Query: DME and a RVU-Based Contract
I am interested in getting any examples of already existing compensation models for the dispensing of DME. The specific scenario I am working with is an employed podiatrist in a large multispecialty group or hospital medical group setting. Our podiatry section has been certified by CMS and functioning for several years, providing both custom and non-custom DME to our patients directly but receive no additional credit for that production. Our compensation model is RVU-based and DME has no current RVU for HCPCS codes. The management team has been trying to explore options but is interested in analyzing any existing models in a similar scenario. We have made several proposals so any comments must be based on already existing programs with mainly RVU-based contracting.
PM News Subscriber
Response: The author of the question is correct. DME cannot be signed RVU. Safe harbors are required to protect both the provider of the service (the parent company) and the referring entity (the individual DPM) from becoming sucked into violations of anti-kickback (Stark laws) for Medicare patients and anti-incentive (all patients, even self-pay). Thus, the complex nature requires the expertise of two other parties:
1) A DME specialist who can assess the practice in order to determine the types of services that are both likely to be provided through the practice and those which will be referred out. The DME specialist would have to have a thorough understanding of the potential revenue stream which may be generated and review the practice’s past as well as making an economic forecast of the impact of DME revenue, doctor by doctor (regardless of whether a specific doctor prescribes or provides DME) as well as for the entirety of the practice.
2) A healthcare attorney: The practice will require the skills and services of a team of healthcare attorneys well versed in DME AND Stark and Anti-Incentive issues. Working together this team can assist the practice and help them navigate the murky waters which, if not done properly, could result in significant issues for everyone involved. Once that is done, a fair legally binding contract with the appropriate “safety nets” can be incorporated.
Since each situation is unique there is no one uniform solution for all.
Paul Kesselman, DPM, Oceanside, NY
