says. Brian Leitten, a Flor- ida-based consultant who, with the help of The VGM Group, spent four months compiling data to make "The Case For Medicare Investment in DME," told Medtrade attendees in October that CMS needs to "invest" in home medical equipment because it can save Medi- care billions, along with generating hand- some ROI for the program. To illustrate his point, Leitten presented cost savings figures for the mobility, respi- ratory and sleep therapy business segments. For mobility, the study looked at the impact of falls on the healthcare cost bur- den and came up with a staggering number: $20.5 billion. That figure represents how much beneficiary falls cost Medicare and the healthcare industry each year, he said, as falls cause severe injuries, resultant sur- geries, extended acute care and sub-acute care stays. In calculating expenditures vs. savings, Leitten concluded that mobility saves Medicare $10.73 for every $1 dollar it invests and that the $1 invested is returned to Medicare in just over five months. The study makes the same assertions for Brian Leitten says CMS needs to "invest" in HME. respiratory therapy on COPD patients— an annual savings of $7.4 billion to $13 billion, and savings of about $6 for every $1 invested with a two-month payback of that dollar. CPAP therapy saves Medicare nearly $11 bil- lion by preventing the sleep apnea complica- tions of coronary disease, congestive heart failure, atrial fibrillation and stroke, according to the study, which did not measure the other co-morbidities of hypertension, obesity and diabetes. CPAP's return on investment for Medicare's $1 investment is $6.21. "These findings should be intuitively obvious to the casual observer," Leitten concluded. "The return is so much greater than the dollars CMS is trying to save." HME Stakeholders find new ways to connect with beneficiaries BY THERESA FLAHERTY, Managing Editor YARMOUTH, Maine – Industry stakeholders have ramped up efforts to get beneficiaries involved in the fight against competitive bidding. At Medtrade in October, the Accredited Medical Equipment Providers of America (AMEPA) unveiled a new patient advo- cacy line (PAL) that will make it easier for beneficiaries to con- tact their lawmakers, said Rob Brant, past president of AMEPA. Callers to the toll-free number listen to a brief message about the competitive bidding program and are given an opportunity to enter their zip code. Doing so connects them to a menu of their lawmaker's offices so they can urge them to support H.R. 1041, the bill to repeal the program. "It's important to get patients involved and reaching out," said Brant. "The hardest part (now) is getting HME providers to participate and give flyers to patients." PAL is based on a similar system used by the American Medical Association. AMEPA tested the program this sum- mer in Florida and Texas, both of which have several Round 1 competitive bidding areas. With Round 2 starting, it's time to ask providers and patients CONNECT SEE PAGE 8 Front of mind: BY LIZ BEAULIEU, Editor ATLANTA – What are the lessons learned from Round 1 of com- petitive bidding? Be accurate and be timely, says Mark Higley, vice presi- dent of develop- ment for The VGM Group. Mark Higley Higley outlined tips for providers in Round 2 in a jam-packed session at Medtrade in October. One tip on how to be accurate: Get a copy of your 855S form and make sure it's up to date. It sounds like a no-brainer, but Higley said a whopping 40% of providers who submitted bids for Round 1 were disqualified due to clerical errors on the enrollment form—things like the wrong name or the wrong social security number. Providers can be timely by doing things like figuring out who will FRONT OF MIND SEE PAGE 10 CMS defines durability, industry awaits CBO score BY THERESA FLAHERTY, Managing Editor WASHINGTON – CMS in Novem- ber issued final rules related to durable medical equipment, including a finalized definition of "durability." CMS proposed defining "durability" as meeting a three-year minimum lifetime standard in the July 8 Fed- eral Register. At the time, stakeholders said they were unsure of what CMS sought to accomplish. They're still unsure. "We're still trying to sort it out," said Jay Witter, senior director of government rela- tions for AAHomecare. "The proposed rule was kind of vague, so our manufactur- ers didn't understand how it would affect their equipment." Initial concerns included whether redesigned equip- ment—improving the tech- nology on an existing wheel- chair for example—meant that it would have to meet the new criteria, and what the process for meeting that criteria would be. "It's still not clear what the process is," said Witter. The other rule finalized pro- visions related to competitive bidding that were included in an interim final rule released in January 2009, and the Medi- care Improvements to Patients and Providers Act of 2008. "They tied up some loose ends, but there was no new policy," said Cara Bachen- heimer, senior vice president of government relations for Invacare. "The more discon- certing thing was that CMS used it as another opportunity to talk about how great Round 1 was." HME BRIEFS Round 2 HHS finalizes ACO reg WASHINGTON – The Department of Health and Human Services (HHS) in October re- leased its final regulation on accountable care organizations (ACOs), which reflects "significant input provided by stakehold- ers, as well as lessons learned," according to a release. The regulation outlines two initiatives—the Medicare Shared Savings Program and the Advance Payment mod- el—that will help providers form ACOs. The Medicare Shared Savings Program will provide incentives for participating providers who agree to work together and become accountable for coordinating care for patients. HHS details RAC program for Medicaid WASHINGTON – The Department of Health and Human Services (DHHS) in October released its final rule for the Medicaid Re- covery Audit Program. The rule contains details like: Recovery Audit Contractors (RACs) can only go back three years from the claim date; and must employ nurses, therapists, certified coders and a physi- cian. Also: Independent auditors will be paid contingency fees out of any improper payments recovered; RAC auditors cannot audit claims that have already been au- dited or are currently being audited; and states may exclude Medicaid managed care claims from RAC reviews and set lim- its on the number and frequency of medi- cal records to be reviewed. RAC audits will begin in January. DHHS expects the audits to save $2.1 billion over the next five years. MA plans to limit coverage to specific manufacturers BALTIMORE – CMS has proposed allowing Medicare Advantage plans to limit coverage of durable medical equipment to specific manufacturers or brands, if certain condi- tions are met. In an Oct. 11 rule, CMS says MA plans could restrict coverage if they meet requirements related to access and medical necessity, transition periods, mid- year changes to preferred DME and sup- plies, appeals and disclosure of coverage limitations. The proposal is based on a 2011 policy that permits different cost-shar- ing levels for DMEPOS and Part B drugs. CMS releases two new informational booklets WASHINGTON – CMS recently released the "Items and Services That Are Not Covered Under the Medicare Program" booklet, which includes information about the four categories and services not covered by Medicare. It outlines applicable exceptions to exclusions and the advance beneficiary notice of noncoverage. A second booklet, "Advance Beneficiary Notice of Noncov- erage Part A and Part B," includes infor- mation on when an ABN should be used and how it should be completed. Both are available at www.cms.gov. AAHomecare pushes unity on bid alternative .......... 1 Good vibe at Medtrade ............................. 8 Q&A: Edward Vishnevetsky ........................ 10 Use ABNs, but don't get "punked" on audits . . . . . . . . . . 10 ■ Proposed rule to reduce regulatory burdens opens door for further discussions, says Walt Gorski. See story page 6.