February 11, 2009
Comments Regarding File Code CMS-1561-NC
Contemplated Delay of 60 days in the effective date of the interim final
rule “Medicare Program Changes to the Competitive Acquisition of Certain Durable
Medical Equipment, Prosthetics and Supplies (DMEPOS) by Certain Provisions of
the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)”.
Per your request for public comment, we agree that the implementation date of the
Interim Final Rule published in the Federal Register on January 16, 2009 should be
delayed a minimum of 60 days.
As published, the Interim Final Rule makes only minor changes to the initial
Round 1 bidding process by deleting Puerto Rico as a CBA, deleting two product
categories, providing notice of missing financial documents and requiring contract
suppliers to disclose information on subcontractors.
THE IFC ignores many of the inherent problems associated with the previous
DMEPOS Round 1 bidding:
Access to quality products
There are no provisions in the IFC that require a supplier to provide brand name,
quality products that provide more optimal care and long term cost savings.
Analysis of many of the single payment prices from the initial Round 1 makes it
readily apparent that suppliers submitted bids based solely on the lowest cost
products that were available to them. In addition, a number of suppliers who were
awarded contracts had very little previous experience with the product categories
for which they submitted bids.
Beneficiary Treatment Plan Compliance
Beneficiaries in the CBAs will have significantly fewer supplier choices than
beneficiaries in non-bidding areas. Beneficiaries will be “steered” to lower cost
items and since they would not be familiar with the products offered will most
likely be less compliant with their treatment plan. This is especially true of
beneficiaries with diabetes, who have a meter and testing strips that they have
been using for years and would now be asked to switch products and suppliers.
Non-compliance will simply shift costs from Part B to Part A thereby creating a
higher overall cost for CMS.
Multiple Tiers of Benefits
The IFC as currently written, creates multiple tiers of uneven benefits for
beneficiaries. Those who reside in CBAs will have less supplier choice and will be
subjected to using lesser quality products. A beneficiary in a Bidding Area, who
has diabetes, needs oxygen and a wheelchair could now have to deal with three
different suppliers. A beneficiary in a Non-Bidding Area would have the
convenience of using a single supplier.
Administrative Costs, Allowables & Job Loss
CMS continues to add more administrative costs for suppliers while attempting to
drive down allowables.
For example, a person with diabetes can walk into a retail drug store and
purchase a box of 50 test strips for $65.00 with their credit card. The retail store
did not need physician orders, copies of patient chart notes, an electronic billing
system, did not have to wait for payment, etc. but was paid almost twice the
current Medicare allowable. In the current atmosphere of accelerating job loses
and federal government attempts to create new jobs and stimulate the
marketplace, the current bid process will eliminate thousands of jobs in many
small businesses.
Recommendations
- We would recommend that CMS work with Congress to delay the
process for longer than 60 days.
- The entire process needs to be reviewed, revamped and rewritten.
- Beneficiaries should have access to quality products from experienced
suppliers on an equal basis for every Medicare beneficiary.
- CMS needs to clarify the Medicare billing regulations so that they are
clear, understandable and enforceable on a consistent basis. All DMEMAC
regions should follow the same regulations without their own interpretation.
- Consistently and clearly enforce the supplier standards. Fraud and
abuse costs CMS a great deal more than DMEPOS Competitive Bidding might
save.
Sincerely,
Jim Potasiewicz
Potasiewicz, Jim
This is comment on Proposed Rule
Medicare Program: Changes to the Competitive Acquisition of Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) by Certain Provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
View Comment
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