Cheer on the athletes at the US OPEN USTA Wheelchair Championships

The US OPEN USTA Wheelchair Championships will be held at the Dwight Davis Tennis Center in Forest Park, St. Louis, Mo. from August 31 through September 5. Admission is $5. The ROHO Group is a title sponsor of the event this year.

Open players will begin play on Tuesday, August 30. Lettered players begin play on Thursday, September 2.

The US Open USTA Wheelchair Championships is the largest and oldest wheelchair tennis tournament in the US. It is one of two tournaments holding ITF Super Series sanctioning on the NEC International Wheelchair Tennis Tour in the US. Players from around the globe including Canada, Germany, Japan, Holland, France, Sweden, Netherlands, Great Britain, Australia, Spain, Korea, Belgium and Italy will compete at this year’s event.

Wheelchair tennis follows the same rules with a few exceptions. The biggest being that wheelchair tennis players are allowed two bounces instead of one. The second bounce can either be in or out of court boundaries. You can check out the USTA/ITF wheelchair rules.

We hope to see everyone at the matches cheering on the athletes.  Find out how you can become a volunteer. You can find a copy of the press release at PRWeb.com.

Help save access to your medical products

I sincerely hope that I’m being “Chicken Little”, believing that the sky is falling when it really isn’t. However, I’ve been in the home care industry for almost 30 years now and I can’t recall a time when I saw the situation as dire as it is right now.

• Medicare  is implementing all kinds of programs that will reduce reimbursement and increase the cost of doing business in the home care industry with competitive bidding be at the top of the list. Most recently, Medicare proudly proclaimed that competitive bidding of DME will reduce Medicare expenditures by over $17 billion over 10 years (based on my math that equates to a cut of more than 15%).
• Many state Medicaid programs are in financial crisis and desperate to find ways to delay payments and cut costs. Multi-month lag on payments and payments with promissory notes is not out of the question.
• Medicare is implementing a variety of prepayment and post-payment audits that are causing providers an extraordinary burden. Imagine getting a letter requesting documentation on hundreds of patients over an extended period to time, just to prove that you have all the documents the auditor “deems necessary” for you to have been reimbursed! In addition, it is not at all unheard of that a provider will be place on 100% prepay audit / review for new claims while they’re being audited for their historic claims. If this happens the provider’s cash flow comes to a screeching halt. Their expenses continue but the money to pay those expenses is held up for months! Sadly, some providers cannot survive.

I know that the home care industry has it’s share of problems and rotten apples. At the same time, it also includes some of the most dedicated folks I’ve ever had the pleasure to work with, and I sincerely believe that the programs being implemented punish the innocent far more than the guilty. In addition, even with all the problems that may exist in home care, I still believe that it is an essential part of the solution to our health care challenges and a key component for the future of health care… so long as it is allowed to survive and thrive.

Left unchecked I don’t see how we can avoid a situation where the quality of goods and services, and the access to those goods and services, will be dramatically reduced. Ultimately, the consumers of these goods and services will suffer most. Yet, how do we get our message across when home care as an industry (whether it be goods or services, DME or HHA) has one of the smallest voices in the health care industry and other players are more than willing to throw dirt at home care?

Our current situation reminds me of a quote that has been credited to both Thomas Paine and Benjamin Franklin, “If we do not hang together we will most assuredly hang separately.” We may have different interests / involvements / allegiances in home care; but, we are all stakeholders (providers, referral sources, clients…) and we need to band together to overcome the common threats we are facing. For that reason I just signed up for the Save Homecare Now Campaign and I hope that you’ll consider doing the same thing. It’s being coordinated by AAH but the message is applicable to any home care stakeholders (AAH member or not). Below is the link if you’re interested in signing up to be an “advocate for home care”.

http://capwiz.com/aahomecare/mlm/signup/

Thanks for taking the time to let me get on my soap box. I hope that you’re all doing well and look forward to any opportunity to see each and every one of you.

Kind regards,

Dave

Join The ROHO Group for Abilities South — Houston

The Abilities Expo South will be held at the Reliant Park Expo Center in Houston, Texas from August 27-29. Abilities Expo is the source for people with disabilities, their families, seniors, veterans, caregivers and healthcare professionals to gain knowledge and meet industry professionals.

The Expo offers free shuttles and parking for $8/day. Rascal Company will also be offering free scooter rental at the Electric Scooters table.

There will be events for all ages include chair yoga, a clinic for wheelchair super x fun course, assistance dogs demonstration, wheelchair line dancing, face painting, competitive billiards, handcycling and more.

Stop by The ROHO Group booth and say hello to Becca and Teresa.

The many uses of the Adaptor Pad

What other purposes do you have for the ROHO Adaptor Pad?

The Results Are In…

• CMS has moved forward with the round 1 competitive bidding “rebid” in nine metropolitan areas (Charlotte, Cincinnati, Dallas-Fort Worth, Kansas City, Miami-Fort Lauderdale, Orlando, Pittsburgh and Riverside-San Bernardino).

• There were nine product categories put up for bid:

1. Oxygen, Oxygen Equipment and Supplies
2. Standard Power Wheelchairs, Scooters, and Related Accessories
3. Complex Rehabilitative Power Wheelchairs and Related Accessories (Group 2 only)
4. Mail-Order Diabetic Supplies
5. Enteral Nutrients, Equipment and Supplies
6. Continuous Positive Airway Pressure (CPAP) Devices, Respiratory Assist Devices (RADs), and Related Supplies and Accessories
7. Hospital Beds and Related Accessories
8. Walkers and Related Accessories
9. Group 2 Support Surfaces (Miami-Ft. Lauderdale only)

• Unfortunately, despite all our efforts and rationale, adjustable seat cushions (HCPCS codes K0734-K0737) were still included in the rebid as an accessory for standard power and complex rehab power.

• On July 1^st CMS (Medicare) announced the winning bid rate for each code in each of the nine metropolitan areas.  Currently, the Medicare allowable for “K0734 – adjustable skin protection seat cushion for wheelchair” (this is the code that the ROHO Single Valve HIGH PROFILE is assigned to, along with a wide variety of other products) is $299.98 when used with a power wheelchair.  Yet, the winning bid rates for adjustable seating varied by over 24% from one metropolitan area to another (from $225.00 in Miami to $293.98 Cincinnati).  Based on the winning bid rates I believe it is going to be very difficult, if not impossible, to obtain a high quality, adjustable cushion as of January 2011 in Dallas, Ft. Worth, Miami, Ft. Lauderdale or Orlando.

• In addition, since 2004 when the new seating policy was implemented by Medicare we’ve already seen the reimbursement for adjustable seating cut by over 20%.  As such, it’s not going to be easy to obtain a quality product, let alone the accompanying services, in any of the competitive bidding areas.   (Why we continue to see cuts in the reimbursement for products intended to reduce the incidence of skin breakdown, when the cost to heal a wound can cost thousands to tens of thousands of dollars, is beyond my understanding.)

• We are continuing to try and get adjustable seating pulled out of round 1 of competitive bidding but the chances of this occurring is becoming less and less likely.  I really believe that “deep down” the folks we’ve met with probably agree with our arguments; however, I also believe they are unwilling to pull adjustable seating out of round 1 because they are afraid that this will create a precedent and create an uproar from other products included in bidding.  Yet, I’m not willing to say that all our efforts are in vain and we will continue to fight for their removal from round one.  In addition, as much as I hate to see what has occurred in these nine metropolitan areas, I do believe that our messages and the round one results may help us to avoid adjustable seating being included in round two, which includes 91 of the largest metropolitan areas in the U.S. (including New York, Los Angeles and Chicago).

• We will continued to argue that the competitive bidding of adjustable skin protection seat cushions:

• Will not maintain, let alone enhance, beneficiary access to the goods and services they need.
  • Choice is critically important to address the unique need of each individual requiring skin protecting seat cushions.  No one product meets everyone’s needs.  As such, there are over 4000 products of unique sizes, shapes, materials, configurations, functions and acquisition costs collectively assigned to the four adjustable skin protection seat cushion codes.
  • Service is essential to effectively select the appropriate product and insure that the product is correctly adjusted to the individual.
  • These two variables cannot be effectively addressed under the existing competitive bidding framework.  To win a provider must be one of the lowest bidders.  This incents the provider to submit bids based on the products that cost them the least to obtain without consideration for the needs and variables described in point 1 above.  Further, there are no service requirements included in competitive bidding.  This incents the provider to reduce or eliminate any services they possibly can in order to lower their bid.

• Will result in an increase in incidence and prevalence of wounds and the other medical complications associated with wounds. Recently, the results of a randomized controlled trial performed by the University of Pittsburgh have started to be announced.  This is a landmark study for skin protection seating including multiple facilities and over 200 participants.  In the study four different seat cushions, all claiming some skin protecting features, were used.  While not all of the data has yet to be fully analyzed and reported, the information presented so far already re-enforces our position.  During the study there were nineteen incidences of ulcers on the sacrum / coccyx.  For three of the included cushions the incidence of sacrum / coccyx ulcers ranged from fourteen to twenty percent.  However, there were no sacrum / coccyx ulcers for the individuals utilizing the ROHO cushion that was included in the study.  While we are very pleased with how the ROHO served the individuals utilizing it during this study it is not my intent to claim that ROHO cushions are the only effective product.  This is certainly not the case.  I merely point this out to illustrate the need to select the right cushion to address the individual’s needs and the impact on wound incidence if this does not occur.

• Will increase overall expenditures for Medicare beneficiaries and the Medicare system.

• If the competitive bidding of adjustable seating results in an increase in the incidence of wounds any gross savings derived from their being included in competitive bidding will be overwhelmed by the cost associated with treating those wound.  It is not an exaggeration to say that the prevention of one wound can pay for over one hundred skin protection seat cushions.
• Regarding the costs for beneficiaries, the competitive bidding of adjustable skin protection seat cushions may force them to make a choice between increasing their risk of skin breakdown and purchasing the cushion they need privately.  Either way their out of pocket costs go up.  Beneficiaries are already finding it more and more difficult to find a provider willing to take assignment on an adjustable skin protection seat cushion.  In many cases they are being forced to purchase the product privately, or purchase the product from a provider on a non-assigned basis.  Under the existing fee-for-service structure the beneficiary can at least recoup 80% of the Medicare allowable for the product they purchase.  However, under competitive bidding they lose this right.  They must obtain a cushion from a winning provider who accepts assignment in order to obtain any reimbursement from Medicare.  If they cannot get the product they need from a winning bidder they must choose to take what they can get or pay 100% of the cost to get what they need.

• Our message remains the same:
  • It is not too late to pull adjustable seating out of round one of competitive bidding (K0734-K0737)!
  • It is imperative that this occur to insure beneficiary access to the goods and services that they need and to avoid serious medical complications for these beneficiaries, including an increase in the incidence of skin breakdown!
  • Do not compound this mistake by including adjustable seating in round two of competitive bidding!

If you’re interested in helping in this fight please contact your Senators and Representative and share your concerns and our message.  Please feel free to use any of the information in this update in developing your own message.

Once again, thank you all for your ongoing interest and support.  I’ll keep you posted!

Dave