Member Editorial: CMS Versus VA – The Alarming Inconsistencies of Patient Care

Posted on in HME Government Issues

By Craig Rae, Penrod Medical Equipment After dealing with the VA and CMS for the past three years, it boggles my imagination that the VA is getting so much bad press when they are light years better than CMS at looking after their patients’ needs for DME. I believe the inconsistencies stem from Congress, who pressures the VA to take care of the veterans, while they pressure CMS to save money. It’s the Medicare beneficiary that suffers from this inconsistency. The VA takes logical, cost-effective, timely actions, while CMS creates a labyrinth of bureaucracy with which nobody can keep up. In fact, at one point, they answered questions to their competitive bidding help line incorrectly 96% of the time. I suggested to a couple of industry trade publications that they “compare and contrast” the two agencies for quality of care, and they contacted several industry providers (including me) for feedback. I thought that I’d share my perspective. It’s frustrating to see the VA get bad ink when it comes to the DME industry, when they’re exponentially better than CMS at servicing their patients. Here are a few “compare and contrast” type of items between the VA and CMS:

  • The VA gets power mobility equipment for veterans on the basis that it is needed for them to get to their doctor’s appointments so that they can stay healthy. In fact, they generally provide a ramp when issuing PWC’s and require a vehicle lift for most PMD, so that the veteran can transport his equipment. The VA covers the cost of both. CMS issues the equipment for use ONLY in the home and will not provide equipment such as ramps and lifts. In fact, CMS will deny approval of PMD if the doctor’s paperwork indicates that the beneficiary will use it to go out to the front porch to pick up the mail or get some fresh air.
  • We’re in a prior approval state. If repairs require prior approval, a beneficiary must go weeks before the repair can be completed, having to wait for documentation to be gathered, submitted, (rejected) and approved. With the VA, a veteran makes a phone call, the VA issues a purchase order (my local VA does so generally within 48 hours), and we visit the veteran in 1-2 days. We’re paid the same day the repair is completed. There is no risk of having the cost of a VA repair recouped if they someday find a clerical error in 5-year old paperwork. There is also no home evaluation.
  • If there’s a question that needs to be answered by somebody at the VA, the contacts are easily available (phone and e-mail) and can help solve problems in minutes. With CMS, you send faxes into black holes, and they respond by U.S. mail days if not weeks later. The response usually – tells you to go to their website to find your answer, when the sole reason that you contacted them was that you couldn’t find the answer on their website. With today’s technology, CMS’s standard of communication using fax and USPS is insane.
  • The culture at the VA reflects that they are a government agency driven to service veterans – people are conscientious and work extremely hard. The culture at CMS is that healthcare providers are all crooks and every attempt to provide a beneficiary with health care/home care is unnecessary and fraudulent until proven otherwise. This is their response each and every day. To think that DME owners have to be fingerprinted to prove that we’re not convicted felons is unconscionable. Owning a DME is now cause for a criminal investigation?
  • It takes about 15 seconds to get a live person on the phone at the VA. It’s nearly five minutes with CMS before you can get to a set of options, none of which have anything to do with what you need. I honestly spent over seven hours on the phone with CMS trying to find the address to send the EFT form (which they first insisted did NOT exist). There is ONE address listed on the form and it states, “Do NOT send this form to this address.” This is remarkable.
  • The VA focuses on patient care and providing it as quickly as possible. CMS focuses on cost savings, regardless if their efforts negatively affect beneficiary care. I hate to think how many Medicare beneficiaries fell and subsequently needed costly care (ambulance, surgery, hospitalization, rehabilitation) because CMS’ requirements to do a $150 repair can easily take weeks to complete. On a similar note, the VA recognizes that the abundance of patient falls take place in the bathroom and provide any and all items necessary to prevent those falls – many items that CMS will not cover.
  • Documentation requirements with the VA are minimal in comparison with CMS. I would estimate 10 minutes total in preparing a quote, completing a delivery invoice, sending an invoice and processing payment. With CMS, the costs are significantly higher and payments take weeks if not months longer.
  • In order to provide goods to the VA, you need to have a GSA contract, which can be costly and time-consuming to obtain, but still far less time-consuming than maintaining accreditation standards.
  • The VA continuously pushes its vendors to speed their response time – they want the fastest reliable service possible to service the veterans. CMS does not pay for service, which is in complete disregard for their beneficiaries.
  • CMS’ rules and regulations are so strict and comprehensive that they prohibit common-sense decision making. The VA also has rules and regulations however they provide latitude for employees at every level to make common-sense decisions.
  • The risk of doing business with the VA is minimal in comparison to the high risk of costly CMS audits. It is remarkable that CMS pays auditors that are wrong over half the time, and that they can recoup payments (plus interest) that industry experts project could take more than 12 years to recover (without interest). They ignore their own rules for adjudication.
A veteran that lost both of his legs will not be denied a wheelchair three years later because somebody forgot to put a date stamp on one of 100+ pages of medical documentation (or any other absurd clerical compliance issue). To think that a quadriplegic can be denied a wheelchair ordered by a qualified physician, because a CMS auditor doesn’t like the quality of that physician’s handwriting and/or that the provider pays the price of a physician’s bad handwriting, demonstrates the insanity of CMS’ rules. These rules are supposed to stop fraud, but do little to stop fraud. They only serve to add costs and delay service and payments. Many thanks to Craig Rae of Penrod Medical Equipment for sharing this editorial with us. If you are interested in submitting an editorial, contact Beth Cox Hollingsworth at [email protected].