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by: Mike Moran - Wednesday, October 21, 2009

Sybil movie download Here are some random thoughts on the state of healthcare in this country today.

1. They new surety bond and accreditation requirements for DME that took effect earlier this month are intended to help reduce fraud and abuse. That means a year from now DME fraud and abuse should be much lower than it is today. If it is not, heads should roll at CMS, the NSC and other contractors charged with protecting the Medicare trust fund.

2. You’ll never hear me complain about Social Security and Medicare. They are great programs, but to be sustainable well into the future, they need to be modernized. That means raising the ages at which people become eligible to receive these benefits. Instead of 65, maybe eligibility begins at 70. And when it comes to Medicare, maybe the co-pay jumps from 20% to 30%. We’d have to implement these changes gradually to allow people time to plan, but other than raising taxes, I don't see any other solution.

3. Let me get this straight: There are actually lawmakers in Washington who believe in their hearts that doctors deserve an extra $247 billion over 10 years? That is the so-called Medicare doc fix, and what a joke it is. Lawmakers propose reimbursement cuts for HMEs and other provider groups as part of healthcare reform, but the docs get a big fat raise. Whatever happens with reform, physicians must share the pain just like everyone else. The AMA is not AIG, after all. Let’s get something straight: Doctors are not underpaid. Check out this physician salary survey

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4. We’ve got two not-for-profit hospitals in our Portland, Maine community. One is always adding new additions and the other has just competed a big new fancy hospital facility. When it comes to non-profit hospitals, I must be missing something. How do some of them make so much money? Whatever, it seems like a lot of fun: Make a lot of money; spend a lot of money; pay no taxes. What’s not to like? Check out this salary survey: Top hospital executives make pretty good money


5. If I were a CMS official, I’d be very interested in talking to crooks convicted of defrauding Medicare. Specifically, I’d want to know how they got hold of a provider number? What can be done to reduce fraud and abuse—how can CMS keep the crooks out?

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Maybe CMS and government law enforcement agencies have done this, Z.P.G. but with Medicare fraud and abuse now practically an industry unto itself, you’d never know it. Great job, guys.

— Mike Moran

by: Mike Moran - Tuesday, October 20, 2009

The Senate Finance Committee has released the legislative language for its health reform bill, "America's Health Future Act of 2009." The committee approved the bill by a margin of 14 to 9 on Oct. 13.

Before it can move forward for a full Senate vote, the language must be combined with the Senate Health, Education, Labor and Pensions (HELP) Committee’s health reform bill, “Affordable Health Choices Act.”

Here is an analysis by The VGM Group of the finance committee's DME provisions:

Sec. 5010.  Adjustments to the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Acquisition Program.

Present Law

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Medicare Part B covers a wide variety of durable medical equipment, prosthetics, orthotics, and other medical supplies (DMEPOS) if they are medically necessary and are prescribed by a physician.

Medicare pays for most durable medical equipment (DME) on the basis of a fee schedule.  The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA, P.L. 108-173) required the Secretary to establish a competitive acquisition program for specified durable medical equipment; the single payment amount derived from the competitive acquisition program would replace the Medicare fee schedule payments.  The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA, P.L. 110-271) delayed the phase-in and made changes to the program.  The program is to be phased-in, starting in nine of the largest metropolitan statistical areas (MSAs) in 2009 (round one), expanding to an additional 70 of the largest MSAs in 2011 (round two), and remaining areas after 2011.

Starting in 2011, the Secretary has the authority to use information on payments determined in competitive acquisition areas to adjust payments for items and services in non-competitive acquisition areas.  Before 2015, the following three types of areas are exempt from the competitive acquisition program:  (a) rural areas; (b) metropolitan statistical areas (MSA) not selected under round one or round two with a population of less than 250,000; and (c) areas with a low population density within an MSA that is otherwise selected to be part of the competitive acquisition program.

Committee Bill

The Committee Bill would require the Secretary to expand the number of areas to be included in Round Two of the program from 79 of the largest MSAs to 100 of the largest MSAs by including the next 21 largest MSAs by population.  The provision would also require that the Secretary extend the competitive acquisition program, or apply competitively-bid rates, to the remaining areas by 2016.  All other provisions in Present Law would remain in place, such as the Secretary‘s discretion to exempt rural areas and areas with low population density within an MSA.

Sec. 3136.  Revision of Payment for Power-Driven Wheelchairs.

Present Law

Wheelchairs, including power-driven wheelchairs, are covered by Medicare under the capped-rental category of the durable medical equipment (DME) benefit. Medicare pays for power-driven wheelchairs in one of two ways: either Medicare will pay the supplier a monthly rental amount during the beneficiary‘s period of medical need (though payments are not to exceed 13 continuous months), or the payment is made on a lump-sum basis at the time the supplier furnishes the chair if the beneficiary chooses the lump-sum payment option. If the reasonable lifetime of a power-driven wheelchair is reached, or the wheelchair is lost or irreparably damaged, Medicare will pay for a replacement. The beneficiary may elect to have the replacement purchased through either monthly rental payments not to exceed 13 months, or a lump-sum payment.

Rental payments for wheelchairs are statutorily determined as ten percent of the purchase price of the chair for each of the first three months of rental and 7.5 percent of the purchase price for each of the remaining ten months of the rental period.

Medicare pays for most DME on the basis of a fee schedule.  However, the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA, 108-173) required the Secretary to establish a competitive acquisition program for specified durable medical equipment; the competitive acquisition program would replace the Medicare fee schedule payments.  The program is to be phased-in, starting in nine of the largest metropolitan statistical areas (MSAs) in 2009; expanding to 80 of the largest MSAs in 2011 and remaining areas after 2011.

Committee Bill

Starting January 1, 2011, the Committee Bill would limit the option to purchase a power-driven wheelchair with a lump-sum payment only to complex, rehabilitative power wheelchairs. The lump-sum payment option would be eliminated for all other wheelchairs. The provision would also eliminate the lump-sum purchase option for replacing a wheelchair for all chairs except complex, rehabilitative power wheelchairs.  This provision would not apply to competitive
acquisition areas prior to January 1, 2011.

Also starting January 1, 2011, the Committee Bill would change the calculation of the rental payment for power-driven wheel chairs.  The rental payment for power-driven wheelchairs would be 15 percent of the purchase price for each of the first three months (instead of ten percent), and six percent of the purchase price for each of the remaining ten months of the rental period (instead of 7.5 percent).

Productivity Adjustments:

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Certain durable medical equipment.  The productivity adjustment factor would be applied to the CPI-U used to increase the fee schedules for certain durable medical equipment (DME) beginning in CY2011.  Under Present Law, certain DME are to receive a payment increase of CPI-U plus 2 percentage points in CY2014.  The provision would eliminate the two percentage point increase.

buy Charlie's Angels: Full Throttle Prosthetic devices, orthotics, and prosthetics.  The productivity adjustment factor would be applied to the CPI-U update for the applicable fee schedule for this DME category starting in CY2011.

Other items.  The productivity adjustment factor would be applied to the CPI-U update for this DME category starting in CY2011.

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Sec. 6009. Imposition of Annual Fee on Medical Device Manufacturers and Importers.

Present Law

IRS authority to assess and collect taxes is generally provided in subtitle F of the Code (secs. 6001 -7874), relating to procedure and administration.  That subtitle establishes the rules governing both how taxpayers are required to report information to the IRS and to pay their taxes, as well as their rights. It also establishes the duties and authority of the IRS to enforce the Federal tax law, and sets forth rules relating to judicial proceedings involving Federal tax.

Present law does not impose an annual sector fee on companies that manufacture or import medical devices for sale in the United States.

Committee Bill

The Committee Bill imposes a fee each calendar year on each covered entity engaged in the business of manufacturing or importing medical devices offered for sale in the United States.  The aggregate fee under the provision is $4 billion payable annually beginning in 2010.  The fee is due each calendar year on a date to be determined by the Secretary, but in no event later than September 30th.  Under the provision, the aggregate fee would be apportioned among the covered entities each year based on each entity's relative share of gross receipts from medical device sales taken into account for the prior year.

A covered entity is defined under the provision as any manufacturer or importer with gross receipts from medical device sales.  For purposes of the provision, covered entity includes all persons treated as a single employer under subsection (a) or (b) of section 52 or subsection (m) or (o) of section 414.  The otherwise applicable exclusion of foreign corporations under those rules is disregarded for these purposes.

Under the Committee Bill, medical device sales means sales for use in the United States of any medical device, other than the sales of a medical device that has been classified in class II under section 513 of the Federal Food, Drug, and Cosmetic Act and is primarily sold to consumers at retail for not more than $100 per unit, or has been classified in class I under such section.  A medical device is any device as defined in section 201(h) of the Federal Food, Drug, and Cosmetic Act intended for humans.  The Secretary has authority under this provision to publish guidance necessary to carry out the purposes of this provision.  It is expected that the Secretary will provide guidance as to class II items primarily sold to consumers at retail for not more than $100 per unit, such as a list of class II items excluded under this provision.  The provision is intended to exclude low cost items (such as pregnancy tests, contact lenses, and b lood pressure monitors) that are normally sold directly to consumers through retail outlets.  The Committee intends that a unit is an entire item as typically sold (for example a box of 30 disposable contact lenses), and does not refer to an item's component parts.  Additionally the Secretary may publish guidance for the treatment of gross receipts from the sale of medical devices by a covered entity directly to another covered entity for use as a material in the manufacture or production of, or as a component part of a medical device for subsequent sale in order to eliminate double inclusion of the gross receipts from such sales.

Under the Committee Bill, each covered entity is required to file an annual report of its gross receipts from medical device sales for the preceding calendar year.  Under the provision, a covered entity‘s individual assessment for each calendar year is the total fee multiplied by the ratio of (1) the covered entity's gross receipts from medical device sales taken into account during the preceding calendar year to (2) the aggregate gross receipts from medical device sales of all covered entities taken into account during such preceding calendar year.

Sales taken into account for this purpose includes zero percent of a covered entity‘s gross receipts from medical device sales for the preceding calendar year up to $5 million; 50 percent of a covered entity‘s gross receipts from medical device sales for the preceding calendar year over $5 million and up to $25 million; and 100 percent of a covered entity‘s gross receipts from medical device sales for the preceding calendar year over $25 million.

The following is an example of how the relative market share would be determined if the medical device market included three covered entities, Company A with gross receipts from covered medical device sales of $1 million, Company B with gross receipts from covered medical device sales of $20 million and Company C with gross receipts from covered medical device sales of $979 million for a combined market of $1 billion.

Effective Date

The Committee Bill is effective for calendar years beginning after 2009.  The fee is allocated based on the market share of gross receipts from medical device sales for calendar years beginning after December 31, 2008.

Sec. 3110.  Exemption of Certain Pharmacies from Accreditation Requirements

Present Law

MMA required the Secretary to establish and implement quality standards for suppliers of durable medical equipment, prosthetics and supplies (DMEPOS) under Part B of Medicare. MIPPA requires DMEPOS suppliers to prove their compliance with the quality standards by being accredited by October 1, 2009. MIPPA, however, exempted eligible professionals from having to comply with the accreditation requirement unless the standards and accreditation
requirements being applied were specifically designed to be applied to those professionals. The statutes defines the following as eligible professionals: physicians, physical or occupational therapists, qualified speech-language pathologists, qualified audiologists, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists, or registered dietitians or
nutrition professionals. The Secretary was given authority to exempt additional professionals from the accreditation requirements. Pharmacists and pharmacies were not listed as exempt from the accreditation requirements.

Committee Bill

Effective January 1, 2010, the Committee Bill would make certain pharmacies eligible for an exemption from the accreditation requirements.  A pharmacy would be exempt from the accreditation requirements under the following circumstances: (1) the pharmacy submits an attestation that its total Medicare DMEPOS billings are, and continue to be, less than a rolling three year average of five percent of total pharmacy sales; (2) the pharmacy submits an attestation that it is enrolled as a provider of durable medical equipment, prosthetics, orthotics, and supplies under the Medicare program for at least 5 years and has had no adverse determination against it for the last five years due to fraud; and (3) the pharmacy is willing to submit documentation to the Secretary (based on a random sample of pharmacies) that would allow the Secretary to verify the information in (1) and (2).  The documentation submitted for (3) would be required to consist of an accountant certification or filing of tax returns by the pharmacy.

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The provision would also allow the Secretary to determine accreditation standards that are more appropriate for pharmacies. The Secretary would have the authority to implement this amendment by program instruction or otherwise.

Sec. 5005.  Physicians who Order Items and Services Required to be Medicare Enrolled Physicians or Eligible Professionals.

Present Law

Medicare statute defines ?eligible professionals? as physicians, certain types of practitioners (i.e., physician assistants, nurse practitioners, clinical social workers, and others), physical or occupational therapists, qualified speech language pathologists, or qualified audiologists.

Committee Bill

Beginning January 1, 2010, the Committee Bill would require durable medical equipment or home health services to be ordered by a Medicare eligible professional or physician enrolled in the Medicare program. The Secretary would have the authority to extend these requirements to other Medicare items and services, including covered Part D drugs, to reduce fraud, waste, and abuse.

Sec. 5007.  Face-to-Face Encounter with Patient Required Before Physicians May Certify Eligibility for Home Health Services or Durable Medical Equipment Under Medicare.

Present Law

Home health services are covered under Medicare Parts A and B. In order to receive payment from Medicare, physicians are required to certify and re-certify that specified services (i.e., inpatient psychiatric services, post-hospital extended care services, and home health services) meet certain conditions. In the case of home health services, physicians are required to certify that such services were required because the individual was confined to his home and needed
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skilled nursing care or physical, speech, or occupational therapy; a plan for furnishing services to the individual has been established; and such services were provided under the care of a physician.

In the case of DME, the Secretary is authorized to require that payment be made for specified covered items and services only if a physician has submitted to the supplier a written order for the item.

Committee Bill

The Committee Bill would require that, after January 1, 2010, physicians have a face-to-face encounter (including through telehealth) with the individual prior to issuing a certification for home health services or DME as a condition for payment under Medicare Parts A and B. The Committee Bill would also apply to physicians making home health and DME certifications in Medicaid and CHIP. Physicians must document that they had the face-to-face encounter with the
individual during the six-month period preceding the certification, or other reasonable timeframe as determined by the Secretary. The Secretary would be authorized to apply the face-to-face encounter requirement to other Medicare items and services based upon a finding that doing so would reduce the risk of fraud, waste, and abuse.

Sec. 5011.  Expansion of the Recovery Audit Contractor (RAC) Program.

Present Law

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Recovery Audit Contractors (RACs) are private organizations that contract with the CMS to identify and collect improper payments made in Medicare‘s fee-for-service (FFS) program.  In the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173), Congress required the Secretary to conduct a three-year demonstration of RACs.  However, the Tax Relief and Health Care Act of 2006 (TRHCA, P.L. 109-432) made the RAC program permanent and mandated its expansion nationwide by January 1, 2010. The RAC program expansion still applied only to Medicare Parts A and B.  CMS began the national rollout of the permanent RAC program in 19 states in March 2009.

Committee Bill

By December 31, 2010, states would be required to establish contracts, consistent with state law, and similar to the contracts the Secretary has established for the Medicare RAC program, with one or more RACs.  These state RAC contracts would be established to identify underpayments and overpayments and to recoup overpayments made for services provided under state Medicaid plans as well as state plan waivers.

The state Medicaid RAC program would be subject to exceptions and requirements the Secretary may establish for the state RAC program or for individual states.  States would be required to provide the Secretary with the following assurances for their RAC programs:

(1) RACs would be paid only from recovered amounts;
(2) the contracts would be contingent on collecting overpayments;
(3) payments may be made in such amounts as the state may specify for identifying
(4) the state has a process for appealing adverse RAC determinations;
(5) the state‘s RAC program follows requirements established by the Secretary;
(6) amounts expended by the state would be considered administrative expenditures (as
necessary for the proper and efficient administration of the state plan or waiver);
(7) recovered amounts would be subject to a state‘s quarterly expenditure estimates and the
funding of the state‘s share; and
(8) the state will coordinate the efforts of RACs with other program integrity contractors
performing audits of entities receiving payments for any Medicaid services, including
coordination with Federal and state law enforcement (the Department of Justice, the
Federal Bureau of Investigation, the HHS OIG, and the state Medicaid fraud control

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The Secretary, acting through CMS, would be required to coordinate with states on the RAC program expansion to Medicaid, particularly to ensure that each state enters into a contract with a RAC prior to December 31, 2010.  The Secretary would be required to promulgate regulations to implement the RAC program expansion to Medicaid, including conditions for Federal financial participation.

In addition, the Secretary would be required to submit an annual report to Congress.  The Secretary‘s report would assess the effectiveness of the RAC program expansion to Medicaid and Medicare Parts C and D and also would include recommendations for expanding or improving the program.

by: Mike Moran - Monday, October 19, 2009

I had a strange epiphany this weekend about Medicare fraud and abuse and the great futile lengths CMS has gone to eradicate it.

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For several years now, I’ve had an ongoing battle with the gray squirrels in my neighborhood, which goes by the name Oakhurst, and with good reason. It’s loaded with oak trees, which produce acorns, which, as you know, are a dietary staple for Sciurus carolinensis.

Here’s the thing about squirrels: No matter how many billions of acorns are available, they’ll never pass up a chance to raid a birdfeeder stocked with delicious oily sunflower seeds. More than once, I’ve filled up our feeder in the morning, and returned home in the evening to find it empty. We’ve got a lot of backyard birds (cardinals, chickadees, nuthatches, gold finches, house finches, downy and hairy woodpeckers and an occasional flicker, to name a few), and I know from experience that a full birdfeeder will last my feathered friends a good 5-7 days. A couple of squirrels, however, will empty it in a day. Many a time I’ve watched incredulously as a squirrel practically drank my birdfeeder dry.

I’ve tried everything to keep that from happening. I’ve thrown rocks at them; bought a feeder advertised as squirrel safe (it wasn’t); yelled at them. I have, in short, fought honorably no avail.

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So this summer I bought a pump action .177-caliber pellet gun. I know some people may consider this cruel (my wife’s not crazy about it), but it is very effective. Mirror, Mirror III: The Voyeur rip Over a 10-day period in July, I shot and killed 10 squirrels, and for the next two months, the gray varmints avoided our yard like the plague. I don't want to go over the top with this, but it was very satisfying. (In case you are wondering: I generally bury the squirrel carcasses, but occasionally I’ll leave them for the foxes and coyotes that prowl about during the night, looking for someone’s cat to consume.)

Here’s where HME fraud and abuse comes in. You may not like or approve of my method of squirrel control, but do you think CMS could do better?

If CMS officials attempted to keep squirrels from a bird feeder, it would get very ugly— FOR THE BIRDS! First, the bureaucrats would excavate a moat around the feeder. When that didn’t work, they would encase the feeder in a cage. They would then electrify the cage, and maybe even concocted some kind of flaming wall. Each layer of defense would make the bird feeder more impenetrable for the birds. The squirrels, on the other hand, being an ingenious bunch with plenty of time on their hands, would eventually find some way around all of these barriers.

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In this little story, of course, the birds represent providers, the feeder is the Medicare trust fund and squirrels are the crooks.

I’m not advocating that CMS shoot crooks that defraud Medicare out of billions of dollars a year (at least not yet). But it’s apparent that adding layer upon layer of bureaucracy has done little to solve the fraud and abuse problem. This strategy only makes it more difficult and expensive for legitimate providers to serve Medicare beneficiaries.

Competitive bidding for DME is just one more sorry attempt by CMS to tackle the fraud issue. Instead of zeroing in on the crooks, CMS has developed a program that will hurt legitimate providers and limit beneficiary access.

I use a pellet gun to selectively eliminate unwanted pests. The birds I enjoy are never at risk. With competitive bidding, however, CMS is getting ready to drop the bomb. What bothers me most about this strategy—besides the fact that I’m pretty sure crooks will still figure out a way to game the system—is that CMS seems perfectly willing to accept a fair number of civilian casualties.

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I'm beginning to think that if CMS really wants to eliminate fraud and abuse, the agency is going to have to hire some squirrels.

— Mike Moran

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by: Mike Moran - Wednesday, October 14, 2009

So, I am here in the office today, making the telephonic rounds of all you providers (at least those of you who will take my call) out there to get a feeling for what's keeping you up at night.

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Pretty in Pink movies The list is long, and not all that surprising: competitive bidding, oxygen reform (BIG disappointment among the rank and file with the stakeholders about the fracturing of the message), accreditation, reimbursement, and so on.

I will report that despite their overall disillusion with the industry, most providers continue to hang in there, looking for ways to run leaner and meaner operations. They are looking to add new product lines. They are calling their lawmakers every time there is a call to action.

I've also been lucky to receive a few unsolicited calls from providers today excited to share with me their latest news. Contrary to the romantic notion of reporters, my phone does not ring daily with hot tips whispered in my ear.  I even had one call me this afternoon and leave a message thanking me for a feature story we just ran on their company (you're welcome, Freeport Home Medical. It was a pleasure talking to you).

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So what are you up to these days? Anything new? Good, bad or ugly, call me. We'll talk.

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by: Mike Moran - Tuesday, October 13, 2009

Chemical Wedding Under Suspicion psp A bill to repeal the perennially unpopular national competitive bidding program was introduced into the House of Representatives today by Rep. Kendrick Meek, D-Fla.

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"We are appreciative of Congressman Meek's realization of how detrimental competitive bidding will be for seniors and communities that rely on home medical equipment providers for quality products and timely services," said AMEPA president Rob Brant.

Industry stakeholders plan to try and get the bill, HR 3790, included in the House healthcare reform bill is budget neutral and currently has 16 cosponsors.

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Check back tomorrow for more details.

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by: Mike Moran - Thursday, October 8, 2009

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When Fox News ran a hit piece

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I heard the Fox News report this morning about durable medical equipment. I enjoy Fox News very much but I have to speak out and say this report was not right. As the owner of a durable medical equipment business for the last 35 years, I know your story is inaccurate and deserves to be rebutted. Fox news was remiss not to report the complete story. What Fox News failed to report is that the equipment they mentioned must be:

- Delivered
- Set up
- Maintained
- Billed—in most cases the equipment is rented for a period of time before it's owned. Essentially, we as providers are banks for the government. In addition, when we accept assignment, we have no guarantee that we will be paid.
- It’s unfair to compare what Medicare pays us to what equipment can be bought for online. Online retailers don’t bill Medicare or have bricks-and-mortar expense. We are in a completely different class.

We, the DME industry, serve as a very important component to our health care system. We are part of the solution when it comes to healthcare reform. There are a few bad apples that have given our industry a bad name. But as a whole, the DME industry is made up of hundreds of small businesses through out the U.S., providing a very important service. The key word is service. When Mrs. Jones runs out of oxygen at 2 in the morning, guess who is there? Yes, that's right. Us. If Mrs. Smith’s hospital bed fails to work, who goes to the home on a Friday at 4:30 p.m. to replace it? Us again. It’s all about service.

I agree our healthcare system is broke and needs to be fixed, but to come down on the DME industry and lead people to believe that the industry is ripping off the American tax payer is absurd. We pay for the equipment; we deliver the equipment; and we service the equipment. We have a right like any other business to make a fair profit.

Report the whole story, its proper journalism.

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by: Mike Moran - Tuesday, October 6, 2009

I know AAHomecare and other industry leaders have worked hard to demonstrate the value of home medical equipment, but that message is a hard sell when reporters keep comng out with stories like this one from Fox News: “Tracking your Taxes: Medicare Waste Goes Unchecked.”

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Here’s what the story has to say about DME:

According to their own auditors, Medicare knowingly overpays for almost everything it buys. Examples include:

—    $7,215 to rent an oxygen concentrator, when the purchase price is $600
—     $4,018 for a standard wheelchair, while the private sector pays $1,048.
—    $1,825 for a hospital bed, compared to an Internet price of $1,071.

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—    $3,335 for a respiratory pump, versus an advertised price of $1,987.
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—    $82 for a diabetic supply kit, instead of a $47 price on the Web

If you are just a regular taxpayer—not someone who understands how to run a business and how expensive it is to maneuver through Medicare’s bureaucracy—these numbers look outrageous.

Undead dvd If you want to see just how outrageous, read the comments people made regarding this story.  These comments are peppered with angry words and phrases like: kill; free stuff from the government; this is a f¬¬__ing joke!; and we all know MSRP is already bloated price for a product.

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It goes on.

The bottom line is that a lot of people think government is riddled with incompetence and controlled by special interests. I feel a little bit like this myself, especially when it comes to the pharmaceutical and oil industries, which seem to make astronomical profits at the expense of the U.S. taxpayer.

So when a news report comes out that paints the DME industry as just another overpaid special interest group, it doesn’t surprise me that people fret and fume and lob nasty comments like grenades at Washington. People these days are frustrated and cynical, and with the country in financial shambles—thanks mostly to special interests and government officials who are/were ideological, cowardly, asleep at the wheel or a pathetic combination of all three—who can blame them?

There’s no easy answer here, no magic bullet that will turn the tide for HME providers. The industry must keep fighting the good fight. But these are tough times, and it’s beginning to look more and more like only the strong will survive.

— Mike Moran

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by: Mike Moran - Monday, October 5, 2009

Provider Dallas Jackson got a rude awakening this morning. It seems Fox News is doing a piece comparing Medicare reimbursement for DME like hospital beds to—you guessed it—Internet pricing.

The piece said Medicare often paid thousands for a bed that could be bought online for $1,000, said Jackson.

What really burns Jackson, an accredited provider with 10 years in the industry? He advertises on Fox. A lot.

"Everybody says 'Oh, you're the man from the medical company," said Jackson, who owns 3 California locations. "Now, ,Fox is making me out to be a crook."

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Jackson, was already drafting a letter to let them know they had it all wrong.

"I told them what our cost is and what it takes to get a bed from us to them and assembled and their furniture moved and in-servicing," said Jackson. "And, then the reverse on the other end and the patient only has it a month. Do you want to charge the American public $1,000 for a hospital bed they only need for a week?"

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Jackson planned to notify industry groups like the California Association of Medical Equipment Suppliers and the VGM Group to let them know about the latest mainstream media outrage, for what it's worth, he said.

"It's hard for an individual guy out here in Vacaville" said Jackson. "They are not getting enough feedback from the industry."

I couldn't find the segment on the Internet, but AAHomecare seems to have. In an email blast the association says: To express your thoughts to Fox (please be polite and share your own personal perspective as a provider), contact Steve Doocy at Fox News, 212-301-3033 ( and William La Jeunesse, the correspondent, at 310-571-2000 (
Go for it. Loudly.

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by: Mike Moran - Friday, October 2, 2009

Here’s some good news for your kids and grand kids, and I would add, homecare providers: Half of all babies born in industrialized nations since the year 2000 can expect to live to 100, according to a new study

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It reminds me of the old saying that $1 million ain’t what it used to be. Now we can say the same thing about making it to 100. Personally, I know a guy who is 106, plays golf everyday, smokes a big fat cigar during the round, and sips a martini in the clubhouse bar afterward. He used to have two martinis when he was younger so age has caught up with him a little. But even though he is 106, he still practices. He’s 106 and wants to get better!  That’s positive thinking.

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In 80 or 90 years, there are going to be a lot more of these healthy old codgers. Many of them, I suspect, won’t be so healthy that they don’t need a scooter, walker or some other piece of durable medical equipment.

Congress and bureaucrats can complain about the HME industry all they want and continue to cut reimbursement, but it won’t change the fact as the years go by, our population is going to get older and older.

I think they’d be wise to sit down with a martini and read the writing on the wall: We, as a country, can’t afford to take care of all these people humanely with out embracing homecare services.

— Mike Moran

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by: Mike Moran - Tuesday, September 29, 2009

What a waste of time all this back and forth on healthcare reform has been. The answer's been right in front of our faces the whole time: Expand Medicare to everyone.

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How simple is that?

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If Medicare is good enough for our seniors, why isn’t it good enough for everyone else? It’s a program that works and, with the possible exception of some real right-wing anti-government types, is universally loved.

So lets expand it and then figure out how to pay for it. We also need to figure out a way to drive down fraud and abuse. But otherwise we are good to go.

There are a lot of Republicans and some Democrats out there screaming about no more big government programs, but most of us, it seems, love big government programs. I mean, who doesn’t like Social Security, Medicare, Medicaid, unemployment insurance, the U.S. Post Office? These program may need a little modernizing, but they work.

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George S. McGovern, the former senator from South Dakota and the 1972 Democratic nominee for president, is a big proponent for expanding Medicare and lays out his argument in today's Washington Post.

At this point, it ain't going to happen. The political will doesn't exist. What we are going to get, if we get anything, is some watered-down version of health care reform that doesn't satisfy anyone. What a waste of time.

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— Mike Moran