BIRMINGHAM, Ala. (November 4, 2020)—The DMEPOS competitive bidding program was designed to find competitive rates of reimbursement for DME items, not necessarily the lowest, said John Gallagher, vice president of government relations at VGM & Associates, during a presentation for the 2020 Medtrade Virtual conference.
That's why, he said, the statement in the recent Centers for Medicare & Medicaid Services (CMS) proposed rule about payment amounts “not achieving expected savings” was odd.
The recent proposed rule determined that Round 2021 of the program would not proceed as normal, with contracts only awarded for off the shelf orthotic braces. (See our coverage of the rule here.)
A recent House sign-on letter calling for the pause of the program for 18 months garnered 101 supporters. Gallagher said he believed this letter prompted CMS’s actions more than other forms of advocacy.
For providers who received contracts for braces, they have until Nov. 10 and 9 p.m. EST to respond.
In addition to highlighting the changes made to the competitive program, Gallagher also discussed the importance of grass roots advocacy. It’s important for providers to be proactive and not reactive and raise issues with Congress before they become a problem at CMS. Many of the ranking Senate members represent rural or non-rural areas, which can work in the industry’s favor, Gallagher noted.
While the Republicans were defending 21 seats in the Senate this election cycle, many of the ranking members on both sides of the aisle were either not running or retiring. Sen. Joni Ernst of Iowa, Vice Chairwoman of the Senate Republican Conference, kept her seat in a tight race.
Maintaining relationships at the state level is also important as DME providers look to improve licensure requirements under the competitive bidding program. The current requirements allow a provider with a facility in one state to supply patients in another. In the Atlanta competitive bid area, the average distance for an oxygen supplier from the patient is 470 miles. Gallagher noted that changing the provision to be within two hours of the patient would be more realistic, but that would vary distance state to state.
Finally, Gallagher called on the DME industry to partner together for grassroots advocacy. VGM & Associates has started a program called “Together We Will.” The program unites the industry in goals and voice surrounding industry issues. Learn more here.
