AAHomecare Says Story Causes Irreparable Harm to DME Manufacturers and Providers
WASHINGTON, April 8, 2013 /PRNewswire-USNewswire/ -- The following letter was released today:
Mr. Gary Pruitt
President and CEO
Dear Mr. Pruitt:
We are very disappointed in the AP's reporting on a recent story about power scooter sales and believe that a correction, or at a minimum, a clarification is warranted. The story, which has appeared in media outlets worldwide, contains incomplete and misleading information in two specific areas. We strongly believe that if left uncorrected the perceptions created could do irreparable harm to the manufacturers and providers of power mobility equipment.
In the first instance, the story talks about "a nearly $1 billion U.S. market for power wheelchairs and scooters." While the need for power mobility devices, which include both power wheelchairs and scooters, has increased, Medicare expenditures have decreased significantly. In 2006—the year of highest spending on power mobility—Medicare spent just over $1.1 billion on these items. In contrast, Medicare spent only $397 million on power mobility in 2011. The story then makes references to Medicare, leaving a strong impression on readers that Medicare is paying for scooters that are unnecessary and that taxpayer dollars are being misused. However, that is far from the truth. In fact, utilization records from the Centers for Medicare & Medicaid Services (CMS) clearly show that scooters account for a mere two percent of all power mobility devices received by Medicare patients.
Secondly, the story says, "Government inspectors say up to 80 percent of the scooters and power wheelchairs Medicare buys go to people who don't meet the requirements." This statement comes from a July 2011 report from the U.S. Department of Health and Human Services Office of Inspector General (OIG). The OIG took the liberty of including "claims that lacked sufficient documentation" in the same category with those that they say didn't meet medical necessity requirements. Perhaps they were chasing headlines, because combining these two very different conditions badly overstated the facts. A close reading of the OIG report reveals that medical necessity was actually only questioned on nine percent of the claims for power mobility devices that were reviewed in 2007. Of that nine percent, seven percent simply needed a different type of power wheelchair, while only two percent needed a less expensive piece of equipment. The 80 percent figure is clearly tainted.
Furthermore, many claims do not meet requirements because the CMS documentation system is subjective, haphazard, and inconsistent. Through AAHomecare, the industry has been working to address the documentation error rate:
- developed a clinical medical template with the help of providers and physicians that outlines all the mandated requirements established in CMS' coverage policy;
- encouraged CMS to provide additional education to physicians and providers on documentation and coverage requirements; and
- supported and lobbied for an effective and efficient prior authorization program to fix documentation errors prior to CMS paying claims.
The recent OIG report on the CMS handling of surety bonds should alert the media and Capitol Hill to the management lapses at CMS that are impacting Medicare beneficiaries and DME providers. The AP story has done a disservice to Medicare beneficiaries, as well as the DME providers who are dedicated to assisting some of the most vulnerable people in our society. We call on the AP to correct the public record, and provide more comprehensive reporting in the future.
Tyler J. Wilson
American Association for Homecare (AAHomecare)
1707 L Street, NW, Suite 350
Washington, DC 20036
The American Association for Homecare represents providers of home medical or durable medical equipment and services who serve the needs of millions of Americans who require prescribed oxygen therapy, wheelchairs, enteral feeding, and other medical equipment, services, and supplies at home. Visit www.aahomecare.org.
SOURCE American Association for Homecare