AMARILLO, TX – CMS recently published a proposed rule addressing multiple issues. Many of the issues discussed in the proposed rule do not directly affect the DME industry. However, two of the issues do affect DME suppliers: (i) telehealth and (ii) remote physiological monitoring (“RPM”). In response to the proposed rule, AAHomecare will submit the following comments to CMS regarding these two issues:
At the outset, AAHomecare acknowledges that Congress must make some statutory changes in order for CMS to make permanent the ability of providers to engage in expanded telehealth activity. Nevertheless, AAHomecare believes that it is important for it to voice its support and explain how telehealth and other virtual services can be an efficient and effective way for physicians and beneficiaries to communicate about ongoing needs for DMEPOS.
AAHomecare points out that telehealth can often effectively replace in-person visits with no concomitant disadvantages. Further, during and after the public health emergency (“PHE”), AAHomecare supports the ability of beneficiaries and prescribers to engage in virtual services (e.g., telehealth, e-visits, and virtual check-ins) in lieu of certain in-office visits. Virtual services allow the beneficiary and prescriber to appropriated communicate about ongoing needs and, in many situations, eliminate the need for an in-person visit to the physician’s office.
In its comments, AAHomecare voices its strong support for CMS’s expansion of telehealth services during the PHE to facilitate access to care while minimizing in-person encounters. AAHomecare points out that (i) during the PHE telehealth encounters promotes social distancing and (ii) expansion of telehealth improves access to care without compromising the quality of services.
In its comments, AAHomecare discusses the fact that in the DME space, there are a number of scenarios where the beneficiary is required to re-visit the prescriber to ensure continuing medical need and to obtain a prescription for refills of supplies. The purpose of these visits is to have the prescriber check in with the beneficiary to (i) ensure that he/she is using the equipment/supplies properly and (ii) determine if the equipment/supplies are still medically needed. AAHomecare points out that this type of visit can be effectively conducted via a virtual visit…and encourages CMS to continue to allow these types of visits after the PHE is over.
While AAHomecare recommends that CMS allow virtual services after the PHE, AAHomecare recommends that virtual services be reserved for prescribers with an established beneficiary relationship. In other words, virtual services can be effectively used in situations where the prescriber (i) has an ongoing relationship with the beneficiary, (ii) has already prescribed the medically necessary item, and (iii) simply needs to check in with the beneficiary to ensure continued need or a recommended change.
AAHomecare also points out that another benefit resulting from telehealth is that it provides an opportunity for patients to seek medical care before needing to visit a facility, such as a hospital. The CDC reported that emergency department visits dropped by 42% between January 1, 2020 and May 1, 2020 as a result of the PHE. Although this steep drop is disconcerting, the expansion of telehealth during the PHE is likely limiting some ER visits. AAHomecare points out that telehealth allows patients to obtain medical attention without leaving their homes…and that this is particularly important for high risk patients who should limit leaving their homes during the PHE.
Prior to the PHE, telehealth was limited to Medicare beneficiaries residing in a rural area. AAHomecare points out that the difficulty accessing a clinician’s office is not limited to rural areas. For a variety of reasons, even beneficiaries residing in urban areas can struggle to visit a physician’s office. According to AAHomecare, whether it is due to a transportation issue, a medical condition, or the flu/pandemic (where the patient is fragile), there are situation in which telehealth is safer than an in-person visit.
In its comments, AAHomecare voices its support for the expansion of RPM to further enable access and quality of care for beneficiaries. Digitally enabled medical devices, including certain DME items, help collapse time and space by capturing snapshots of physiological data. AAHomecare points out that digital health allows multifaceted capture, documentation, and reporting of precise health conditions, triggering events, dates, times, and other contextual data. Some devices not only monitor the patient’s disease status but also deliver medicine and/or therapeutic care. According to AAHomecare, by using digitally enabled medical devices and their associated services, Medical practitioners and payors can monitor patient conditions, while documenting use, functions, trends, conditions, environmental status, location, and other aspects of patient compliance, care and necessities. AAHomecare states that unlike the past when this information was only captured episodically (between in-person visits), the availability of this new information can help improve care management, leading to better patient outcomes, and potentially resulting in increased cost savings.
For the purpose of gathering information related to diagnosing, treating, and managing a clinical condition for which DME is ordered, AAHomecare recommends that CMS allow RPM to satisfy the requirement for the face-to-face encounter. RPM allows physicians and other clinicians to gather information and monitor patient treatment.
AAHomecare recommends that CMS adopt policies that will improve the partnership between the DME industry and the physician community in caring for patients. DME suppliers are more frequently in contact with beneficiaries after a physician’s visit and are in the position to monitor and communicate between patients, caregivers and physicians. AAHomecare points out that some DME suppliers already provide equipment with monitoring technology that has improved the supervision of patient health in real time. RPM can be used in tandem with expanded virtual services to provide a robust patient-centered visit without the need for an in-person visit.
AAHomecare’s Retail Work Group
The Retail Work Group is a vibrant network of DME industry stakeholders (suppliers, manufacturers, consultants) that meets once a month via video conference during which (i) an expert guest will present a topic on an aspect of selling products at retail, and (ii) a question and answer period will follow. The next Retail Work Group video conference is scheduled for October 8, 2020, at 11:00 a.m. Central. Mike Scarsella of Compass Health Brands will address “Key Considerations for Improving Customer Retention.” Participation in the Retail Work Group is free to AAHomecare members. For more information, contact Ashley Plauché Manager of Member & Public Relations, AAHomecare (firstname.lastname@example.org).
AAHOMECARE’S EDUCATIONAL WEBINAR
Collaborative Arrangements with Physicians, Hospitals and Other Referral Sources
Presented by: Jeffrey S. Baird, Esq., Brown & Fortunato, P.C.
Tuesday, September 29, 2020
1:30-2:30 p.m. CENTRAL TIME
The lifeblood of a DME supplier is to develop relationships with physicians, hospitals and other referral sources. In so doing, it is important that the supplier avoid violating federal and state anti-fraud laws. This program will discuss the federal anti-fraud laws that suppliers must follow, including the federal anti-kickback statute, the Stark physician self-referral statute, the False Claims Act, the beneficiary inducement statute, and The Travel Act. The program will also discuss examples of state anti-fraud laws. The program will then pivot to a discussion of the types of arrangements that are legally permissible … and those that should be avoided. Examples include Medical Director Agreements, Preferred Provider Agreements, placement of employee liaisons, meals to physicians’ staffs, gifts to physicians, payment to physicians for providing education programs, and loan closet arrangements.
Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato, PC, a law firm with a national health care practice based in Texas. He represents pharmacies, infusion companies, HME companies, manufacturers and other health care providers throughout the United States. Mr. Baird is Board Certified in Health Law by the Texas Board of Legal Specialization, and can be reached at (806) 345-6320 or email@example.com.