Double Standard

• By David Kopf
• Oct 01, 2008

Some providers of home medical equipment are more equal than others.

It’s good to know that the Centers for Medicare & Medicaid Services doesn’t have an agenda when it comes to the HME industry. Truly, CMS regulates (or is that “reigns over?”) all things healthcare with a wise, even hand, seeking what is best for patients, providers and taxpayers alike.

And if you believe that, I have some ocean-front property in Idaho that I’d love to sell you.

No, equity and fairness are words that probably don’t get mentioned much at CMS’s headquarters. Take the recent ruling by CMS that physicians, therapists and other healthcare providers that also can provide HME do not have to obtain accreditation in order to continue billing Medicare for that equipment.

It’s as though CMS Acting Administrator Kerry Weems, said, “Okay everybody in healthcare has to get accredited if they want to keep billing us for HME.

Except for physicians. And occupational therapists. And speech pathologists. Oh yeah, and physician assistants, certified registered nurse anesthetists, and clinical social workers, too. ... Hmm ... that just leaves, you, HME providers.”

Its nice to know you’re wanted, I guess, but the fact that this happened after CMS got its hat handed to it when H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, passed through Congress with a veto-proof vote, thus delaying CMS’s clearly flawed competitive bidding program, speaks volumes to me.

Start Making Sense
Why shouldn’t these other providers be held to the same standard? If accreditation ensures quality service and helps fight fraud, why exactly should it be limited to HME providers? A casual Internet search of “Medicare fraud” and “doctor” will yield story after sleazy story of doctors pulling a fast one on the taxpayer.

It’s as though CMS is trying to win the “mother of all double standards” award in some kind of twisted Olympiad for bureaucrats.

But these days, double standards like CMS’s accreditation dispensation seem to be the order of the day. At the same time CMS targets HME, the Federal government is handing out countless billions of taxpayer dollars to investment and banking firms that nearly scuttled our economy by engaging in financial practices that went beyond the “ill advised” category, and straight into “what are you, nuts?” territory.

Yet, CMS still sets its accreditation sights on HME providers as if an industry that makes up less than 2 percent of its budget is the central source of Medicare fraud.

Strength in Numbers
Fortunately, providers are tough, and tough people know how to band together and fight back. Just look at buying groups. As this issue’s cover story, “MSOs: All for One” (page 28) shows, buying groups have evolved from just group purchasing into member service organizations that do everything from providing professional education to provider to helping them mobilize in the face of adversarial regulation.

Another great example of how providers get tough in the toughest of times is the industry’s recent response to hurricanes Gustav and Ike (read more on page 8). Providers and associations across hurricane-struck states sprang into action to help ensure their patients had everything they needed. I know I join everybody in the industry in congratulating them on a job well done.

Fortunately, it’s not always a cataclysmic weather or regulatory event that brings providers together. October’s Fall Medtrade show is just around the corner. If you’re eagerly awaiting the date, or if can’t see the show in person, we’ve collected a sneak preview of Medtrade Fall starting on page 14. And if you can make it, I hope to see you there.

This article originally appeared in the October 2008 issue of HME Business.