Selected Tag: NCB

Common Sense (and Dollars)

July 26th, 2010

Does anyone else think it’s amazing that a government that can make a trillion dollars disappear at the drop of a hat is gloating at the possibility of saving only $17 billion over ten years? It’s even more ironic that they’re proudly going through with National Competitive Bidding at the expense of job-creating small and medium businesses, who will simply erode the current tax base from both an employer and employee perspective.

I’m all for reining in waste at all levels of government, but where’s the common sense here? And this is before we ever get to the points of NCB sustainability.

Will hospital discharge planners need to coordinate with a half-dozen home care suppliers, three of which are out-of-state, to send one Medicare patient home? I can hear the 2011 conversation now:

“You’re saying that you can supply the hospital bed, but can no longer supply the oxygen?”

“That’s right. You see, we didn’t bid 30% below our cost; however, I’m sure the bid winner who’s three states away will be happy to take your call.”

All for $1.7 billion annually for ten years. Maybe Thomas Paine should be required reading to become a bureaucrat.

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PECOS Phase 2 Delayed (Again)

February 18th, 2010

Did you ever wonder how these decisions are made? I mean, imagine the political appointees sitting around a conference table to discuss PECOS.

I can just imagine how pleased they must have been with themselves after one presented the idea to create a whole new database of physicians for the sole purpose of verifying their NPIs, which already (supposedly) had been a vetting process to help prevent health care fraud and abuse. My head spins just thinking about it.

When I allow my imagination to delve into these dark places, I can picture them high-fiving each other as their meeting adjourns. “Another victory for the American taxpayer.”

Of course, they delegate other minions (paid for by us) to administer PECOS, yet another government health care directive and its details. If it weren’t so absurd, it’d be laughable.

How bad is this idea? If PECOS was so wonderful, why has Phase 2 implementation been delayed a second time — this time for nearly a full year? Just counting all the ways is depressing.

Let’s start with putting the onus on the providers that can’t get reimbursed without action by other providers who have no incentive to comply because their reimbursement isn’t affected. I wonder who came up with that one.

Then there’s the eventual unveiling of the great and wonderful PECOS database — as a PDF! Obviously, some government employees had been tasked to create the database. But then they were tasked to convert it to a nearly useless format so companies like ours would need to spend time to reverse the process in order to properly help our clients.

When testing our version of the PECOS database against client data, we discovered that approximately 50% of physicians had enrolled. So, the same people you need to bother for ever more medical necessity documentation now also must enroll in PECOS for the same reason: so you, the HME provider, can get paid for products and services rendered.

Anyone have aspirin? My head hurts, and another brilliant government idea called NCB is still barreling toward us at breakneck speed.

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Still a Major Threat – Part 2

February 17th, 2010

Hopefully, you’ve had an opportunity to read Part 1 of Todd Tyson’s guest post regarding national competitive bidding. Let’s continue with Part 2:

“What does this mean for Medicare beneficiaries? Limited access, no choice, substandard equipment and services. What good can come from low bid providers being awarded contracts with Medicare? Savings sure, but at what cost? Extended hospital stays, patients’ safety concerns, restricted number of providers, elimination of 90% of small business providers.

“HME is the most cost-effective and slowest-growing portion of Medicare spending according to the most recent National Health Expenditures data from CMS. HME accounts for less than 1.5% of the Medicare budget; and, CMS hopes to expand CB to physicians, hospitals and other health care providers in order to cut costs and ration health care to seniors and people with disabilities.

“CB will likely increase spending because it will shift cost from Medicare Part B (Home) to Part A (Hospital). Longer hospital stays and cost shifting from home to the institutional setting will surely follow service disruption and limited access for beneficiaries. Currently under Medicare, a day of oxygen therapy costs less than $7 per day while a day in the hospital costs more than $5500.

“Home care is the most cost effective way to treat most patients; and, home is where most people would rather be. HME is one solution to rising health care costs; but, once again the Federal government has put our Medicare beneficiaries at risk in order to eliminate providers, because they cannot control costs, fraud or abuse in the system. Once again they want to say that providers are the crooks when they [the Feds] are the ones that issued the provider a supplier number and are responsible for policing the behavior.

“There are numerous home care heroes that are out at all hours of the day and night providing in-home services so that patients can live independently in their homes where they prefer to be. These heroes appear at a moment’s notice ready to discharge you from the hospital, follow you home to install equipment, educate/instruct patients and caregivers on proper use, and then leave only to provide 24 hour, 7 day per week on-call services and follow-up to those that need it. Congress is clueless about the services component involved with HME and only reimburses for the equipment. HME is so much more than that and deserves the recognition that HME is the solution and NOT the problem.

“Crook or Caregiver? You be the judge! Call your representatives and ask them to protect HME by sponsoring HR3790 to repeal Medicare Competitive Bidding.”

Thanks to Todd for his contribution. He’s touched on several valid points. Please comment if you have anything to add.

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Still a Major Threat to Home Care Viability

February 15th, 2010

Just for the record, we received more snow; but, compared to last week, we’ve barely felt Round Three of February’s worst. The real storm that threatens home care as we know it is national competitive bidding.

A well-respected HME provider and ten-year CAU client, Todd Tyson, recently authored his thoughts regarding the recurring NCB nightmare and what you can do about it. Here’s Part 1:

“Atlanta will soon begin the bidding process for the second round of Competitive Bidding (CB) for Medicare Home Medical Equipment (HME) slated to begin in Atlanta in 2011. CB was part of the Medicare Modernization Act (MMA) of 2003 that most of us recognize as the prescription drug bill which mandates that Medicare bid for home medical equipment and services. CB was originally supposed to begin in 10 Metropolitan Service Area (MSAs) in 2009 and expand to 80 more in 2010 including Atlanta however the program was so fatally flawed that Congress passed the Medicare Improvement for Patients and Providers Act (MIPPA) to postpone the implementation until 2010 so that the Centers for Medicare and Medicaid Services (CMS) could fix the problems inherent in the MMA.

“Sadly CMS has decided to move forward again with CB in 9 MSAs without any real improvement to the initial plan or process. The first round of bidding awarded contracts to providers that were not appropriately qualified or licensed to satisfy the regulatory requirements established by CMS supplier standards. Many winning bidders had never provided the services that they bid for and were awarded. Most did not have the credit necessary to fund the business and the growth required to satisfy the capacity that they were legally obligated to provide. One manufacturer was even quoted as saying that of the 380 winning bidders he would not extend credit to, more than 50% and several of the other 50% were already on credit hold.

“The original bid process was to yield a 27% saving to Medicare HME only because non-qualified underfunded bidders bid way below Medicare allowed fees. Some local providers bid low for fear that they would be barred from participation and other non-local providers bid even lower in order to eliminate local providers and gain new markets. No one truly understands why providers were willing to low ball bids, but the reality of the contracts was unsustainable for most bid winners.

“What does this mean for Medicare beneficiaries?” We’ll find out next time as we continue with Todd’s guest post. Meanwhile, you’re welcome to add your opinion to the conversation.

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HME Welcomes Another NCB Ally

December 18th, 2009

The Center for Regulatory Effectiveness has sided with HME providers in the struggle against National Competitive Bidding. The CRE, established to provide Congress with independent analysis of agency regulations, has filed a petition against CMS to stop DMEPOS competitive bidding until it publishes financial standards for the program as required by law.

The interesting blog post explains the details, including quotes from a provider and a beneficiary. Maybe, just maybe, this independent analysis will catch the attention of more of our representatives in Congress.

The flawed NCB plan really has no redeeming value. It hurts beneficiaries; will only (potentially) save from DMEPOS to exponentially increase hospital stays (and costs); loses jobs; and, basically tells small business owners to go away. All of this flies in the face of our current domestic economic challenges and will create undue harm to our aging population.

Having CRE on the same sideline isn’t the knockout blow, but it could help for Congress to hear these same messages from another independent source.

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More Bad News for NCB

August 14th, 2009

A recent HME Business e-zine article outlined a new economic study by Brian O’Roark, PhD, of Robert Morris University. If you have a stake in CMS’ National Competitive Bidding program, this study (funded by PAMS) will surely reinforce your debate.

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