American Association for Homecare Calls for Market-Based Alternative to Medicare’s Bidding Program; Cites Lack of Access for Beneficiaries
Current Bid System Replaces Cost-Effective Home Medical Equipment with ER Visits and Hospitalizations
WASHINGTON, Feb. 16, 2012 /PRNewswire-USNewswire/ — Citing the likelihood that Medicare beneficiaries are not receiving necessary medical equipment and services, the American Association for Homecare is urging Congress to adopt the Market Pricing Program (MPP) to replace the controversial bidding program for home medical equipment and services, or durable medical equipment (DME).
Data from the Centers for Medicare and Medicaid Services (CMS), which implemented the bidding program in nine test areas a year ago, shows that reimbursement claims for home medical equipment fell in those metropolitan areas – Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside, California.
CURRENT SYSTEM IS DANGEROUSLY FLAWED
Consumer advocates, auction experts, DME providers, and economists are concerned that seniors and people living with disabilities are not receiving critical medical equipment and services. Since the program was implemented in 2011, the American Association for Homecare has received reports from hundreds of Medicare patients about difficulty finding local equipment and service providers, delays in obtaining medically required DME, and fewer choices when selecting equipment and providers.
Medical oxygen, walkers, respiratory devices, hospital beds, wheelchairs, and other medical equipment and supplies prescribed for Medicare beneficiaries reduce spending by preventing treatment in higher-cost settings. Data from CMS shows that when Medicare patients don’t use prescribed home medical equipment and services, their use of emergency room and hospital services increases. So while the current bidding program may further reduce spending on DME (which represents 1.4 percent of Medicare spending and is falling), taxpayers will see spending increase dramatically in hospitals and ERs as patients’ options for home-based care continue to shut down.
ECONOMISTS, CONSUMERS, CONGRESS OPPOSE FLAWED BID SYSTEM
Lined up in opposition to the current Medicare bidding program are 244 economists, 30 consumer and disability groups such as United Spinal and the ALS Association, and 166 members of Congress.
CMS is now expanding the bidding program to 91 additional metropolitan areas throughout the U.S. However, economists have warned that expanding the deeply flawed program is a mistake. Yesterday, University of Maryland economist Peter Cramton, Ph.D., told American Association for Homecare annual conference participants, “Now is not the time to scale up a program that everyone agrees is fatally flawed. The Market Pricing Program steps in and fixes each of the flaws with direct and understandable solutions.”
Kennesaw State economics professor Brett Katzman, Ph.D., spoke to the same group and commented about the current Medicare bidding program, stating, “I am a proponent of competitive bidding. What you have now is not competitive bidding.”
One reason why utilization has declined is that the current bidding program prevents several thousand qualified DME providers from serving Medicare beneficiaries. “The existing system reduces choice, access, and quality of care for seniors and people with disabilities who require home medical equipment and services,” said Tyler J. Wilson, president of the American Association for Homecare.
MARKET PRICING CAN BE ACHIEVED THROUGH BETTER DESIGN
In calling on Congress to enact the Market Pricing Program, Wilson explained that the current system, which allows non-binding bids, encourages irresponsible bids and creates unsustainable prices while doing nothing to ensure that winning bidders are qualified to provide the products and services to Medicare beneficiaries.
The Market Pricing Program is based on recommendations by economists and auction experts who have studied the current program. MPP features an auction system to establish market-based prices around the country and would require Medicare to make fundamental changes to ensure the long-term viability of the pricing program. Key components include:
- The Market Pricing Program is designed to achieve an accurate market price.
- Bids are binding for the bidders and cash deposits are required to ensure that only serious homecare providers participate.
- The bid price is based on the clearing price, not the median price of winners.
- The program includes the same equipment and services as the current bidding system and would be implemented across the country during the same timeframe.
- Two product categories per market area would be bid. Eight additional product categories in that same area would have prices reduced based on auctions conducted simultaneously in comparable geographic areas.
“The market-based system would ensure that Medicare beneficiaries receive the services and equipment that they need and ensure that the government pays fair, competitive prices for the equipment and services provided,” Wilson said. “That makes it a win-win for taxpayers and beneficiaries.”