Texas Politics, Poverty, & Medicaid

Texas Politics, Poverty and Medicaid

Good news, our Governor  won’t seek reelection in 2015; bad news we can’t wait till then to end the Medicaid debate.

Just google Texas and Medicaid expansion for current thinking and a quick overview. Our Governor can stand on Pro Life and be morally deficient on turning down billions of federal dollars that would have paid for health care coverage for 1.5 million poor Texans. Texas has the highest rate of uninsured residents in the country, 1 in 4 have no health coverage. How many avoidable deaths could be avoided with this expansion?

Statewide, Texas will forfeit an estimated $100 billion in federal Medicaid funds by rejecting Medicaid expansion.

The economic advantages of participating in Medicaid expansion are profound, according to a study by the Perryman Group, a Waco-based economic and financial analysis firm. While the cost to the state general fund of making almost 1.5 million more residents eligible for Medicaid is estimated at $1.3 billion through fiscal year 2017, Texas would be eligible for an estimated $24 billion under Medicaid expansion, according to the study. The federal government would pay 100 percent of the cost of Medicaid expansion from 2014 to 2016 then ratchet its share down gradually to 90 percent by 2020, where it would level off going forward, according to the Perryman Group.

Conversely, not participating in expansion means Texas will suffer “a significant economic downside which must be weighed against potential savings in direct State outlays,” according to the report. A large uninsured population leads to higher private insurance premiums and higher taxes to cover the cost of uncompensated care, Perryman says.

Healthcare providers are frustrated at Rick Perry and state Republican lawmakers to set aside their opposition and expand Medicaid under the Affordable Care Act. It is clear to everyone that this expansion helps subsidies insurance to make it affordable and guarantee care to the poor and near poor. The politicians refusal to spend money on  the poor & vulnerable will hurt and alienate while reinforcing how little regard G.O.P has for their care.

Tom Banning, chief executive officer of the Texas Academy of Family Physicians, lobbied hard but unsuccessfully for Medicaid expansion. He’s beside himself with frustration.

“These people don’t choose to get sick. When they do, they’re going to access our health care system at the most inefficient and expensive point, which is the emergency room,” Banning says. “And it’s going to cost the taxpayers, and it’s going to cost employers a lot of money to care for them. And we’re going to be forgoing billions of dollars that the feds have set aside for the state to pay for and provide this care.”

Paula Gomez, executive director of the Brownsville Community Health Center, said her clinic treats a little more than 20,000 patients a year. Between that and Su Clinica’s Brownsville clinic, she estimates only 15 percent of the actual need is being met in the city.

“People are waiting till their illness gets to the point where they end up in the emergency room, and at that point we pay for it anyway because they still don’t have ability to pay,” she said.  These are working poor. If they’re really sick they’re not going to be able to work. If you can’t work, you can’t produce. If you can’t produce, you can’t make money. If can’t make money, you can’t provide for your family. It hurts all the way around.”

Spending on healthcare creates economic stimulus throughout the region,  makes for a healthy population with fewer deaths and better voters. Perry can cement his legacy with a change of heart and compassion.

Selecting an In-home Hospital Bed

For many, hospital beds carry a reputation for being uncomfortable and sterile because of their association with an unpleasant hospital stay.  However, there are many options for comfortable in-home hospital beds that carry many benefits for the patient and the caregiver.

What kind of hospital bed should I get?

In-home hospital bed

When shopping for an in-home hospital bed, you’ll see three main categories; manual, semi-electric and full-electric.  The manual bed operates through a series of cranks that are body-powered.  The semi-electric bed is controlled by a combination of body-powered cranks and electricity and the full-electric bed operates completely on electricity.  At Specialty Medical Sales, we carry full-electric hospital beds as we’ve found them to be the best choice for both the caregiver and the patient.

Where should I put my hospital bed?

There are several key factors to keep in mind when deciding where to place your in-home hospital bed.  Most importantly, if you are working with a semi-electric or full-electric hospital bed, you will need an electrical outlet nearby.  Also, think about the daily care you’ll need to provide your patient and also their interactions with you.  As the caregiver, you won’t want to go up and down stairs to get to your patient and you also don’t want to isolate the patient from any visitors to the house as this could cause them to feel very alienated.  Consider placing the bed on the main level of the house in a room that is close to the main rooms of the house such as the living room or kitchen.

What hospital bed mattress do I need?

Finally, you’ll need to decide on your hospital bed mattress.  The type of mattress you choose depends on the diagnosis of your patient.  At Specialty Medical, we offer several options in hospital bed mattress.  Our BioTherapy mattresses are designed to increase peripheral circulation and reduce tissue pressure.  The Geo Mattress is designed for patients at risk for skin breakdown with an antimicrobial, self-deodorizing cover.  We also carry several air mattresses that not only enhance the comfort of your patient, but also are designed to help prevent and treat pressure ulcers.

If you have additional questions about our hospital beds and mattresses, give us a call at 800-531-7059 or leave a comment below!

Round 1 after 1 year, Round 2 begins.

Competitive Bidding Round 2:

I have been asked by our customers, friends and referral sources if we planned to bid in Round 2 of the Medicare program. The plan is to roll this out to 91 cities on 1/1/2013. In Texas, DFW was in Round 1 that began 1/1/2011, now Houston, Austin, & San Antonio will fall this summer.

My answer was NO; the paperwork to re- register our company, the time to bid on hundreds of line items and the fact we have no presence in these areas to support beneficiaries. CMS doesn’t think this is crucial to service; after all if one is awarded a contract the company can accept, reject or find subcontractors who will work on the cheap.

It has been almost a year since we lost out on select Medicare bid categories. Our 2011 Results: Sales & profits are up over 2010. We have seen more business in all segments of our company. When I tell people this they react with a smile and say wonderful, what’s your secret? As one social worker commented, it is slow and difficult to get a winning provider to respond in a timely manner. Many managers have been spoiled on quick deliveries for last minute discharges. Some of providers are balking at the small orders; delivery cost / setup and low margins create poor service.

Our secret, people and relationships, our great staff provide outstanding personal service. Many in the area know Wendy, Daniel and Lisa who have been with the company for years. In this business, many fees are set in contract or by the state, so competition hinges not on pricing but on service, contacts, associations and people skills.

Merry Christmas and a Healthy Happy New Year.

Tom Polston

Owner

” Bully” “Medicare” “Fraud” “Incompetence”

What do these words have in common? They describe the current administration of the Medicare system. For years our business has been regulated by Medicare and certain State / Local regulations which include unannounced visits to be sure we are what we say we are. Oh yes, these inspectors take pictures of the storefront, hours we are open, signage and how much inventory we have in the store & warehouse. When I started there were 12 supplier standards we now have 30, mandatory accreditation (every 3 yrs. at a cost of $ 6000 to $ 8000) and a surety bond. Yes, insurance protection in case we fly the coop and or can’t pay back money that was erroneously billed. There are now contractors hired to audit suppliers on previously filed claims to be sure everything was filed & documented. Even providers with perfect documentation must still go through the audit process, which is time consuming and freeze potentially funding until complete. These companies are paid a percent on what is recovered. Can you visualize the paper trail that is required (10 years we are required to store patient records) takes time and space? Have you got the picture? Fear – Intimidation – Watchdogs for Taxpayers – Over burdensome Bureaucrats – Bullies of small business owners.

I have not mentioned the “ Competitive Bidding “ fiasco that will reduce the number of suppliers in this market and if implemented 1/1/2011 will further show the lack of concern CMS has for it’s beneficiaries. Patients will have fewer choices with more people being hospitalized and more cost in the long run. Any policy that eliminates equipment providers, that make home – based care possible is headed in the wrong direction and needs to be repealed. The 2010 mid term elections are where we can make our voice heard! If you want more information, email me at tom@specialtymedical.com

We have been in business 22 years because we take care of patients who become customers and many are now friends who rely on our staff for help. Our staff has grown to six with 49 years of combined experience in handling almost every issue of service, claims, insurance and communicating the nuances of this complex system to our customers.

We are not dependent on Medicare revenue to survive; this is by design as diversification is crucial in any business and personal finance. My point iswe play by the rules and it has become too burdensome. I see the double standard that exists with the“ to big to fail “ mentality of the Government. Wall Street, Bankers, AIG, GM get bailed out while the real economy of this country soldiers on. Small businesses in our Industry will go out of business but it should not be because of CMS and their poor policies, punitive attitude of indifference and gross incompetence.

Example:

CMS’ Inability to Curb Fraud
Senate Finance Ranking Member Charles Grassley (R-Iowa) has raised concern about CMS’ apparent inability to curb fraud. In a recent letter to CMS Administrator Donald Berwick and HHS Secretary Kathleen Sebelilus, Grassley reiterated his concerns about the “lack of or management and oversight of contractors by the Centers for Medicare and Medicaid Services (CMS)” to curb fraud, waste, and abuse.

Referring to the U.S. government-filed complaint against All-Med Billing Corp. in 2004, the senator states, “MAC’s responsibilities include adjudicating and processing claims, yet it appears from this case that Palmetto GBA allowed millions to be paid to the DME companies for fraudulent claims.
According to the complaint, All-Med had submitted $250 million in Medicare claims to the Medicare Administrative Contractor, Palmetto Governmental Benefits Administrator (Palmetto GBA) from Jan. 2004 to June 2004 for medical equipment that had neither been ordered by a physician nor delivered to the beneficiary. It was not until Feb. 2010 that a judgment against All-Med was entered, requiring more than $445 million repayment to the U.S. government.

As Grassley expresses his concern about CMS’ incompetence, the media continues to report of Medicare fraud. Meanwhile, CMS continues to chase small providers with bogus audits as millions of dollars are being paid to bogus clinic addresses. This was reported the week of Oct. 11 in the Dallas Morning News and I have copied the following content:
“A recent New York Times City Room Blog reported that 44 individuals are being charged for Medicare fraud. An Armenian-American crime syndicate operated the “largest Medicare fraud operation ever carried out by a single group.” The crime group had 118 phantom clinics and stole the identities of both doctors and patients to bill Medicare $100 million in nonexistent treatments. The group, official said, was aware that each clinic had a limited shelf life and would simply turn to another fraudulent clinic — they existed only on paper with an address that was usually a mail drop — operating at least 118 in 25 states. The group succeeded in stealing $35 million in Medicare reimbursements, officials said, before the charges were leveled and arrests were made on Wednesday.

“The diabolical beauty of the Medicare fraud scheme — from the criminals’ standpoint — was that it was completely notional,” Ms. Fedarcyk said in a statement released in the early afternoon. “There were no real medical clinics behind the fraudulent billings, just stolen doctors’ identities. There were no runners or colluding patients showing up at clinics for unneeded or “upcoded” treatments, just stolen patient identities. The whole doctor-patient interaction was a mirage.”

While the CMS noted in a release that it would “identify and shut down the bogus clinics after several months,” the agency had already paid millions of dollars to the phantom clinics, according to the blog.

How nice of CMS to waste our tax dollars and yet they know were our business is located but can’t locate and follow their own protocol on approving new companies that want to bill Medicare. This scenario is consistent with CMS and their poor business practices.

My advice is leave our industry alone, we are 1.3% of the Medicare budget, establish a fair fee for products & services and enforce the same standards on every medical provider. Every clinic can be physical checked by the same contractors who visit us to take pictures before assigning a Medicare provider number. If you did thisyou would have found the PO Boxes that served as a clinic and saved taxpayers $ 35 million.

UPDATE ON COMPETITIVE BIDDING, DFW AREA

Medicare has published the “ new rates “ on the 5 bid product categories. Their were roughly 1400 companies in 9 cities that submitted bids; best quess is that 364 providers will be offered contracts. Medicare has not released the names nor have they released how the bids were evaluated. This lack of transparency prompted 136 representatives to send a letter to CMS Administrator Donald Berwick asking to release the provider names and the overall qualifications of these providers. The issue in the first go around was bidders did not have the financial resources to deliver services in a large area. NOTE: Rotech Healthcare was offered 17 contracts in this latest bid and has $ 513 million in long term debt and has been considering filing for BANKRUPTCY and states it will lose up to $ 900,000 in the 1 st qtr. 2011.
In the DFW area, estimates are 37 selected providers with 2 from out of state. These providers have to service all 11 counties. The average discount on these bids was 32 % off the Medicare allowable schedule; this does not take into account the 9.5% reduction all providers took in 2009. What business can stand a 42 % plus cut and no fee increases for 3 years?
The unintended consequences for Beneficiaries are many:
* Access, choice and quality. Eliminating 80 to 90% of qualified providers will create an access problem for all consumers, not just Medicare patients.
* Lower payments to suppliers will reduce access to high quality, brand name and customizable equipment.
* Quality and service will deteriorate. Suppliers will reduce service and quality to make a profit.
* This program is not competition; it distorts the marketplace by reducing competition. The Government is creating OLIGOPOLIES.
* Estimated 2200 jobs will be lost in DFW area. Overall 100,000 jobs by 2013 when the remainder of the country is covered.
The program takes affect Jan. 1, 2011

Call your Legislator today, we need access and choice. Your local providers are being forced out of business and in the long run this reduces competition.

Tom Polston

We are an Accredited Provider, another milestone.

We are pleased to announce another milestone in our journey toward continuous quality improvements; we achieved accreditation status through HQAA on June 4th, 2010. This is our second accreditation, Medicare requires all DME’s be accredited to participate in the program. This is good for 3 years.

Our staff was here for the first survey in 2007 so their experience and professionalism made it smoother the second time.

Gold Medal for Accreditation

Accessibility Solutions, New Service

We offer real solutions to independent living challenges for the handicapped, severely disabled and those wishing to age in place.

We are pleased to announce that Special Medical Sales is now a member of Accessible Home Improvement of America  (AHIA).  This is a comprehensive network of certified providers and contractors dedicated to providing accessible home modifications and related products and services. We are trained and qualified C.E.A.C.  (Certified Environmental Access Consultant) provider.   Insurance carriers, life-care planners, case managers and the contractor community require the C.E.A.C. credential.

Accessibility products and barrier free design can help you live more independently.        Examples of Solutions

BATHROOM

• Non-slip flooring  * shower bench * roll-in shower * walk – in tubs
• Grab bars by toilet, tub & shower * Room is at least 5’ x 8’

BEDROOM

• Portable lifts for transfer from bed to wheelchair
• Ceiling lifts for transfer from bed to bath to shower

INSIDE YOUR HOME

• A minimum of 32” of clearance through doors.
• Bedroom and bathroom on main floor
• Laundry on main floor
• No area rugs, use low pile carpeting with firm padding

KITCHEN

• Clear space with a minimum 60 “ turning radius
• Lever faucets
• Handles (not knobs) on cabinets & drawers
• Accessible counters

ENTRANCE

• Ramps or a gently sloping path
• Well-lit entry
• At least one entrance without steps

We will assist in finding consumer funding for projects through workers’ comp, wavier programs, private & public grants, non-profit organizations and private financing.

Please call Specialty Medical Sales ask for Tom Polston 972-434-2073

Call your U.S. Representative now to co- sponsor H.R. 3790 to repeal Competitive Bidding.

Support H.R. 3790 to Protect Patients and End “Competitive” Bidding for Home Medical EquipmentIssue
Congressman Kendrick Meek (D-Fla.) introduced H.R. 3790 to end the Medicare “competitive” bidding program for home medical equipment and services (HME) because the program is fatally flawed. The program encourages “suicide bidding,” using economic coercion by forcing providers to submit unsustainable bids necessary to win a contract. Although Congress delayed the implementation of the selective contracting program in 2008 to allow for needed changes, the Centers for Medicare and Medicaid Services (CMS) ignored congressional intent and was not able or not willing to address the flaws that precipitated the congressionally mandated delay. H.R. 3790 protects patients’ access to medically required home medical equipment and services without raising Medicare spending. The American Association for Homecare (AAHomecare) urges support for H.R. 3790.
Congress Must Eliminate the Anti-Competitive Bidding Program:
H.R. 3790 Will Achieve Savings through Cost Offsets:
1) Reimbursement cuts were implemented in 2008 to pay for the bidding program delay:
• In 2008, HME payment rates were reduced by 9.5 percent nationwide for ALL providers to delay the botched program.
2) HR 3790 would cut HME reimbursements to offset elimination of the bidding program:
• In 2010, 2011, and 2012, the bill would eliminate the annual payment update (CPI-U) and
reduce payment rates for all HME items by 0.25 percent in each year.
• In 2014, the bill would eliminate the additional two percent increase in HME payment rates. All HME items would still receive the annual CPI-U update.
• In 2015, the bill would eliminate the annual CPI-U update for all HME items and reduce
payment rates for all HME items by 0.5 percent.
Congress Must Eliminate the Anti-Competitive Bidding Program:
1. It Sacrifices Care for Seniors and People with Disabilities. Competitive bidding restricts
access and choice for HME items and services.
2. The Program Is a Job Killer, and It Is Anti-Competitive. It reduces the number of competitors. Estimate 80,000 to 100,000 job losses; Dallas area will lose 2100 jobs.
3. Not Cost-Effective, Not a Solution for Health Care.The bidding program will
increase Medicare costs. It disrupts the continuum and coordination of care between doctors, discharge planners, patients, and HME providers.It will lead to longer, more expensive hospital stays and more physician office visits, nursing home admissions, and emergency room visits.

To fast track the process and move this bill forward we need 218 co – sponsor, we have 184 as of 3/19.

We need healthcare providers, beneficiaries and consumers to call their U.S. Representative and get them to support H.R. 3790, a budget – neutral bill to repeal the DME competitive bidding program.  Visit this site to locate your Rep.  http://capwiz.com/vgm/dbq/officials/

or call 202-224-3121 .   You can call now or visit their district office during  Easter recess.

Thank You

Tom Polston

Health Care, Fear and Debt

Our company was notified that Amerigroup (Texas Medicaid partner and for profit public company) has lowered the reimbursement on nebulizers and related devices to treat asthma effective 1/1/2010. What is alarming is how steep the cuts are, 50% or more and now we lose money. Our choice is either drop the program or find a cheap alternative and face the poor quality issues. North Texas has many children affected by respiratory conditions and the pendulum swings wide before balance is restored. We will keep you updated.

We set a new record for  2009.

Health care consumed a record 17.3% of all spending on the economy, $ 2.5 trillion. This was the largest single one-year jump in 50 years and by 2012 spending on health care will overtake private health care spending. The fuel for our economy was consumer spending; there will be fewer dollars for high-ticket items let alone discretionary whims.

Our growing deficit, debt and the interest on Government borrowing will consume everything to keep the US afloat with little else for consumer spending. I read an article that said on the average, Americans pay 21% of their income in federal taxes and another 10% to state & local governments. Given the current trend , by 2030 this could be 45% and by 2040 53%.  The unfunded promises on social security and medicare are $ 60 trillion.  I won’t be around but my kids and grandkids will be faced with the bill and that is just morally wrong. This is a wake up call for those mid – 30 year olds whose future is at stake.

You can’t expand health care without first controlling costs. The bitter pill is regulatory action; all fees, procedures, supplies, meds are adjusted down and fixed, no exceptions. We need a crash diet of restraint on every entitlement program or face bankruptcy and anarchy. In addition, we simplify the tax code, raise taxes, increase the retirement age, cut the military and CIA budget , eliminate all earmarks and impose term limits on Congress .  Our leaders can participate in social security and the same health care we enjoy. We are all living longer and for what, to watch a great country go bankrupt. Does anyone trust our legislators? Enforce this diet for 5 years , yes it is drastic and painful for everyone but  it is only way to cure our addiction.

Mad as Hell

Tom

GAO confirms faults with Round 1 Bidding

GAO (Government Accounting Office) confirms multiple failings of round 1 competitive bidding.

A 65 page report released 12/7/09 by GAO entitled “CMS working to address problems from round 1 of DME competitive bidding program”, said that of the 6374 bids submitted by 1010 suppliers, half were disqualified before competing on price.

1.   Information CMS provided to providers was at times unclear & inconsistent, particularly regarding financials documentation.

2.   Round One presented several challenges to HME’s, poor timing, lack of clarity in the bid submission process, failure to inform all providers that losing bids could be reviewed and an inadequate electronic bid submission system. Did anyone know that CMS had a post – bidding review process? No, poor communication.

3.   CMS found that some bids had been incorrectly disqualified. 150 suppliers complained they were improperly disqualified from bidding. It was reported that 630 of 1005 providers were disqualified 63%. The electronic bid process reported loss of data from automatic logouts and numerous downtimes.

Some corrections were made in the new “ Rebid “ process however, the basic flaw is that seniors access to quality, cost-effective care at home will be reduced and thousands of hard-working providers will be out of business.

Support the Meek bill H.R. 3790. See my blog.

Tom Polston