Tuesday, April 2, 2013

How to?

There are about 450 Electoral Districts in the United States and the citizens of each elect their representative. Most legislation start in the House and then go to the Senate before they can be passed.

I live in District 15 in Florida whose representative is Bill Posey, and we have some very active DME providers. They arranged to meet Congressman Posey’s Director of Community Relations, Pam Gillespie. A date was chosen and to everyone’s surprise Rep. Posey met with us (the providers invited me to attend). Stuart Burns, his Chief of Staff in DC, was on the phone for the entire meeting.

The providers came to discuss how Part 1 of the Competitive Bid failed and what Part 2 would create when it is activated. The dealers spoke of how the threatened reimbursement reductions would force many to close their doors. The new reductions are often less than the dealer’s cost of the product.

Senior citizens, patients and their family caregivers were greatly affected by Part 1. They were unable to get supplies and care locally from the dealers who have been their source (and friend). A number said they had to do without what was ordered, because it was too difficult for them to seek products at other locations.

Reimbursements have to be in a range based on things like quality, etc., not one price.  The dealers then explained how fraud and abuse has created this monster. There currently aren’t standards. Patient walkers range in price. The difference between a Lumex and an offshore knock-off is tremendous. The reimbursement schedules should reflect not only the price. The cheaper units will not last very long, and often break or even injure the patient. I repeat, providers and dealers have to be reimbursed based on standards and quality!

There are no requirements to become a DME/HME provider. A pharmacist, nurse, physician, dentist, therapist, and all other health care professionals must have a license or a degree in their specialty. Our industry is taking a giant step toward that accomplishment with the accreditation program.
Unhappily, CMS and Congress have not recognized accreditation. To be effective, accreditation must have teeth. Only when providers earn it will be able to participate in both Medicare and Medicaid. If a dealer is found to be dishonest, his certification can be revoked. Otherwise they would be unable to participate in Medicare.

When a crook is caught selling drugs, playing numbers, or other crimes, they go to jail. But when the quick-buck operators are found to be sending phony bills they are closed and may be fined. This is a lot better than prison! I read in my local newspaper when several “companies” were caught, the principals went back to Croatia with millions of dollars.

When asked, CMS told us it would be too expensive to prepare standards and they did not see the need to have inspectors. They could not absorb the cost, but the fraud and abuse is taking out so much more. The good health, the care and welfare of the recipients, patients, senior citizens and family caregivers are not a consideration to them.

I know this is rather time consuming, but in order to survive we must all get involved and work diligently to maintain our industry and profession.

Please make an appointment to see your representative.

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