CMS said it will soon publish a cushion code policy update to be available at http://www.cms.hhs.gov/suppliers/dmepos.

Open the HCPCS Coding Process, Stakeholders Say
BALTIMORE--More players should be involved in the process for revising HCPCS codes, some health care representatives told CMS at a special Open Door Forum on the process held Oct. 27.

Last month CMS announced its plan to overhaul the HCPCS coding process, including expanding public meetings on DME coding issues to include other medical supplies and services. Other changes CMS announced include implementing an appeals process for denied applicants during the 2007 coding cycle, publishing a public notice of all preliminary and final decisions and revising the HCPCS code application form.

"There need to be more stakeholders, other people helping to make the coding decisions" such as clinicians and others with intimate knowledge of the equipment, offered Marcia Nusgart, executive director of the Coalitions of Respiratory Care, Seating & Positioning, Enteral Nutrition and Wound Care Manufacturers. The coalitions have been working with CMS to reform the HCPCS coding system for the past several years.

Jack Emery of the American Medical Association's Division of Federal Affairs said he was concerned that the process is controlled by the payer community.

A CMS spokesman responded, explaining that "there is no closed door consulting" and the agency has held public meetings so everyone has the opportunity to give input.

"We have always been more than willing to meet with, discuss with, get more information from people who come in and want to meet with us," the agency spokesman said. "But in terms of part in the decision-making process, there certainly are strict federal rules that we have to adhere to."

CMS plans to phase in the process changes over an 18-month period beginning with the 2006 coding cycle. The first change will occur with the coding application deadline, pushed up from April 1 to Jan. 3.

A number of meeting attendees, however, expressed concern that a Jan. 3 application deadline is unrealistic. CMS said the early deadline is necessary because the agency has a "tremendous workload" ahead in expanding the comment period on preliminary coding decisions.

Busy Week in Orlando at Medtrade 2004
ORLANDO, Fla.--While providers attending Medtrade 2004 said they are worried about next year's DME reimbursement cuts, they also said they are ready to replace the revenue and are optimistic about the future for their businesses.

Held Oct. 26-28 in Orlando at the Orange County Convention Center, the 25th annual show and expo, produced by Atlanta-based VNU Expositions, drew providers from across the country with 850 exhibitors and 300,000 square feet of floor space.

"We're worried about the cuts, so we're looking at ways to cut costs and increase cash sales," said Cynthia Jarman, director of operations for Alliance Medical Inc. (AMI) in Albemarle, N. C. Jarman said the HME is planning to expand product offerings by growing the company's respiratory business. She and others from the firm were also combing the show for "higher-end equipment where people will pay the difference."

"We're watching what we do and paying attention to how we're buying," said Cathy Roberts of Lech's Pharmacy, with locations in Tunkhannock and Nicholson, Pa. Roberts and the company's Lori Krukowski said they were particularly interested in new respiratory products "that can keep patients off plugs," and were searching for any new products that "can give our patients freedom and mobility."

Along with prowling the aisles for products, providers took advantage of the show's conference sessions. "I've been in business for 14 months. I haven't fallen on my face, but I know I have a long way to go," said Justin Rogers, general manager of Primary Medical Supply, Midland, Texas, at a session called "Meet the HME Experts in Sales and Marketing."

Similar "Meet the HME Experts" sessions on billing and reimbursement and legal and regulatory issues also drew crowds, as did the all-day Continuum of Care, which preceded the show on Oct. 25, a session on accreditation with panelists from JCAHO, CHAP and ACHC, and a presentation on benchmarking HME business. Other conference highlights included an account of his personal struggle with multiple sclerosis by industry advocate David Williams, author of Battling the Beast Within, a line-up of speakers at Grassroots Central and a retail design workshop for HME showrooms.

Political analyst Stuart Rothenberg delivered Medtrade's keynote address on Oct. 27. To appear with commentary on CNN's election night coverage tomorrow, the Washington insider told his audience that all presidential polls are too close to call, and that the election could be so close that it could end in a bitter legal battle.

He said seniors, "a strong voter group where health care is disproportionately more important," are making predictions especially difficult, adding that many live in states, including Florida, where electoral votes are up for grabs. Regardless, he said, Washington will remain "a tough place for a couple of years," especially for groups like HME competing to attain--and keep--government funding.

Heard at the Show
--M&A on the rise. "This industry is extraordinarily entrepreneurial, ever finding ways to conduct business and find a way through" the changes handed down by the government, said Dexter Braff, president of The Braff Group, Pittsburgh, during a Thursday morning session on mergers and acquisitions. The industry will continue to show its flexibility no matter who is elected president come election day, he said. Braff explained that despite industry uncertainty, M&A activity in the sector has risen to unprecedented levels, as buyers are under pressure to reach a critical mass and diversify to withstand government cuts, while other companies are eager to sell before their business loses value after the cuts take place.

--Days Sales Outstanding (DSOs) declines. For the 114 providers who participated in AAHomecare's annual Financial Performance Survey, DSO decreased from an average of 83 days in 2002 to 74 days in 2003. "That decrease allows [HMEs] to free up money to go into the business," said Dr. William Cron, professor of marketing at Texas Christian University, who presented the study at a Tuesday morning session.

-- Still waiting. Some providers who applied in December 2003 have yet to obtain their supplier numbers; last week, they received letters from the National Supplier Clearinghouse explaining that, because of delays caused by increased scrutiny under Operation Wheeler Dealer, their supplier number applications have yet to be processed. That's according to several providers who attended a Wednesday session held by the NSC. "I never got a letter in the mail that said I failed the site inspection," said Andrew Ross of Med-Time, based in South Florida. "I made numerous calls to the NSC and Medicare, asking what was going on. The response was, 'Your application is still in process.'" An NSC representative at the session said he would look into the issue.

Watch for a Medtrade wrap-up in the December issue of HomeCare magazine.

Report Advocates Consumer-Directed Care for People with Disabilities
WASHINGTON--Consumer-directed health options, instead of rigid long-term care programs, should be made available to more people with disabilities, according to an Oct. 25 report from the National Council on Disabilities.

The report, titled Consumer-Directed Health Care: How Well Does It Work?, stated that the government should move "from oversight of tightly defined program options to a broader responsibility ... to assess consumer needs on an ongoing basis across disability groups and age categories." These needs include, among other things, more emphasis on the government's "money follows the person" initiative ensuring that funding follows the person wherever caregiving occurs, from institutional care to home care.

The report also recommends that the government's Health Resources and Services Administration be responsible for coordinating the care of the disabled.

The NCD, an independent federal agency that works with the executive and legislative branches of government to promote the independence of disabled people, sent the report to the White House and Congressional leadership. A copy of the report is on the NCD's Web site, available by clicking here.

Paintsville Scooter Story Paints Wrong Picture of PWC Problem, RAMP Says
PAINTSVILLE, Ky.--On Oct. 22, NBC's Today Show told the story of a small Kentucky town with a large elderly population on the streets with their motorized scooters, and of the townspeople concerned about safety issues and traffic congestion the scooters cause. A mobility industry coalition responded that the story about the Paintsville scooters implied that "Medicare is the cause of the problem."

"We don't know why there may by a disproportionate number of scooters in Paintsville," the Restore Access to Mobility Partnership (RAMP), said in a statement released Oct. 25. "But we do know that across the country senior citizens and Americans with disabilities are experiencing a far different problem: Medicare benefits for power wheelchairs and scooters are being restricted."

The group, representing power wheelchair providers and manufacturers, added that "scooters are largely paid for by the users" and not Medicare.

Carilion Sells DME Business to Advanced Home Care
ROANOKE, N.C.--Carilion Health System has announced it is selling its DME business to High Point, N.C.-based Advanced Home Care, The Roanoke Times reported Oct. 27.

The regional health system said it is divesting the business because DME falls outside of its central purpose of providing health care, Carilion spokesperson Eric Earnhart told the paper last week. He added that about 60 Carilion employees will lose their jobs, but Advanced Home Care expects to have positions for many of them.

Advanced Home Care's CEO Joel Mills is past chairman for the American Association for Homecare. The sale is scheduled for Dec. 3, according to the report.

Coming Up
The Joint Commission on the Accreditation of Health Care Organizations (JCAHO) will present a seminar titled "Joint Commission Accreditation Essentials: Home Care," on Nov. 4-5 in Oakbrook Terrace, Ill. For more information, visit www.jcaho.org, or call (877) 223-6866.

The MED Group will present a technical training seminar Nov. 8-11 in St. Louis. For more information, visit www.medgroup.com, or call (800) 825-5633.

Joe Groden of JG Consulting will host a tele-visual conference on customer service Nov. 17. For more information, visit www.jgconsults.com, or call (585) 388-8824.

The Florida Association of Medical Equipment Services (FAMES) will hold its Annual Conference Nov. 17-19 in Sarasota, Fla. For more information, visit www.famesonline.org, or call (407) 895-5573.

VGM & Associates will present "Sales Training with Louis Feuer" Dec. 1-2 in Atlanta. For more information, visit www.vgm.com, or call (800) 642-6065.

The American Association for Respiratory Care (AARC) will hold its 50th International Respiratory Congress Dec. 4-7 in New Orleans. For more information, visit www.aarc.org, or call (972) 243-2272.

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