Helping Shape Healthcare Change

• By Ted L. Jones, Jr.
• Jan 01, 2009

How the industry can help the incoming Obama administration reform healthcare

There is a great deal to speculate about our nation’s current economic climate and the impact to be felt by the Homecare industry, along with the movement for change driven by President-elect Barack Obama’s healthcare transition team.

That team’s leader and the next head of Health and Human Services (HHS) Senator Tom Daschle (see News, Trends & Analysis, page 8) is preparing to take on the challenges of reexamining and implementing healthcare change by first ensuring a smooth transition of the current health care system in a way that leaves no gaps or dropped balls.

This is necessary to ensure continued coverage and services during the administrative hand-off from the Bush administration to the Obama administration. Proactively transitioning the United States into an era of universal healthcare, which is yet to be defined, we all can play an active roll going forward to paint a picture of what that system will look like.

Reform Minded

Senator Daschle’s background as the former Senate Minority and Majority leader make him well suited to handle the discussions and debates to come, namely over what universality will look like for business owners, consumers, seniors and average Americans.

Senator Daschle and his transition team have been reaching out to get input from industry leaders, workers, families, and seniors, listening intently about the direction Americans want for health coverage.

Reform has been a passion of Senator Daschle’s as he has authored several articles and has co-authored a book, “Critical: What We Can Do About the Health-Care Crisis,” concerning the issues within healthcare, such as quality and access to care, reimbursement issues, and reduction of fraud, waste and abuse.

The Industry’s Agenda

So what can the homecare industry tell Senator Daschle about what it would like to see for the future of homecare? Here’s what I’ve heard over the past three years:
•    Eliminate competitive bidding entirely, and return the lost tax dollars spent on the implementation of the unsuccessful plan to the system.
•    Reward small providers who put the community first, by protecting their businesses from giant retail chains. Monopolies don’t provide choice, service or improve access to care.
•    Remove the cap on oxygen; listen to the providers who care for beneficiaries who say a cap is a bad idea.
•    Improve the reimbursement structure for HME providers who have uncompensated responsibilities for transportation (product delivery, set up and service), insurance and fuel costs, staffing certified professionals, and other uncompensated overhead.
•    Improve the way CMS identifies and eliminates fraud, waste, and abuse; get rid of the opportunistic MD’s, HME owners and marketers who pray on seniors with get rich quick schemes, that rob us all through fraudulent billing and theft of much needed equipment benefits from patients.
•    CMS should work to become proactive with real-time claims adjudication rather than working reactively when they notice a blip of the radar. In most cases, the money has already been spent and the crooks are long gone by the time they identify an issue.

These issues are just the tip of the iceberg, but constitute the concerns of a majority of legitimate HME owners across the country. It’s time for the government to wake up and cut the red tape that paralyzes its ability to improve CMS for patients and providers. The system will not self-correct; it takes intervention.

Blindly slashing services such as oxygen may save dollars in the short term, but ultimately it will cost the government more if providers find it impossible to carry the burden of the service without financial support; ultimately some will make the business decision to stop providing oxygen services altogether. The losers in this situation are the patients, suffering from respiratory diseases, who find it difficult to locate providers who can provide the best service; a good provider is typically one who has the appropriate capacity, time and resources to do the job correctly.

What you can do.

If you find your business being placed under immense strain by the current changes rolled out by CMS, then now is the time to speak up, collectively and individually for appropriate solutions.

Speak out against those suppliers and physicians in your communities that are committing fraud, report them and provide the necessary assistance to authorities to aide in the removal of these individuals. Not doing so has brought us to the current situation, where costs are skyrocketing for CMS and mass distrust of the HME industry.

Contact the next HHS leaders and voice your opinions about what works and what won’t. Your government needs your help to understand what is happening under its nose. Remember CMS is in a virtual vacuum unable to see the true nature of the forces that are causing spending to go through the roof.

Identifying Fraud

Some of the scams that need to be rooted out are:
•    Theft of Medicare beneficiary identification numbers. This happens in a couple of ways. Either staff in medical offices are selling beneficiary information, or lists are available for purchase of beneficiary social security numbers
•    Suppliers are billing for items never purchased or distributed. They might offer alternatives to service in exchange for things such as food, clothing, manicures/pedicures or transportation around town for the elderly. Or they might fraudulently bill on a regular basis for equipment accessories, such as wheelchair batteries, anti tippers, elevated leg rests, and seat cushions, with full knowledge that this is fraud.
•    In the Medicaid programs, diapers are a big problem in that some providers are not supplying them at all. Yet they continue to bill for these items each month without fail. They then turn around and sell the items to third parties for additional profit. The third parties then distribute the items to beneficiaries for a net gain by bypassing the manufactures and then bill Medicaid.
•    Marketers often come into town and set up “Tupperware parties” where patients are brought to someone’s home where they are worked up by a physician with bogus conditions and then they have a team of “Chart artist” who create false patient records that are sold to crooked suppliers who then bill for the services for a profit. Meanwhile the patients attending the “party” never receive the items nor are the items ever purchased from a manufacturer.
To improve the outlook on homecare it’s going to require all of us to step up to the plate and do something about the No. 1 problem plaguing CMS: fraud. You can contact CMS to report abuse in your communities, and you should continually let your opinions be know be telling your story at change.gov.

This article originally appeared in the January 2009 issue of HME Business.