I've been thinking about the Mike Thomas commentary published in the Orlando Sentinel on July 14. There's been a lot of buzz about it and, of course, a very negative reaction to it from the DME industry. That's to be expected, considering how negative the commentary was.
The comments about it on the Sentinel's site are about what I'd expect to see and the poll results are what I'd expect as well. I think it's very fair to say that the vast majority of those who commented and who participated in the poll are people who have a vested interest in the future of DME. Am I surprised? No.
Mike Thomas's scenario about how the fee schedule works had to be tongue-in-cheek; no one with even the smallest amount of intelligence could present it as or believe it to be plausible. He bases it, he says, on the articles that have appeared in the Miami Herald, which were, apparently written by investigative reporters who go take a look at Medicare fraud every so often.
To those who took Thomas to task about his apparent failure to do any independent research on the topic, I can honestly say that I agree with that criticism. If one is going to do a commentary on something, one should make oneself as knowledgeable as possible before writing the article. I don't see how Thomas could have a valid, informed opinion based on a single source, but it seems obvious that he and the Orlando Sentinel are fine with it.
What Mike Thomas is correct about is that there is a fraud issue. He had to get this "Medical equipment suppliers in the Southeast, based mainly in Miami-Dade, used the names of 2,454 dead doctors for prescriptions to file Medicare claims and got paid $3.9 million in reimbursements from January 2007 to the end of June…" from somewhere.
Yes, there is licensure and there are criminal background checks in Florida, which should, in theory, make it impossible for criminals to get into DME. Despite these requirements, fraudulent billing continues, and the people who do so are criminals. To pose the licensure and background check argument is (let's be honest here) somewhat ingenuous. We all know that a determined person will, in most cases, find a way around a system. It happens all the time. It shouldn't, but it does.
Another argument tossed at Thomas by those who commented on the Orlando Sentinel's website is that beneficiaries will lose services. I don't know a lot about the bid demonstrations in San Antonio and Polk County (FL), but did the beneficiaries in those two areas complain about loss of services or loss of equipment accessibility (or both)? The winners of the bids will have to continue to offer repair and maintenance services on the equipment they provide.
One commenter offered this: "Legitimate med equipment suppliers provide SERVICES to customers. The type of service that no one from Amazon is going to provide. For instance, do you think that Amazon is going to come out to a patient’s home at 2am during a hurricane and provide emergency oxygen tanks to a critically ill patient without power." Does Amazon provide oxygen? Of course not, which makes that portion of his comment rather ridiculous. That same person continued with a more legitimate argument about personal delivery, set-up, and adjustments to other DME items that Amazon may or may not sell, and that's some of what Thomas missed.
DMEs - honest DMEs - do those things. And doing things like that cost the provider money. Added costs of doing business are licensure (if required), accreditation, the various required insurances, staff salaries and any related benefits, equipment purchase, and so on. There are real costs of doing business for providers, and those costs aren't going down. But there are costs involved with doing business (any business), and if you choose to be in the business, you're going to have to meet them. Whether or not those costs are fair isn't the point.
Framing an argument of patient harm is premature. Another person who posted on the Sentinel's site said this when a poster said to stop posting scare rhetoric: "It's not scare rhetoric. It's exactly what happened when the program was first tried and subsequently repealed in 08. Check the facts and see for yourself. The flaws in the program have not been addressed well enough to not compromise patient care. If it goes through as is, you will see the results will be the same as they were in 08."
What patient care was compromised in 2008? Who was harmed by the program in 2008? No one was because the delay in the doc fix prevented the implementation of the original round one bid. To state otherwise undermines the credibility of the industry, and harms the legitimate statements made about it. Perhaps that particular poster should have checked his own facts? Yes. He certainly should have.
I think everyone has known for a long time that the DME industry has a severe image problem (it isn't totally undeserved, even though ethical providers suffer from it). Nothing it (the industry) has said or done has seemed to solve the problem. There have been vague rumblings about the industry policing itself, but is that a realistic answer? I'm going to say no, and here's why.
I've heard rumors (they're unconfirmed, I admit that, but they're persistent and consistent) that there was a provider who was "investigated" by a local news station that had complaints from the public. This news station contacted one of the state associations, asking for a referral for another provider who could loan a power chair that the news station could take to the suspect provider to see what the repair estimate would be. This the association did, and that's all the association did. A small adjustment was made to the power chair to render it inoperable, and it was taken to the suspect provider, who gave an estimate of more than $3,000.00 for repairs that did not address the $10.00 adjustment that would have fixed the power chair. When the beneficiary expressed dismay over the amount of the estimate, the suspect supplier told the beneficiary not to worry because Medicare would pay for it.
Needless to say, the suspect provider was furious for having been exposed, and incorrectly blamed the association. He was angry enough to complain to a major industry manufacturer who, instead of supporting the association and the exposure of a supplier of apparently questionable business practices, withdrew its support from the organization that really had no involvement. I can only conclude that the manufacturer in this story (who won't be named at this time) chose to ignore the obvious and look at its bottom line instead. Shameful!
An interesting side note is that when the story aired on television, the supplier who supplied the power chair got angry calls from others in the industry, not support. Ridiculous!
This is why the DME industry has the reputation it has, and this is why the DME industry cannot police itself.
I think it's a very good thing that Mike Thomas didn't know about the power chair incident, because it makes most involved look very bad, but it illustrates the hypocrisy within. If you want to improve the DME industry's reputation, closing ranks with suspect providers and punishing the whistle-blowers is not the smartest way to go about achieving the goal. In fact, it's pretty darned stupid.
If the industry is going to preach ethics and professionalism, then the industry should practice ethics and professionalism. If someone from within has the courage to take an active stand on fraud, angry phone calls should not be the result. My point? The next time someone prints a negative story about DME, ask yourself what you're doing to improve the industry (and its image), and what you're doing to support those who are making an effort to clean it up. It's not enough these days to quietly go about your business, no matter how honest and ethical you are. For decades the criminals have shaped the image. You also have the power to shape it in the other direction. It's up to you to put forth the effort and to actively support those who go out on a limb to expose those who don't belong.
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