Page 11 - HME Business, October 2018

GAO: Non-Bid Areas Didn’t See Patient Access Problems in 2016
GAO conflicts with various studies, including those involving case managers and discharge planners, as well as CMS’s recently proposed rulemaking.
Study: Not
Investing in
HME Costs CMS
‘Significantly’ More
Leitten Medicare Cost Shift study details how repeated cuts to DMEPOS reimbursement are sending patients back to the hospital and costing Medicare Part A as a result.
As providers and industry advocates work to lobby lawmakers while they are back in their districts for the August congressional recess, they have some convincing data to help them make their case: The Leitten Medicare Cost Shift study.
The study, conducted by Leitten Consulting and sponsored by VGM, shows how reduced access
to home medical equipment and related products actually costs Medicare Part A (and taxpaers)
more money in the long run. To make the case,
the study examined three areas where costs get shifted to Part A: fall injuries, COPD exacerbations, and untreated sleep apnea.
Leitten tabulated the cost to treat each injury or condition, and calculated by how much they exceed the cost of the HME items that would have obviated or mitigated the issue. Some key costs:
• The failure to provide mobility equipment to
patients needing such devices winds up costing Medicare between $4,705 and $5,029 due to injuries incurred in events such as falls.
• COPD-related exacerbations resulting from Medicare impeding patients’ access to the right oxygen equipment cost Part A approximately $14,350.
• Sleep apnea complications due to patients not receiving CPAP equipment cost Medicare $1,631.
“In sum, Medicare ends up paying significantly more to treat the medical complications that result from its failure to adequately invest in DME,” Leitten notes in the survey. “By shifting both the cost and the focus of CMS to provide needed treatment for patients up front, the government can dramatically reduce overall healthcare costs and improve the care provided to its Medicare beneficiaries.”
To read the full Leitten study, visit bit. ly/2M9PN4Q. n
Non-bid areas did not experience signif- icantly reduced patient access to home medical equipment after the national expansion of bidding- derived reimbursement, according to a report from the Government Accountability Office (GAO).
The GAO report, available at bit.ly/2C1Q7hK, stated that “there were no widespread effects on beneficiary access in the year after the adjusted rates went into effect,” but added that “some effects may take longer to appear, underscoring the importance of CMS’s continued monitoring activities.”
In its report highlights, the GAO dismissed reports of reduced patient access to medical equipment from HME stakeholders such as bene- ficiary groups, hospital organizations and HME associations. The GAO noted that it had “reviewed several publicly released studies that assessed
the effect of the implementation of adjusted rates on beneficiaries, DME suppliers, and others.” The GAO went on to say that “We found these studies did not provide persuasive evidence.”
“We would assume the ‘others’ they reference would include the highly credible input of 358 hospital case managers/discharge planners, more than 75 percent of whom said they ‘experienced difficulties with the ease and timeliness of the discharge process for patients who require HME since July 2016,’” the American Association noted in a statement regarding the GAO report.
AAHomecare commissioned healthcare research group Dobson DaVanzo & Associates to carry out a survey of HME providers, Medicare beneficiaries, caregivers and hospital case managers, discharge planners and staff on the negative impacts of bid expansion they were witnessing. A highlights page of the report is available at bit.ly/2LHoY2Q.
AAHomecare also underscored that the report is in “stark contrast” to the rural relief IFR imple- mented earlier this year and CMS’s proposed ESRD and bidding rule current reality at CMS. Simply put, why would CMS scramble to protect patients’ access if there were no problems with access, per GAO’s contention?
“In the Interim Final Rule on non-CBA reim- bursement rates released in May, CMS provided emergency relief to providers in rural non-CBA areas and noted problems with its monitoring efforts,” AAHomecare noted. “In the recent ESRD/
DMEPOS proposed rule, CMS acknowledges competitive bidding flaws, including the use of median bid pricing, and is delaying the next round of bidding until major fixes can be implemented. CMS is also proposing an extension of the relief in rural areas through 2020.
“CMS’ language in these two recent rules, coupled with what hospital case managers, bene- ficiaries, and DME suppliers are saying about patient access problems, indicates that there are still major problems with the bidding program and non-bid area reimbursement rates that need to be addressed,” the association’s statement added.
That said, there are two upsides to the report, according to AAHomecare:
“First of all, it confirms that payment rate decreases in non-bid areas are consistent with what our industry has been reporting: approxi- mately 50 percent reductions since the new rates went into effect over the course of 2016,” the asso- ciation noted. “GAO’s report also tracks closely with our own findings on the significant erosion of the DME supplier base since the bidding program went into effect, with more than 35 percent losses in DME suppliers from 2010-2016, including an 8 percent drop from 2015 to 2016.” n
UPCOMING COVERAGE
More industry intelligence is available at hme-business.com.
Developing Stories — Watch HME-Business and subscribe to e-Source during October to monitor key stories, especially coverage of our New Product of the Year Awards, the news from Medtrade 2018, and how the industry’s drive for comments on CMS’s proposed ESRD/DMEPOS rule could influence the final rule.
e-Source — Sign up for our weekly e-newsletter, e-Source, to ensure you stay up to date on the latest industry news, trends and developments. You can enter your email address on the hme-business.com homepage to subscribe.
Management Solutions | Technology | Products
hme-business.com | October 2018 | HMEBusiness 9