LETTER: Medicare And Competitive Bidding
From: Hartford Courant
This is a wake-up call for anyone on or nearing the age of Medicare. As of July, Medicare will put into effect competitive bidding. This is what it will mean to you;
1. You will lose your right to chose you equipment provider. Many of the providers who win the bids are not local and some are out of state. If service is inadequate, there’s no alternative. The beneficiary’s choice doesn’t matter, and neither does the therapist’s — one can only go where CMS dictates.
2. Delays in obtaining medically required equipment and services; also delay in the maintenance of equipment.
Industry opens up multiple fronts against bid program
From: HME News
by: Leif Kothe
WASHINGTON – With a new bill for the market-pricing program (MPP) expected to drop soon, industry stakeholders are mulling another legislative tactic in the fight against competitive bidding: a delay in the implementation of Round 2.
Congress has mandated CMS to implement Round 2 in 2013—but not necessarily on July 1. Stakeholders are working with members of Congress to create legislation that would delay the program’s start date until the end of the year.
“We’re using this delay as a tactic to advance the ultimate goal, which is passage of the market-pricing program,” says Seth Johnson, vice president of government affairs for Pride Mobility.
From a Reader on CMS’ Additional 2% Price Cut: “This additional cut only adds insult to injury.”
Editor’s Note: The following is the verbatim communication received from a health care provider. CRE thanks the writer for their insights and their commitiment to caring for Medicare beneficiaries despite CMS’ policies that harm the quality of care. The legal issue raised by the reader should be addressed by HHS/CMS.
To Whom It May Concern,
CMS’ Secret Financial Standards In Action
Editor’s Note: CRE repeatedly attempted to compel CMS to disclose the “applicable financial standards specified by the Secretary, taking into account the needs of small providers” that DME providers are required to meet to be eligible in the competitive bidding program. CMS prevailed in maintaining secrecy regarding exactly what financial standards/algorithm they used in evaluating bidders. The consequences of CMS’ refusal to meaningfully propose their financial standards for notice and comment are starting to become apparent.
From: HME News
Rotech to file for bankruptcy
ORLANDO, Fla. – Rotech Healthcare announced late on Friday that it plans to restructure and reorganize under Chapter 11 of the U.S. Bankruptcy Code.
Medicare’s looming changes to home health care to hurt many
From: The Bakersfield Californian
by Allen Kennedy
The Medicare program as we know it today is in the midst of many changes. For some individuals, the word Medicare brings to mind government assistance and provisions for physician visits, hospitalization or surgical procedures. However, for those who need assistance at home, it means so much more. For these individuals, Medicare has provisions for home-based medical equipment that allow them to be cared for by a home health nurse or family member and, in many cases, remain independent within their own home.
Lop another 2% off bid rates
From: HME News
WASHINGTON – CMS notified providers on March 8 that reimbursement for claims for durable medical equipment and supplies, including those provided in competitive bidding areas, will be reduced by 2% on April 1.
The reimbursement for claims will be reduced based on whether the date of service, or the start date for rental equipment or multi-day supplies, is on or after April 1.
The cut is part of mandatory across-the-board spending cuts in federal spending.
Diabetes Caucus Asks GAO To Study Pay Cuts To Diabetes Test Strips
From: Inside Health Policy
Diabetes Caucus co-chairs Dianna DeGette (D-CO) and Ed Whitfield (R-KY) are asking the Government Accountability Office to study whether pay cuts for retail diabetic test strips have made those supplies more difficult to find. Medicare reimbursement is set to plummet on July 1 due to the latest round of competitive bidding cuts and savings wrapped into the end-of-the-year Medicare physicians payment package.
DeGette and Whitfield, in a Feb. 27 letter, say they are concerned about the impact of the lowered reimbursements on Medicare beneficiaries’ access to their current diabetes testing strips and the corresponding glucose monitor. “We think it is incumbent upon us to make sure that the current quality of care is upheld,” the letter says.
Fiscal Cliff Disaster Looms for Diabetes Testing Supplies
From: Diabetes Health
B. Douglas Hoey, RPh, MBA, CEO National Community Pharmacists Association
The short-term legislation enacted to avoid the “fiscal cliff” at the start of 2013 has long-term consequences for Medicare beneficiaries’ access to diabetes testing supplies (DTS). The legislation drastically cuts independent community pharmacy reimbursement for DTS and will likely decrease beneficiary access. Decreased beneficiary access to DTS could result in less patient adherence and increased long-term costs due to avoidable complications in the management of diabetes.
Federal Judge: CMS appears “indifferent to, if not ignore entirely, the large number of individuals in the [USA] that are developmentally disabled and have other disabilities…
Editor’s Note: In the Order and Memorandum attached here, a Federal Judge issued a blistering criticism of CMS’ management of the competitive bidding program. The following are excerpts from the US District Court Judge Donovan W. Frank’s Memorandum and Order in Key Medical Supply, Inc. v. Sebelius et al.
While the decision on the motions is supported by law, the Court is deeply concerned about the unjust consequences of its order. As such, the Court feels compelled to issue a short memorandum herewith, prior to issuing its full memorandum and opinion.
Judge criticizes Medicare bidding program
By Terry Baynes
(Reuters) – A federal judge in Minnesota delivered a sharp rebuke to the government’s new competitive bidding program that affects who can supply certain medical equipment and how much they can be paid by Medicare.
U.S. District Judge Donovan Frank said in an order on Tuesday that while he lacked the authority to rule on the legality of the program, the government was ignoring the harm inflicted on people with disabilities.
“This is a sad day for those who believe that when a judge adheres, even-handedly, to his or her oath of office, justice will prevail and the public interest will be served,” Frank wrote.