• CMS dumps cushions from Round 2

    From: HME News

    By Elizabeth Deprey, Associate Editor

    WASHINGTON – The complex rehab industry had another reason to celebrate this week when efforts to remove skin protection wheelchair cushions from Round 2 of competitive bidding finally paid off.

    Industry efforts to exclude the four codes (E2622, E2623, E2624 and E2625) began even before Round 1 was implemented Jan. 1, 2011, and CMS agreed to make the change Dec. 28.

  • The Medicare Debate

    Editor’s Note:  The following discusses the potential of competition to lower costs but does not explain that CMS’s existing implementation of competitive bidding is anythng but competitive.

    From: National Review

    by James C. Capretta

    There are many reasons to be grateful for the introduction of the Medicare “premium support” plan by Democratic senator Ron Wyden and Republican House Budget Committee chairman Paul Ryan.

  • Survey: Bidding program really does limit access

    From: HME News

    By Theresa Flaherty, Managing Editor

    CHICAGO – Beneficiaries in Round 1 competitive bid areas have limited access to the most widely used diabetes testing supplies, says the American Association of Diabetes Educators (AADE).
    A survey by the association found that mail order contract suppliers, on average, offered only 38% of the product brands that are listed on www.medicare.gov. Of the nine brands identified by the Office of Inspector General in a 2010 report as the top mail order brands by market share, contractor suppliers offered, on average, only 1.44 of the brands, or 16%.
    “We were getting all of these stories from our educators who were hearing about problems, or having their patients tell them they don’t have a certain meter any more,” said Martha Rinker, chief advocacy officer for the AADE. “When we talked to CMS about it, or any other party, they’d say it was just anecdotal. We thought this was the best way to get concrete information.”
    With an average reimbursement cut of 56% for mail order diabetes supplies, it’s not all that surprising that many suppliers are offering lesser-known–and less expensive–brands. Dr. Peter Cramton, a vocal critic of the current competitive bidding program, predicted providers would cherry pick and switch patients to different brands to try and squeeze out a profit.
    “It’s in line with what I expected to see based on the current design of the program and the type of behavior it creates,” said Tom Milam, a member of the Program Advisory and Oversight Committee (PAOC) and former CEO of mail-order diabetes supply firm AmMed Direct. 
    For Round 2, which expands the mail order diabetes bid to all 50 states and several U.S. territories, CMS has implemented changes it believes will prevent low-ball bids: Contract winners must provide, at minimum, 50% of all the different types of diabetes testing supplies on the market by brand names; and contract winners are prohibited from influencing or providing incentives to beneficiaries to switch their brands.
    But unless CMS plans to police suppliers, stakeholders don’t believe the provisions will work.
    “It’s easy to bid and give a low bid and say you’re going to do something and not do it,” said Rinker. “I think it’s going to be up to us who work with the patient community to get some congressional interest in this to make CMS take an interest.”
  • Regulatory bid-rigging will cost medical patients

    Editor’s Note:  The following article highlights an issue that CRE and other authorities have made repeatedly, CMS’ “competitive bidding” system is not competitive, it is a convoluted and opaque form of price fixing.

    From: The Hill’s Congressional Blog

    By Steve Pociask, American Consumer Institute

    The CMS has not done what Congress legislated it to do, and without correction, the result will be reduced patient access to prescribed medical supplies for home use, worsened patient outcomes and increased medical costs.

  • Medicare’s Competitive Bidding Program Fails to Offer Diabetes Supplies as Promised

    From: DiabetesHealth.com

    In some US markets, people with diabetes who are covered by Medicare cannot get the mail order diabetes testing supplies that Medicare promised.

    According to the American Association of Diabetes Educators (AADE), the competitive bidding program for diabetes testing supplies is not working as it should.  In August 2011, after learning that some suppliers were not offering products listed on the www.medicare.gov website, the AADE formally surveyed contract suppliers by telephone in nine markets in different parts of the US. The organization found that contract suppliers offered an average of only 38 percent of the products listed on www.medicare.gov and, in some cases, offered products not listed on the government website.

  • Bipartisan Group of 22 House Members ask CMS to Stop Prepayment Review Project that would Jeopardize Care for Medicare Beneficiaries

    From:  AAHC

    WASHINGTON, Dec. 16, 2011 /PRNewswire via COMTEX/ — A group of 22 bipartisan House Members yesterday wrote to the Centers for Medicare and Medicaid Services (CMS) asking the agency to stop their prepayment review project that could limit access to mobility assistance for Medicare beneficiaries.

    The lawmakers, who included Rep. Bill Flores (R-TX) and Rep. Edolphus Towns (D-NY), cited potential job losses, restricted access to mobility equipment for Medicare patients and lack of sufficient notice among the reasons for CMS to halt the ill-conceived project.

  • OIG report triggers meeting between AOPA, CMS

    From: HME News

    ‘Prosthetists aren’t standing behind a counter handing over legs to patients’

    By Theresa Flaherty, Managing Editor

    WASHINGTON – The American Orthotic & Prosthetic Association (AOPA) wants prosthetists recognized as the allied healthcare professionals they are, rather than as “device dealers.”
    That’s why, last month, AOPA officials met with Peter Budetti, CMS administrator for program integrity, to discuss a number of concerns triggered by an August report from the Office of Inspector General (OIG). The meeting was a good first step, said Joe McTernan, director of coding and reimbursement, education and programming for AOPA, who participated. 
    “We’ll continue to try to follow up with him and his staff,” he said. “We would love to see some recognition that we are not device dealers, and go back to how it has been traditionally-to allow the prosthetist to document the need for clinical care of patients.”
    The report from the OIG said that Medicare in 2009 made $43 million in improper payments for lower limb prostheses that didn’t meet certain requirements, and another $61 million for prostheses with no documentation from referring physicians.
    The report doesn’t accurately reflect how prosthetic care is provided, McTernan says. Typically, if a patient has something wrong with his prosthesis, he calls the prosthetist, not the physician.
    “The prosthetist can do the evaluation, and if there is something that requires referral back to the physician, then the prosthetist is going to suggest the patient go see the physician,” he said. “The physician absolutely has to be involved, but there’s a reason the physician is referring the patient to the prosthetist.”
    Since the release of the OIG report, there’s been an uptick in audits for lower limb prostheses, said McTernan.
    “The DME MACs are recouping monies based solely on the physician documentation,” he said. “There can be pages and pages of good quality progress notes in the records of the prosthetist, but they are ignoring that.”
    AOPA agrees that physicians have the ultimate responsibility for patient care, but the effect of the OIG report was to significantly downplay the role of prosthetists.
    “Prosthetists aren’t standing behind a counter handing over legs to patients,” said McTernan. “There’s a certain amount of skill, knowledge and expertise that goes into a proper fit.” 
  • The Federal Government’s Deeply Flawed System For Controlling Medicare Costs

    From: Forbes

    Sally Pipes, Contributor

    Medicare’s hospital trust fund is set to be exhausted by 2024, according to the latest report from the program’s trustees. Federal officials are understandably looking for easy ways to cut spending in the entitlement program in hopes of shoring up its finances.

    They believe they’ve hit on one with a two-year-old effort to introduce “competitive bidding” into the process for buying medical equipment.

    Unfortunately, the scheme contrived by the feds is deeply flawed. Not only are Medicare’s auctions resulting in the delivery of low-quality or ineffective medical gear — they’re also dampening investment into the research that can yield the next generation of innovative treatments.

  • The Critical Role of Civil Servants

    Historically, federal civil servants played a critical role in developing and implementing federal policy. The attached article in the Administrative Law Review, published by the American Bar Association in conjunction  with the Washington College of Law of the American University, sets forth in Section D on page 54  the critical role career federal employees had in the establishment of centralized regulatory review in the White House Office of Management and Budget.
  • CMS extends competitive bidding program despite protests

    From: Health Care Finance

    Betsy Caron, Contributing Writer

    WASHINGTON – The Centers for Medicare and Medicaid Services (CMS) continue to ignore protests and a proposed bill seeking to eliminate their competitive bidding program for durable medical equipment as they plan for a major expansion of the program with Round Two.

    The competitive bidding program uses competitions between suppliers to set new, lower payment rates for certain medical equipment and supplies such as oxygen equipment, walkers and some types of power wheelchairs.

    Since the program’s implementation in January 2011, Medicare patients, economists, case managers and members of Congress have gone on record opposing the system, according to America Association for Homecare.