Potasiewicz, Jim

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