Concerns Over CMS’ Medicare Integrity Contractors Escalate As Lawmakers Seek GAO Probe

From: Inside Health Policy

A bipartisan group of key legislators has asked Congress’ investigative arm to probe the effectiveness of CMS contractors’ myriad Medicare program integrity audits, citing the need for a coherent strategic plan if the program is to be successful at tracking down improper payments while not unnecessarily burdensome for providers. Providers have long complained that multiple audit programs are defective, redundant and pull staff and providers away from patient care, and HHS’ Office of Inspector General has also raised concerns about the contractors’ effectiveness.

IR makes a comeback?

From: HME News

CMS proposes using inherent reasonableness to set payment amounts for non-mail-order diabetes supplies

WASHINGTON – CMS announced late on Friday that it plans to host a public meeting next month to consult with stakeholders on adjusting Medicare payment amounts for non-mail order diabetes supplies.

CMS already has a national competitive bidding program in place to set payment amounts for mail-order diabetes supplies. But rather than add non-mail order supplies to the mix, the agency is considering using inherent reasonableness (IR) to set payment amounts for these products in the short term.

A show issue, a Special Report and lots of bad news

From: HME News

by: Liz Beaulieu

It’s that time of year when the editorial team here at HME News starts gearing up for Medtrade, Oct. 16-18 in Atlanta. See, our September issue is the pre-show issue and our October issue is the show issue/Show Daily Day 1.

To put all of this in perspective: Right now, we’re already working on our August issue. That’s right, the end of summer is already upon HME News when it has just begun for everyone else!

Health cuts could prove disastrous

From: My San Antonio

Kathleen Weir Vale

As a lifelong provider of home medical equipment and services in the San  Antonio area, I recently shared some of my concerns about Medicare  with Marjorie  McColl Petty, regional director of the Department of Health and Human  Services (HHS).  Here are the points I made:

For three generations, since 1941, Hope Medical has been serving Texans. Our  patients, mostly the elderly, use Medicare, Medicaid, and private insurance. We  employ 49 people in San Antonio and Corpus Christi.

Medicare’s War on Seniors

From: WatchdogWatch.org

is CMS leading a major Medicare program into disaster? That’s not a rhetorical question. The agency is nationally expanding a program for acquiring life-sustaining home medical equipment (oxygen, mobility equipment, diabetes test supplies, etc.) that is heading for failure because of basic design errors by the agency.

A senior Congressional Budget Office official has already issued a warning about the CMS program by stating, “I think there is a high probability of failure in the near future. There is near certainty of failure sometime down the road.”

CMS: Meeting of the Medicare Economic Index Technical Advisory Panel—June 25, 2012

Attached below is an advance copy of a CMS Federal Register notice announcing a public meeting of an advisory committee.  “The purpose of the Panel is to review all aspects of the Medicare Economic Index (MEI). This second meeting will focus on MEI price-measurement proxies and the index’s productivity adjustment.”

VGM: Competitive bidding ‘business killer’

From: Cedar Valley Business

WATERLOO — Opponents of the Medicare Competitive Bidding Program for  durable medical equipment say it’s no bargain for patients in immediate need of  oxygen, a wheelchair or other life-sustaining apparatus.

They also say it’s poison for the related industry.

Competitive bidding is on its way to a national rollout, and it likely will  be a common topic of conversation at VGM Group’s annual Heartland Conference.  The event is scheduled Monday through Thursday at the Five Sullivan Brothers  Convention Center in Waterloo.

Caltech Research Shows Medicare Auction Will Face Severe Difficulties

From: Pasadena Now

By Marcus Woo

Medicare’s new method for buying medical supplies and equipment—everything from wheelchairs and hospital beds to insulin shots and oxygen tanks—is doomed to face severe difficulties, according to a new study by Caltech researchers.

The Center for Medicare and Medicaid Services (CMS) implemented the purchasing process—a novel type of auction—in nine metropolitan areas across the country last year and plans to expand it to 91 in 2013.

Medicare’s competitive bidding program is doomed, researchers say

From: McKnight’s Long Term Care & Assisted Living

Medicare’s competitive bidding program for durable medical equipment was not built to last, new research asserts.

Under the program, about which long-term care groups have had mixed reviews, skilled nursing facilities seeking DME supplies can purchase them only from companies that submit the lowest bid to, and are approved by, the Centers for Medicare & Medicaid Services. Critics charge that the program’s rules could force participants to submit low-ball bids, causing prices to be pushed so far down that companies would have to cancel their offers.

“the CMS auction is not a good auction. … the CMS auction cannot be easily fixed”

A new study by researchers at the California Institute of Technology, attached below, blasts CMS’ “competitive” bidding auction for Durable Medical Equipment.  The study published in the Quarterly Journal of Economics, found that CMS’ decision to use non-binding bids and median bid pricing does NOT result in competitive prices.  Of particular concern to Medicare beneficiaries and their families, the paper also found that the auction “fails to satsify demand.”  Researchers has already shown based on CMS data that utilitzation of life-sustaining home medical equipment dropped sharply under the new acquisition program.  Specifically, the paper concluded that: “The CMS auction fails to generate competitive prices of goods and fails to satisfy demand.”