Billing bonanza for balance assessment inspires unsavory sales pitches

The following Hearing View combines two posts that the author, Alan Desmond, AuD, originally published on January 16 and 23 on his blog, Dizziness Depot.  I am republishing them here because I believe that Alan’s cogent reporting and commentary on questionable sales practices in the health care field deserve a broader audience.

On March 1, I tried to reach Dr. Edward R. Popick, the ostensible author of a letter faxed to one of Dr. Desmond’s ENT colleagues at Blue Ridge Hearing and Balance Clinic. This letter was one of the things that provoked him to write his two-part critique of unsavory marketing.

Before publishing his post about Dr. Popick and the company, Innovative Healthcare Systems, where he was listed as National Medical Director, my blog colleague tried to reach him there, but without success. When I called the company’s number last week and asked for Dr. Popick, I was told that he was “on the other line.”  I was then transferred to two other people in that office, the second of whom was Richard Gant, the CEO and owner of Innovative Healthcare Systems.

Mr. Gant was apparently unaware that HearingHealthMatters.org had written about his company, so I sent him the link to the post. He vigorously defended the marketing material attributed to Dr. Popick that Alan had criticized. In fact, Mr. Gant said that he had written it himself. He also told me that Dr. Popick no longer worked at Innovative Healthcare Systems. When I asked him if his former employee was the same Dr. Edward R. Popick who appears on Mugshots.com (see Alan’s post), he said that he didn’t know, and added that it was irrelevant.

At the conclusion of our telephone conversation, I suggested that Mr. Gant respond to Alan’s original blog post.Now I  would like to invite him and any other readers to send us your comments on the following post.

David H. Kirkwood, Editor, Hearing Views

Alan Desmond

By Alan Desmond 

The road to hell is paved with good intentions. That is a gruff, but probably accurate assessment of how the field of vestibular management was severely injured by the introduction of a low-cost, easy-to-use, quick, inexpensive tool to measure the Vestibular-Ocular Reflex (VOR) for rapid head movements.

Rotational Chair testing had been, and still is, the standard for accurately measuring VOR response to slow to moderate speed head movement. This newer test, known as Active Head Rotation (AHR) was, and still is, a great technique to assess the VOR for rapid head movements where visual stability would be diminished in a patient with a VOR deficit.

So far, so good. We had some brilliant people working to create helpful clinical assessment equipment and protocols. I hold nothing but admiration for them. Unfortunately, some less than brilliant people also got involved. I think the words “greedy, short-sighted, irresponsible, scammers” and so on would be more appropriate. I wrote an article for the May-June 2011 issue of Audiology Today on this subject.

Here is an excerpt, but if you have a minute and are a member of the American Academy of Audiology, you can click here to read the whole article.

“Two things happened around 2002: Reimbursement increased to about $78 per unit, and manufacturers and distributors heavily promoted an Active Head Rotation (AHR) test that technically fell under the descriptor for 92546 (sinusoidal vertical axis rotation), although this was never the intended use for this code. Manufacturers guided their customers to perform three horizontal sweeps, and three vertical sweeps, to reduce artifact and increase test reliability.

“This was clinical advice, and should not have been confused for billing advice. Some distributors offered billing advice and instructed their customers to bill one unit for each sweep, for a total of six units. In 2001, this resulted in a payment of about $150. After 2002, this same billing pattern resulted in a payment of about $460. This windfall was recognized by some equipment distributors and practitioners, and utilization increased dramatically over the next few years. Balance Clinic Packages were being promoted to physician groups that had not previously shown any interest in vestibular testing.”

THE AMA STEPS IN

Consequently, businesses started popping up selling this equipment with some interesting sales approaches. Such companies were apparently quite persuasive in getting primary-care physicians to purchase this equipment. The frequency of billing for the rotation chair code rose by 1400% between 2001 and 2007! In response to this billing bonanza, the American Medical Association issued a statement in 2005 making it perfectly clear that the rotational chair code (92546) should not be used for this new active head rotation system (see Ramsdell in Vestibular Medicine and Rehabilitation).

My issue is not with the manufacturers of AHR equipment. I own two of these units and use them on appropriate patients. However, I do not bill Medicare as if I were doing an actual rotational chair test, which we also do regularly.

I don’t even have much of an issue with the primary-care providers who are using this equipment and billing it incorrectly. They trust these salespeople, and they are making an effort to quantify the patient’s complaint of dizziness. I am an advocate for primary-care physicians becoming more involved in screening for vestibular disorders and treating straightforward conditions such as posterior canal BPPV. But I do fear that they may be a very unhappy group when the RAC (Recovery Audit Contractor) rolls around to audit their billing.

MISLEADING CUSTOMERS

I do have a BIG issue with salespeople and distributors who mislead their customers for a quick sale, give them incorrect billing/coding advice as part of the sales pitch, and, frankly, try to tell them that evaluating dizziness is easy.

After specializing in vestibular disorders for over 20 years, I can tell you it is rewarding, challenging, interesting, but it ain’t easy. And you can’t learn it in a two-day on-site training, with 10 hours of that time devoted to billing and coding. I think that being honest, providing your potential customers with accurate information, not claiming other people’s work as your own, and full disclosure about your company and its principals should be a minimum expectation. Don’t you?

That leads me to a company that does not seem to worry about these standards.

AN OFFER I CAN EASILY REFUSE

A few weeks ago, one of the ENT physicians in our group received a fax from a company called Innovative Healthcare Systems (IHS). No address was given, but the fax number area code was from Palm Beach County, Florida. Attached was a letter from Dr. Edward R. Popick. In the first paragraph of the letter Dr. Popick says, “you may earn an extra $15,000 to $25,000 a month in ancillary income.”

After a few paragraphs of statistics about geriatric falls and hip fractures, Dr. Popick makes the statement, “Medicare and major insurance companies are more than willing to pay for fall prevention testing…” Then there is an offer to “send you a financial projection that will let you know what this program could mean financially for your practice.”

Then, after signing off “Most sincerely, Edward R. Popick M.D.,” he offers, this time in bold print “we are willing to give you a $10,000 Fall Assessment System – FREE (if you respond to us within the next two weeks). Don’t delay!”

Now, if you read my blogs, you know I am a proponent of improving vestibular screening in emergency departments and primary-care offices. The letter never mentioned what the program was, or what equipment the company was selling, although it mentioned several times how much money we could make. So I decided to visit the web site listed on the letter and looked around.

The site confirmed that Innovative Health Systems is based in Royal Palm Beach, Florida. The first thing I noticed was that much of the information looked familiar. Paragraph after paragraph was directly lifted, and another whole section was intermittently paraphrased from publications I had written several years ago. There was no attribution or any indication that the text was not the property of, or written by the company. There was also considerable text that was unfamiliar to me, so I don’t know if they wrote that themselves or lifted it from someone else.

Second, the company listed CPT Code 92546 as part of their test battery when they do not sell rotational chairs. They also describe Active Head Rotation as the appropriate test for this code. They fail to mention that in 49 states Medicare guidelines prohibit the use of 92546 for Active Head Rotation, Don’t you think a company that sells equipment should be aware of policies regarding that equipment?

Lastly, I was curious about Dr. Popick, and read his bio describing him as “a voice of the information age” and a “consultant to ABC News.” But, I have learned that most bios enhance the good stuff, and gloss over the bad stuff, so I Googled him to see what else he may have been involved in. Imagine my surprise when one of the first sites with information on Dr. Edward R. Popick was Mugshots/com. Please click and draw your own conclusions.

Now, to be fair, there is a chance there is more than one Dr. Edward R. Popick of Lake Worth, Florida, age 67. I attempted to contact Dr. Popick through the Balance-Plus web site twice for verification and he did not respond.

Alan Desmond, AuD, is the Founder/Director of Blue Ridge Hearing and Balance Clinic in Bluefield and Princeton, WV. He is the author of two textbooks, several book chapters, and two educational booklets for primary-care physicians, all related to dizziness and vertigo. He is a co-author of the Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo, and represents the American Academy of Audiology at the American Medical Association.