It really is now or never. And what I mean by that is if we don’t all take responsibility right now to make sure every member of Congress understands what will happen if the 45 percent (on average) payment cuts go into effect for Round 2 of the Medicare program’s DME competitive bidding program on July 1, 2013, then we will only have our collective selves to blame. Only Congress can change the course. But Congress will only act if they hear an outcry from all who are affected.
What to do? Call the D.C. or local office of your Representatives and Senators. You don’t have to go to Washington, D.C. You can visit the local office, call and e-mail the D.C. office or all of the above. The important thing is to make sure you effectively convey the implications of the Round 2 rates going into effect. To help you, use the following talking points for your communications:
What’s the issue?
On Jan. 30, 2013, CMS announced the Round 2 prices for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. The prices amounted to an average cut of 45 percent for DME items in 91 competitive bidding areas (CBAs) and diabetic testing supplies under a national mail-order program will be cut by an average of 72 percent. If the program is not stopped, these cuts will go into effect on July 1, 2013, and have a devastating effect on quality and access to DME and providers who furnish these items and services to Medicare beneficiaries.
What’s wrong with CMS’ bidding program?
Arbitrary Pricing Process—Any provider can submit a bid and if awarded a contract they can refuse to accept it. Bids from contract winners who refuse to sign are included in the calculation for the payment amount. This keeps the payment rates artificially low. The payment rate developed by this program sets the reimbursement rate at the median of the providers’ bids. This process encourages unethical manipulation of the bidding system by submitting a “low ball” bid in order to increase the probability of being awarded a contract. At least half the “winners” receive a contract for a payment rate below their bid and will lose money if they accept it.
No transparency—CMS continues to deny industry and congressional requests for information pertaining to the methodology and specific factors used not only for Round 2, but for the Round 1 rebid which has been in place for over two years! This begs the question: Why all the secrecy if CMS has nothing to hide?
No appeal process—Providers have no means to appeal payment rates nor not winning a contract.
What problems has CMS’ bidding program caused?
How do Round 2 prices impact your business? Talk about the area(s) you serve, how many years you’ve been in business, if you are a small or family owned company and how many employees you have. How do Round 2 prices impact your patients? Personalize the problem by giving specific examples.
Why hasn’t Round 1 failed?
Providers and manufacturers made Round 1 work because it was only in nine areas around the country. Providers were able to revenue shift by servicing beneficiaries outside bidding areas to offset reduced reimbursement rates in bidding areas. Providers will not be able to pursue this strategy if Round 2 moves forward in 91 areas around the country.
Is there an alternative?
Yes! The home care industry supports the Market Pricing Program (MPP), which has been developed by experts in the field of government auctions. The MPP would address all of the critical problems while still setting fair market prices.
The “Ask”
That lawmakers stop Round 2 prices from going into effect. Request that lawmakers contact their respective leadership in the House and Senate and tell them that this program will hurt beneficiaries and providers and must be stopped. If the lawmaker is on the House Ways and Means, House Energy and Commerce or Senate Finance Committee, ask him or her to express concerns with his/her respective chairman or ranking member.
