Motorized wheelchairs and scooters, should they be able to advertise that Medicare with cover with little or no cost ... (insurance, dollars)
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The physicians for whom I work are certainly intelligent enough to write a prescription for any durable medical equipment the patient might need based on medical necessity. They don't need to be inudated with forms to review for supplies and equipment the patient did not ask them for directly.
Is this any different than patients who will ask to be put on certain prescriptions because they saw ads on TV and think they will help them? Ads might direct patients in for chairs or meds, but it's up to the doctors to not rubber stamp those requests. I have mixed feeling on making a law against companies advertising medical equipment. On one hand, it is an area of high abuse. One the other hand, is it right or fair to the companies who don't scam to curtail their ability to advertise---say, even with an ad in the telephone book? If they can't advertise then that opens up another area for scamming because the companies will turn to direct marketing to the doctors. "Refer ten patients for wheelchairs or scooters and get a free cruise." The curtain system does works if the doctors do their part and actually exam their patients or send them to an occupational therapist for an evaluation before writing the chair or scoot prescription.
True. A doctor is under no obligation to send in the required prescription for a patient to get a wheelchair just because he/she comes in with an application form they've gotten from a company selling chairs. In fact it would be illegal for a doctor to do so if need can't be documented. Medicare specifically requires a face-to-face meeting with your doctor for him/her to determine if a person meets the requirements, which are actually pretty strict. What a lot of these companies depend on is you'll buy the scooter or wheelchair (out of your own pocket) if you're turned down by Medicare---you can't qualify for a scooter, for example, if you just want it for when you go outside. But their advertising hooks people into calling for the free trial and often they'll end up with a sale even if the person---at their doctor's face-to-face exam---ends up not sending in the claim form to Medicare. Medicare is well aware of the scams and do their own advertising to try to avoid as much as possible. They've also tightened up on claims and are making it harder and harder for people and companies to get away with abuse and fraud.
That is very true. As was mentioned before, suppressing the commercials violates the first amendment, and I have trouble meddling with that, but at the same time, if a company is essentially condoning fraud, I think that violates the first amendment anyway. But still, it comes down to whether the doctor approves it, and if the doc approves it then Medicare can still deny it, right? So while the patient may have ill intentions of just getting a freebie, both the doctor and Medicare office stand in the way still. I guess the blame is shared between all parties, huh?
Is this any different than patients who will ask to be put on certain prescriptions because they saw ads on TV and think they will help them? Ads might direct patients in for chairs or meds, but it's up to the doctors to not rubber stamp those requests. I have mixed feeling on making a law against companies advertising medical equipment. On one hand, it is an area of high abuse. One the other hand, is it right or fair to the companies who don't scam to curtail their ability to advertise---say, even with an ad in the telephone book? If they can't advertise then that opens up another area for scamming because the companies will turn to direct marketing to the doctors. "Refer ten patients for wheelchairs or scooters and get a free cruise." The curtain system does works if the doctors do their part and actually exam their patients or send them to an occupational therapist for an evaluation before writing the chair or scoot prescription.
It's different in that the direct request to the doctor for the medication doesn't cause the physician to be inudated with forms to review for equipment the patient might not need.
If the patient feels he or she needs a motorized scooter or wheelchair he/she can pick up the phone and call the doctor's office. This type of direct marketing deceives seniors and encourages fraud. The salespeople will prompt the patients on what to say to the doctor regarding their need for the equipment. I don't see that as free enterprise.
This is the best argument thus far for getting rid of the commercials.
I was a sales rep for a DME company until last March. I got out of it because I couldn't stand going into the foul homes of elderly people and I also couldn't stand being a part of the utterly ridiculous waste. Our main product was diabetic shoes. The bulk of our customers were type 2 diabetics (which is the less severe category)*who had absolutely no legitimate medical need for the shoes. They have custom molded orthotic insoles and*cost about 400.00 per pair. They're available at no cost to the patient. Medicare will pay for one pair of shoes per person per calendar year. The mark up is substantial with a profit margin in the 35% range on those. We also sold a back brace that was a nice to have rather than a need to have. Our cost on them was 150.00 and the Medicare reimbursement to the company was 1500.00. I made a large commission on them and I would sell about 5-10 per day on average as an add on to the shoe sales visits. Another add on that would fly off the shelf like candy was a 400.00 heating pad system which also had huge mark ups and commissions to the sales people. This is also a nice to have.*It was far from a necessity.**All of these products are also at no cost to the patient and the rates are set by Medicare. Another product that's seen advertized constantly on TV is diabetic blood glucose testing meters. The meter is usually given away for free in order to capture the hugely profitable test strip business which has margins near 100%. We'd go in for a sales call on the shoes and after selling the other add on products we'd give someone a meter when they already had one that was perfectly good. Many people would be sitting on a huge supply of the test strips that would be thrown out after we got them the new cool talking meter. They'd then build up a huge surplus of new test strips that would be thrown out later after someone else sold them (or should I say gave them) the newest, latest, and greatest meter. Once again allot of these people were type 2 diabetics who would hardly ever test their blood because it just wasn't necessary.
We also carried power mobility. The rule for Medicare*is that they will only pay for power chairs if the patient can use it in their home. We would have to do an extensive home survey that required measuring doorways and etc. The rule was they had to be able to access the kitchen, bathroom, and bedroom in order to qualify. Every single person who I worked with that requested one was perfectly able to access all of these areas of their home using a cane or walker or in many cases no assistance at all. These are purely luxury items that are obviously desired*by the user for use outside the home. Of course there are exceptions and there are some people who actually need them but they are a small percentage of the mix. They cost 5000.00 each on the low end.*We also carried an extensive line of other nice to haves with similar markups that were all available at no cost to the patient. It really is insane. It was certainly a big eye opener to me. *****
The Pharma commercials are not really targeting seniors because those brand new expensive drugs are not on the majority of Medicare Part D formularies and if the are, the copay is so high that a senior on a fixed income could not afford the drug. FWIW, I think the Pharma commercials should go away as well.
It's different in that the direct request to the doctor for the medication doesn't cause the physician to be inudated with forms to review for equipment the patient might not need.
How many requests a month would you estimate your physicians are getting for wheelchair or scooter prescriptions?
I was a sales rep for a DME company until last March. I got out of it because I couldn't stand going into the foul homes of elderly people and I also couldn't stand being a part of the utterly ridiculous waste. Our main product was diabetic shoes. The bulk of our customers were type 2 diabetics (which is the less severe category)*who had absolutely no legitimate medical need for the shoes. They have custom molded orthotic insoles and*cost about 400.00 per pair. They're available at no cost to the patient. Medicare will pay for one pair of shoes per person per calendar year. The mark up is substantial with a profit margin in the 35% range on those. We also sold a back brace that was a nice to have rather than a need to have. Our cost on them was 150.00 and the Medicare reimbursement to the company was 1500.00. I made a large commission on them and I would sell about 5-10 per day on average as an add on to the shoe sales visits. Another add on that would fly off the shelf like candy was a 400.00 heating pad system which also had huge mark ups and commissions to the sales people. This is also a nice to have.*It was far from a necessity.**All of these products are also at no cost to the patient and the rates are set by Medicare. Another product that's seen advertized constantly on TV is diabetic blood glucose testing meters. The meter is usually given away for free in order to capture the hugely profitable test strip business which has margins near 100%. We'd go in for a sales call on the shoes and after selling the other add on products we'd give someone a meter when they already had one that was perfectly good. Many people would be sitting on a huge supply of the test strips that would be thrown out after we got them the new cool talking meter. They'd then build up a huge surplus of new test strips that would be thrown out later after someone else sold them (or should I say gave them) the newest, latest, and greatest meter. Once again allot of these people were type 2 diabetics who would hardly ever test their blood because it just wasn't necessary.
We also carried power mobility. The rule for Medicare*is that they will only pay for power chairs if the patient can use it in their home. We would have to do an extensive home survey that required measuring doorways and etc. The rule was they had to be able to access the kitchen, bathroom, and bedroom in order to qualify. Every single person who I worked with that requested one was perfectly able to access all of these areas of their home using a cane or walker or in many cases no assistance at all. These are purely luxury items that are obviously desired*by the user for use outside the home. Of course there are exceptions and there are some people who actually need them but they are a small percentage of the mix. They cost 5000.00 each on the low end.*We also carried an extensive line of other nice to haves with similar markups that were all available at no cost to the patient. It really is insane. It was certainly a big eye opener to me. *****
Profit margins on medical supplies really should be an area where investigations are targeted. It's ridiculous what they charge for most of this stuff. The markups are highway robbery.
Last edited by Wayland Woman; 08-07-2011 at 09:28 AM..
I was a sales rep for a DME company until last March. I got out of it because I couldn't stand going into the foul homes of elderly people and I also couldn't stand being a part of the utterly ridiculous waste. Our main product was diabetic shoes. The bulk of our customers were type 2 diabetics (which is the less severe category)*who had absolutely no legitimate medical need for the shoes. They have custom molded orthotic insoles and*cost about 400.00 per pair. They're available at no cost to the patient. Medicare will pay for one pair of shoes per person per calendar year. The mark up is substantial with a profit margin in the 35% range on those. We also sold a back brace that was a nice to have rather than a need to have. Our cost on them was 150.00 and the Medicare reimbursement to the company was 1500.00. I made a large commission on them and I would sell about 5-10 per day on average as an add on to the shoe sales visits. Another add on that would fly off the shelf like candy was a 400.00 heating pad system which also had huge mark ups and commissions to the sales people. This is also a nice to have.*It was far from a necessity.**All of these products are also at no cost to the patient and the rates are set by Medicare. Another product that's seen advertized constantly on TV is diabetic blood glucose testing meters. The meter is usually given away for free in order to capture the hugely profitable test strip business which has margins near 100%. We'd go in for a sales call on the shoes and after selling the other add on products we'd give someone a meter when they already had one that was perfectly good. Many people would be sitting on a huge supply of the test strips that would be thrown out after we got them the new cool talking meter. They'd then build up a huge surplus of new test strips that would be thrown out later after someone else sold them (or should I say gave them) the newest, latest, and greatest meter. Once again allot of these people were type 2 diabetics who would hardly ever test their blood because it just wasn't necessary.
We also carried power mobility. The rule for Medicare*is that they will only pay for power chairs if the patient can use it in their home. We would have to do an extensive home survey that required measuring doorways and etc. The rule was they had to be able to access the kitchen, bathroom, and bedroom in order to qualify. Every single person who I worked with that requested one was perfectly able to access all of these areas of their home using a cane or walker or in many cases no assistance at all. These are purely luxury items that are obviously desired*by the user for use outside the home. Of course there are exceptions and there are some people who actually need them but they are a small percentage of the mix. They cost 5000.00 each on the low end.*We also carried an extensive line of other nice to haves with similar markups that were all available at no cost to the patient. It really is insane. It was certainly a big eye opener to me. *****
The figures you quote here are disgusting. Sounds like Medicare itself is a huge part of the "waste" we always hear of. The markups are ridiculous.
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