Issue link: https://read.dmtmag.com/i/50323
Rx and Specialty 26 Providers 'Medicare is dying' RN Plus shuns Medicare in favor of managed care BY THERESA FLAHERTY, Managing Editor SAN ANTONIO – Provider Tony Davila's revenues are down from last year, but he's doing just fine, thanks. That's because the president of RN Plus Medical Supplies has actively started pursuing managed care contracts. The result: Medi- care now comprises about 20% of his business, compared to 100% a year ago. "I have dry erase boards with the payers we are targeting," said Davila. "We are showing them how we can save them money." RN Plus offers diabetes and incontinence supplies, and thera- peutic shoes. It's the shoes that have the man- aged care payers taking notice. That's because properly fitted shoes and custom inserts can go a long way toward preventing diabetic foot amputations, said Davila. "A little abrasion on the foot can cause an avalanche of clinical issues," said Davila, a pedorthist. "The managed care organizations WWW.HMENEWS.COM / JANUARY 2012 / HME NEWS know (spending money on preven- tative measures) might prevent a $50,000 amputation. Medicare's (attitude) is 'We can't spend any more money.'" RN Plus currently fits between 80 to 100 pairs of shoes per month—down from 125 pairs a year ago. Reimbursement is also lower than what Medicare pays but, despite the decrease in income, there's an upside, said Davila. "I don't have to jump through all these hoops to obtain physician documentation," he said. "Medi- care has gone overboard with doc- umentation. It's a much smoother program." HME providers eyeing "alterna- tive contracts" can be successful, says industry consultant John All- man, but they need to set realistic goals. "They have to start small," he said. "There are lots of smaller local and regional players they can work with. They are not going to be Apria and get a nationwide deal." For Davila, managed care is the wave of the future. "Medicare is dying," he said. HME AOPA CONTINUED FROM PAGE 25 patient go see the physician," he said. "The physician absolutely has to be involved, but there's a reason the physician is referring the patient to the prosthetist." Since the release of the OIG report, there's been an uptick in audits for lower limb prostheses, said McTernan. "The DME MACs are recouping monies based solely on the phy- sician documentation," he said. "There can be pages and pages of good quality progress notes in the records of the prosthetist, but they are ignoring that." AOPA agrees that physicians have the ultimate responsibility for patient care, but the effect of the OIG report was to significantly downplay the role of prosthetists. "Prosthetists aren't standing behind a counter handing over legs to patients," said McTernan. "There's a certain amount of skill, knowledge and expertise that goes into a proper fit." HME DIABETES CONTINUED FROM PAGE 25 wound care center, as speakers for the event. The result was a schedule of educational sessions on topics ranging from foot care to healthy eating tips. "This was a nice way to present ourselves as a resource, rather than just an equipment provider," said Mooradian. "There's a lot of things we bring to the table." The first 50 participants received gift bags filled with product sam- ples, like socks and lotion, which were donated by manufacturers. Although the main focus of the event was to make people aware of the local resources available to them, it was also a good way for people to learn more about HSS, said Mooradian. "People are not just going to stop in our showroom and check us out," he said. "Our most effec- tive form of advertising is actually inviting people to the store and seeing all the different ways we can help them." HME