One of the critical failings of CMS’ bid-based acquisition program for DME is that it prices only goods, not the services which are an integral part of life-sustaining home medical equipment.

The problems from CMS’s failure to include services as part of the DME they put out for bids started to become apparent at a hearing of the Health Subcommittee of the House Ways and Means Committee.

A member of the Committee, Rep. Gerlach asked a senior CMS official official whether the national mail order competition for diabetes testing supplies could mean that nursing homes may not be able to receive the specific brands of products that the physician prescribed and may be required to settle for products which are not, in the view of the docter, most appropriate.

In response to the question, CMS’ Director of their Chronic Care Policy Group, Laurence Wilson, suggested that “a caregiver at the nursing home could pick up the test strips and bring them back.”

CMS’ answer is astonishing.

The agency is now on record in Congressional testimony as stating the professional caregivers may have to become errand runners in order to try to maintain quality of care.  CMS made no statement as to how patients in residential facilities would be impacted by caregiver’s services leaving the facility to run errands because CMS refuses to recognize that services, including but not limited to product delivery, are a basic part of DME.

Since no mention was made by CMS of how the caregivers would be compensated for their additional duties, it appears that Medicare expects nurses and other skilled caregivers to become volunteers.

Turning professional caregivers into volunteers is only the tip of the DME services iceberg.  CMS’ refusal to allow compensation for the vital services that go with oxygen supply and other life-support equipment remains to be addressed.  Patients, their families and advocates, and professional caregivers all have reason for concern.

The question by Rep. Gerlach and the response by Mr. Wilson may be found begining at the time mark of 1:21:58 in the tape of the hearing found here, http://waysandmeans.granicus.com/MediaPlayer.php?view_id=2&clip_id=304.  Mr. Wilson’s response quoted above begins at 1:24:56.