ATLANTA — In a week of bad press, three media heavyweights took aim at the DME sector in stories industry stakeholders called incomplete and misleading.
Springing off the debate about health care reform currently engaging both houses of Congress and the president, CNN, The Washington Post and The Wall Street Journal each filed stories that took issue with the Medicare wheelchair benefit (CNN), the oxygen benefit (The Wall Street Journal) and the delay of competitive bidding (The Washington Post).
The reports generated fiery responses from industry stakeholders who, among other things, questioned the absence of relevant facts.
CNN's "One wheelchair — one lesson of problems in heath care reform," by Drew Griffin with Kathleen Johnston, drew particular steam from providers. The piece, which began airing July 20, focused on an Apria wheelchair patient who said her rented wheelchair had cost taxpayers $1,200 over four years when it could be bought on the Internet for $440. CNN reporters said they found an even better deal than that: They purchased a wheelchair directly from Apria for $349, they said.
In an almost immediate response to the piece, NRRTS uploaded a video on YouTube featuring its executive director, Simon Margolis.
The story "presented a very one-sided look at a multi-faceted problem," Margolis said, noting that the piece did not include any comments from industry representatives, nor did it discuss the costs associated with providing equipment, such as delivery, pick-up, service and adjustments to the wheelchair.
"There is also the cost of filing for Medicare payment and billing the patient monthly, 13 separate times, for the copay. These costs are not present in the cash price of the chair that [the] undercover agent purchased," he said.
"I think [the story] was slanted and distorted," said Tim Pederson, CEO of WestMed Rehab in Rapid City, S.D. "They seem to be blaming the providers for the situation instead of the government. We're not the ones who came up with the capped rental system."
Michael Reinemer, vice president, communications and policy, for the American Association for Homecare, called the CNN piece "sophomoric and laden with errors and misrepresentations."
Ironically, AAHomecare had worked with reporters Griffin and Johnston to provide industry facts for the piece.
"[AAHomecare] provided ample information to CNN about the costs of providing equipment and services to Medicare beneficiaries in their homes," Reinemer said. "The association also presented information about the controversial competitive bidding program that Medicare implemented last year. However, CNN used a combination of incorrect figures and cherry-picked facts to paint a false picture of both topics."
Reinemer said the story "perpetuated two myths that harm the public's understanding of the home medical equipment benefit in Medicare."
The first myth, he said, is that Medicare overpays for DME because it can be purchased cheaper from the Internet. The two cannot be equated, he said, because the Internet versions do not include any services or maintenance.
"The costs of providing home medical equipment and services to Medicare patients include delivery, often within hours of discharge from a hospital, set-up, patient education, compliance and 24-hour on-call service," Reinemer pointed out.
The second myth, he said, is that HME providers "escaped the price reductions that competitive bidding would have imposed."
While Reinemer said the reporters and their producer knew the competitive bidding program was delayed to address its flaws and that the HME sector had paid for the delay by taking a 9.5 percent reimbursement cut, that information was not included in the story.
"CNN had this information but failed to mention it," Reinemer said. "Instead, CNN left its viewers with the impression that providers of medical equipment escaped any negative impact because of intervention by Congress. The stark reality is that hundreds of home medical equipment providers are struggling and in some cases failing as a result of the 9.5 percent cut, and a 27 percent total cut for oxygen therapy in 2009, and even deeper cuts in reimbursement for power wheelchairs in recent years."
The story also did not note that competitive bidding would exclude "as many as 80 percent of providers, even if they agreed to the lower bid prices," Reinemer said.
Lake Forest, Calif.-based Apria, which had also worked with CNN on the piece, expressed serious concerns about it. A six-page rebuttal to the report from Lisa Getson, Apria executive vice president, government relations, said:
- The piece failed to mention that the patient is still subject to Medicare rules from 2005, important because reimbursement for her exact wheelchair was reduced beginning Jan. 1, 2006, Getson wrote. Also, she said, Apria has been reimbursed $960 for the chair by Medicare, not $1,200; the other 20 percent came from the patient's private insurance.
- "CNN did not adequately research or tell the whole story about the limited services Internet vendors of DMEPOS equipment provide versus those that are required of local providers by the Medicare program," Getson asserted, making her point with a chart comparing services that Medicare beneficiaries can expect from a local provider to those provided by Internet vendors.
- "CNN gave little coverage to the complex, time-consuming Medicare patient qualification, coverage guidelines and other paperwork requirements associated with serving Medicare beneficiaries, including those who require wheelchairs. The Internet vendors are not subject to these requirements and, in fact, state this on their Web sites," Getson said in her letter.
Getson told CNN executives that Apria had "billed Medicare appropriately under all existing regulations and Medicare paid Apria under these rules." She also pointed out that, while CNN reported the patient said she had not been notified about an option for Medicare to purchase her chair for her, Apria did indeed send a letter to the patient in 2004 as required by Medicare "and she consciously chose to continue the rental option."
Both Getson and Reinemer asked CNN to print corrections and clarifications.
But NRRTS' Margolis said he agreed with CNN's Griffin on one point: "All wheelchairs for Medicare and other beneficiaries who have long-term complex physical and functional needs should not be rented. They should be purchased outright from Day 1. This is by far the most cost-effective solution to the long-term needs for Americans with disabilities who require complex mobility systems … Congress should take heed of what Mr. Griffin has to say about wasting money on wheelchair rental."
(A provision in the House of Representatives' health care reform bill, currently under debate, would eliminate the first-month purchase option for Groups 1 and 2 power wheelchairs.)
Newspaper Articles Take Jabs
Meanwhile, The Washington Post and The Wall Street Journal added to the industry's frustration with articles on Friday.
The Post article, "Bush Official Sees Peril in Health Plan," by David S. Hilzenrath, centered on comments from Michael Leavitt, former secretary of the Department of Health and Human Services under President George W. Bush.
Leavitt charged in the story that Congress authorized competitive bidding for DMEPOS — "and then bowed to pressure from the industry, putting a stop to the initiative just as it was being implemented," Hilzenrath wrote.
"In a system that's run by the government, lobbyists and various commercial interests, including doctors, hospitals, nurses, medical equipment dealers and every other part of the system, use the political process to restrict the capacity for change," Leavitt was quoted as saying.
AAHomecare's Reinemer responded to Hilzenrath, saying the article was "extremely misleading." He pointed out that Congress did not "stop" the competitive bidding program, rather, delayed it. Again he noted the industry paid for the delay with a 9.5 percent reimbursement cut.
"Congress delayed the program last year — it starts again this year — because it was a badly designed and implemented scheme that was going to put most of the providers out of business, even if they agreed to new, lower bid prices," Reinemer told Hilzenrath.
About the 9.5 percent reimbursement cut, he added, "The implication that the home medical sector weaseled out of a large payment reduction through congressional intervention is absolutely false."
Laura Meckler's article in The Wall Street Journal, "Obama's Health Expert Gets Political," focused on Peter Orszag, director of the Office of Management and Budget, whom she describes as "taken aback" when a House Democrat said her top priority was winning higher payments for oxygen suppliers.
"Officials have been trying for years to cut payments to suppliers of oxygen and other medical equipment, which critics say are inflated," Meckler wrote. "Yet when a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan. They are still fighting to block changes."
Reinemer, in a communication with Meckler, pointed out that she had failed to mention the 9.5 percent reimbursement cut the industry had taken to pay for the delay of competitive bidding.
"It's discouraging to see no context or history or figures in your discussion of oxygen and bidding if the topic is controlling health care spending in Medicare," he wrote.
The three reports illustrate how far the industry has to go to gain the public's and consumer press' understanding of how it operates, stakeholders said.
"I think that one of the things that we have failed to communicate is the overhead that you have in a system where you have to meet all the insurance and Medicare requirements and regulations," said Randy Wolfe, owner of Lambert's Healthcare, a 53-year-old Knoxville, Tenn.-based DME company with three locations.
"We have to do a better job of describing to the average Joe just how many layers of red tape we go through to do this business," he continued. "We have to show the enormous difference between a cash transaction and an insurance transaction."
Wolfe said the key to health reform is to take some of the cost out of the delivery system. And much of that cost, he said, comes from all the demands on the industry.
"They have created so many rules to manage us that they don't realize how excessive they have become," he said, referring to Medicare and insurance officials. "It creates overhead for us … If I have to be Dr. Kildare and Dick Tracy and Perry Mason to get our money, it's going to cost, and it's going to cost a lot."
In Wolfe's view, the press consistently misses the main story. "The comparison they are making [between the Medicare and Internet prices] is not where the story is," he said. "The story is the overhead and the bureaucracy. It costs everybody too much money."
Wolfe, who is the chairman for the Stand Up for Homecare committee for AAHomecare, believes the industry must do a better job of educating the press.
"One of the things I want to look at this year is what our messages are and how effective they are," he said. "What the press knows about us is so limited. We need to do a better job of defining things and telling them how things work."
It's time, Wolfe said, to "build knowledge of our industry, the good things we do, and explain some of this stuff and not be reactive all the time. We have a great message, we have a great industry."
WestMed's Pederson agreed the consumer media needs educating. The CNN piece, he said, was, in fact, an indictment of the capped rental system.
"That's the point that needs to be driven [home] to the news organizations," he said. "Yes, this is a silly system, but we didn't create it. We just have to live with it."
View the CNN segment.
View the NRRTS video response.
