CMS Defines Durability

CMS defines durability

Industry's initial reaction: 'We don't see a need for it'

By Liz Beaulieu, Editor HME News - 07.15.2011

WASHINGTON - How long should durable medical equipment last? Three years, according to CMS. In a proposed rule published in the Federal Register July 8, CMS floats the idea of "a 3-year minimum lifetime standard for items to meet the durability criterion for DME." Currently, Medicare policy states only this: "An item is durable if it can withstand repeated use." "Our initial reaction is we don't see a need for it," said Cara Bachenheimer, senior vice president of government affairs for Invacare. "If an item isn't a supply or isn't disposable, it's clearly durable. This seems rather arbitrary." CMS states in the rule that the Department of Commerce, as well as various dictionaries, encyclopedias and economics textbooks, use three years as a benchmark for durable goods. Industry stakeholders aren't sure why CMS is looking to further define durable, but they suspect it has something to do with savings. If it's in writing that DME must last at least three years, then the agency may be able to save on repairs and replacements, they say. "They're looking for savings in every nook and cranny," said Julie Piriano, director of rehab industry affairs for Pride Mobility Products. Initially, there was confusion over whether CMS is seeking to change the reasonable useful lifetime of DME from five years to three years. But the rule states: "It is important to note that the 3-year minimum period of durability does not replace the RUL standard." "This proposed rule deals with coverage criteria," Bachenheimer said. "The RUL deals with payment criteria." As is often the case with proposed rules, industry stakeholders say the devil is in the details. Of the impact, CMS states: "The revised regulation would provide clear guidance to CMS and other stakeholders for making consistent informal benefit category determinations and national coverage determinations for DME. It would assist manufacturers in designing and developing new medical equipment to have a better understanding of how long a period of time an item must be able to withstand repeated use to be considered DME for Medicare purposes." "It would have an impact; we're just not sure what kind of impact yet," Piriano said. CMS will accept comments on the rule until Aug. 30. To comment, go to http://www.regulations.gov. The agency plans to respond in a final rule on Nov. 1. Article written by HME News.

Traveling with Oxygen

Travel Oxygen Top 5 Tips

1. Planning is key. Don’t purchase an airline ticket without first knowing the oxygen policy of your preferred airline. Know that some airlines DO provide oxygen during some flights, not all. Know that the airline will only provide oxygen on the plane, NOT at the airport. A Gate Pass can be obtained for someone to escort a person using oxygen at the airport. Don’t be discouraged about having to setup arrangements for your travel oxygen needs. Traveling with oxygen can definitely be accomplished, with the proper planning.

2. Always travel with a copy of your prescription for oxygen as well as any other medication. If you are in need of additional equipment, you will be ready. Be sure to have multiple copies, just in case.

3. If you are relying on a company to deliver oxygen equipment to you when you arrive at a specific location at a specific time, be sure to get it in writing. Have a 24hr contact name and telephone number ready in case you can not locate equipment, or if additional service is needed.

4. Be educated on the oxygen equipment that is available to you. If you have never used Liquid Oxygen before, learning how to fill a portable unit from a reservoir in your cabin on the first day of a cruise is not the time to do so. If you are traveling internationally, know exactly what’s available to you and where to get it. In Italy, for instance, Liquid Oxygen is the most common equipment. Talk to your local oxygen provider about education on Liquid Oxygen prior to traveling to Italy. When using a Portable Oxygen Concentrator, know that if you’re not plugged into a wall or car outlet, you must only rely on battery power. Having enough batteries for your trip is vital.

5. Always consult your physician prior to traveling with oxygen. Flying and traveling to higher altitudes can affect the way you use therapeutic oxygen.

It's time to pull off the band-aid, eat our peas.

HME 'Very, Very Vulnerable' as Debt Talks Drag On

Jul 12, 2011 12:03 PM

WASHINGTON — As the Aug 2. debt ceiling deadline creeps closer, President Obama and congressional leaders continue to debate the issue, and industry stakeholders continue to watch and worry that cuts to HME remain on the table.

A "grand" deal to reduce the deficit and raise the debt ceiling seems to have left the building in weekend talks. As part of the deal, press reports said, Obama was ready to raise the Medicare eligibility age in exchange for a raft of new revenues. The president had previously proposed applying DME competitive bidding rates to Medicaid.

But Democrats don't want the president, or anybody, messing with the entitlement programs, and Republicans say raising taxes isn't an option. At a press conference yesterday, Obama said of the budget talks, "It's time to pull off the band-aid, eat our peas."

What will happen as the economic calamity looms and the high-level talks focus on health care spending is anybody's guess, according to Cara Bachenheimer, senior vice president of government relations for Invacare.

"There are really very few people involved in making these decisions," Bachenheimer said Friday. "We're not sure what will turn out."

Even so, as the discussions go on, "there are numerous reports that home medical equipment is vulnerable to further hits from both Republicans and Democrats," AAHomecare told members last week.

Any new cuts "would come on top of a decade of slashing that has totaled between 40 to 50 percent for the home medical equipment sector," the association reported. "Further reductions to Medicare payments before the current cuts are fully in effect will create access and quality issues and weaken the home care infrastructure in the United States."

Call senators and representatives and "Tell Congress 'No cuts to home care!'" AAHomecare urged providers.

Stakeholders in other health care sectors are worried, too. Hospitals have begun a national ad campaign protesting any payment cuts and showing how they could result in overcrowded emergency rooms and reduced access. A July 4 article in The New York Times said a hospital coalition would spend up to $1 million a week through the summer on the ads. Nursing homes and drugmakers are also braced for cuts.

"I think it's safe to assume that we are very, very vulnerable," said Bachenheimer. "But so is everybody else."

Patients, Providers File CMS Bid Program Complaints

We have received hundreds of complaints about the Medicare “competitive” bidding program for home medical equipment (HME). This program is fatally flawed and unsustainable. The program is designed to eliminate more than 85 percent of HME providers in any area in which it is run, and patients are being harmed because they do not have access to the appropriate products and services they need.

• Read the summary of bid complaints
• Learn more about H.R. 1041

Fear factor: Will lawmakers target HME as part of Medicare cuts?

Fear factor: Will lawmakers target HME as part of Medicare cuts?

'Everything is potentially on the table'

By Theresa Flaherty, Managing Editor, HME News - 07.01.2011

WASHINGTON - So far, there's no word on whether Medicare spending for HME is part of heated discussions on Capitol Hill about raising the debt ceiling and cutting costs, say industry stakeholders. "It's all closed door discussions," said Cara Bachenheimer, senior vice president of government relations for Invacare. "The problem is, they are looking for money and everything is potentially on the table. We just don't know anything at this point." In a speech June 29, President Obama said Medicare and Medicaid cuts could be part of a deal to raise the debt ceiling. Also last week, Inside Health Policy reported that Medicaid cuts are on the table, including capping durable medical equipment payments at competitive bidding rates. Just because nobody knows for sure what will happen, doesn't mean HME providers should sit back and wait, says Walt Gorski. "HME suppliers should be on high alert and reaching out to members," said Gorski, vice president of government relations for AAHomecare. "The HME community has taken a number of very significant cuts over the past five or seven years and additional cuts will threaten the ability of providers to keep people in their homes." With lawmakers focused on the debt ceiling, it will be difficult to grab their attention on industry issues like competitive bidding, stakeholders admit, but it's important to push on. In Chicago last week, members of the Illinois Association for Medical Equipment Services called on eight congressmen--back home for recess--to seek support for H.R. 1041. "We've got to keep up the momentum on H.R. 1041 so we can get the Senate to pick it up," said John Gallagher, vice president of government relations for The VGM Group, who attended the meetings. "Right now, they are focused on the debt ceiling, but that will end between now and August, and then lawmakers will go on recess and start campaigning. That's our time to get in front of all those folks." Article written by HME News.