Washington, DC, US – June 24 2022:
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Durable medical equipment (DME), such as CPAP machines and hospital beds, help keep many patients from expensive nursing care in their homes. Unfortunately, the creation of the right payment model has long fled Medicare and Medicaid Services (CMS) centers. On the contrary, they are now planning to extend an incorrect bidding process to include urology, tracheostomy and ostomy supplies that could create even more negative branching for patients.
But how did we get to this point? In 2011, the CMS implemented the current competitive submission system in response to the failed timetable for fixed fees for the compensation of DME suppliers. This fixed pay system was widely blotchy as a waste, outdated and lacking logical foundation. Critics included the General Accounting Office (GAO) and the Inspector General of the Ministry of Health and Human Services.
The bidding process eventually implemented was still incorrect. CMS set The winning offer equal to the average (or average) value of all victorious candidates. This ”We never saw before“The bidding process makes no sense and it has created various negative motives.
From the patient’s point of view, the structure with a biased victory for lower costs and lower quality medical equipment. Often, these supplies were inappropriate and therefore reduced the quality of patient care.
The previous bidding rounds are also plagued by the supplier friction and access gaps. GAO found that in previous tenders, dozens of contract suppliers became inactive, leaving the beneficiaries without coverage options. The most recent round of competitive bid (round 2021) failed to achieve the savings goals due to very few sustainable bids, leaving a two -year “vacuum” in which the CMS returned to the timetable of fees.
Due to the failures of previous competitive bidding rounds, the CMS plans to change its structure when the program resumes. While aimed at some of the imperfections of the previous system, the new procedure still has some worrying problems.
Even more worrying, revisions will also extend the DME products that will undergo the competitive bid process. The CMS should focus on dealing with the continuing defects of the system before considering any type of expansion.
When examining the extensions, however, the CMS should represent the different requirements for adaptation of DME alternatives. It is important to remember that CMS is not the end user – patients are. Therefore, CMS is only an effective negotiator when the body’s interests are aligned with patients. This alignment is much more difficult to achieve for DME products that require wide variations of the specifications. Unfortunately for patients, the revised program expands the competitive bidding process to conditions that require greater adaptation.
For example, according to the proposed competitive supply model, urology, tracheostomy and ostomy supplies will be included. But these are clinically managed DME, not out of Shelf or one size-its in all products. They are personalized prosthetic designed for specific patients. The competitive bidding process is suitable to calculate the individuality that is inherent in these medical supplies. It is important that the deviations from the personalized needs of patients can cause infections and possibly hospitalizations.
The possible increase in infections and hospitalizations is particularly alarming because these patients are more clinically vulnerable and less capable of tolerating their care disorders. Ironically, the greatest use of the most expensive hospitalizations could crush any savings that the competitive tender process could create.
Implementing the process of competitive bids to personalized DME would also discourage technological developments, as the bidding process does not reward the adapted innovations.
Recognizing their clinical complexity and potential risk of patients, Congress deliberately excludes prosthetic, such as osmology, urology and tracheostomy from the competitive contribution to the 2003 Medicare Modernization Act that approved the competitive tender process. The proposed extension will be reversed by 20 years of bilateral policy without new security data.
Reviewing the CMS competitive bid process is a necessary and positive change. However, it makes no sense to extend the program until there are documented improvements in the program functions. Even then, the expansion of competitive offering to personalized DME products, such as urology and ostomy supplies, is a policy mistake.
In this way they endanger patients, undermines innovation and creates questionable savings
