Taking the AP to task

Tyler Wilson

Editor's note: The following is in response to a recent article written by the Associated Press and picked up by news outlets across the country.

We are very disappointed in the AP’s reporting on a recent story about power scooters 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 Wilson is the president of AAHomecare.


Why not put it ALL on the line and have the AP investigate and research the CMS Contractors that do shoddy, ineffective and substandard work while collecting taxpayors money dessimating an industry and making it more difficult for Medicare Beneficiaries to obtain the much needed and deserved healthcare?  Why NOT expose it for what it is disclosing that these contractors are operating throughout the entire healthcare system NOT just HME?

Why is this?  Because currently, the Contractors have NO fear for error.  The current system has NO penalty for shoddy work by the Contractors.  Why is this?  If you are contracting with reputable entities then they shouldn't need any veil from shoddy work.  They should be able to sufficiently perform the tasks assigned to them as every other standard of work ethic.  The current system allows for CMS to use elementary school children as "Gatekeepers" or better yet a group of "Monkeys" fed a daily alottment of bananas without any recourse.  Tell AP to investigate the minimum requirements placed upon Contractors for the personnel Contractors hire to guard the gates!

An old cliche is, the one pointing the finger is generally the guilty party.  Tell AP to investigate CMS.  As they do ALL the screaming and complaining pointing fingers they continue to disrupt the entire healthcare industry NOT just HME but ALL it's branches with inept Contractors.  Tell AP that CMS Contractors are the ones assigned to issue Provider Numbers to ALL the Providers they claim are benefactors from the practice of F & A.

Tell the truth with an unbalanced industry having rules and guidelines that affect only one side of the equation such as healthcare, chaos will remain rampant.  I have said this before currently, CMS is a "runaway train".  It is on a collision course to completely destroy the entire healthcare system as we know it.

At the end of the day after ALL this is done and the data is analyzed then see the real waste in government spending and where it is!!!




Just "Curiosity"!!  Did anyone check to see if these reported statistics were before or after the review or appeal process??