Moving the HME Industry Forward

Legislative/Advocacy

AAHomecare in Action – Importance of OIG Patient Access Study

February 16, 2015

WASHINGTON, DC – Last Thursday, eleven AAHomecare staff members and industry stakeholders met with the HHS Office of the Inspector General (OIG) to discuss their upcoming study on the CMS competitive bidding program and the effects on patient access. The group discussed the goals for the OIG report as well as the methodology that has been used in previous reporting on access and utilization rates.

AAHomecare shared examples of how CMS requirements make the process of acquiring or supplying necessary home medical equipment extremely burdensome and have caused many patients to start paying out of pocket for the supplies they need. The HME community knows that this is not a positive shift for many of the patients that can’t afford to do so.

The importance of the upcoming OIG study was amplified when a survey on limited access to insulin pumps and testing strips for diabetes patients was published by the American Association of Diabetes Educators. According to their research, beneficiaries reported difficulties in finding providers with the supplies they needed or the replacement equipment for the insulin pump systems they were already using.

“We in the HME industry know the situation is much more complicated than simply stating providers are not carrying the necessary supplies,” said Kim Brummett, AAHomecare vice president of regulatory affairs. “Low-ball bidding has made it impossible for honest suppliers to carry certain products when the reimbursement rate is lower than the cost of the product, and documentation requirements from Medicare make the process difficult. This is a problem many AAHomecare members are well acquainted with.”

“It is our strong belief that the results of the OIG study will reflect that patient access is affected by competitive bidding. CMS wants to go with the line that it is good that oxygen claims are decreasing. But the truth is that COPD diagnosis has increased over the years, so how are those patients getting serviced?” said Tom Ryan, AAHomecare president and CEO. “Competitive bidding not only hurts businesses by eliminating healthy, real competition, it also hurts patients.”

AAHomecare Group Meets with CMS CERT and RAC Teams
WASHINGTON, DC – Last week, Kim Brummett (pictured), vice president of regulatory affairs, Mina Uehara, regulatory affairs associate, and members of the AAHomecare Regulatory Council, met with staff at CMS to discuss audit issues. The group met with both the CERT Oversight team and the RAC Oversight team.

The CERT team was very engaged in discussing the error rate and ways AAHomecare can be more involved in an effort to drop the rate. A follow-up meeting has already been scheduled to address this.

In their discussion with the RAC team, the group shared information on how the current RAC improvements impact suppliers. AAHomecare also asked how audits will be impacted due to the protest by Performant Recovery, Inc. regarding the RAC being awarded to another contractor. CMS responded that the RAC audits will continue as normal, and will not be halted due to the protest.