|By PR Newswire||
|April 18, 2014 12:15 PM EDT||
WASHINGTON, April 18, 2014 /PRNewswire-USNewswire/ -- Despite mounting criticism of the Medicare bidding program for durable medical equipment (DME), the President's fiscal year 2015 budget includes a proposal to use the program's unrealistically low reimbursement rates for Medicaid. It's bad enough that the bidding program's reimbursement rates, which the government sets virtually arbitrarily, will be applied to areas not yet covered by the controversial program by 2016 unless Congress acts now, says the American Association for Homecare (AAHomecare).
Such a broad expansion of the bidding program has patients across the country worried even though it comes at a time when consensus is building on Capitol Hill that the program must be significantly changed. In fact, 171 House members are cosponsoring legislation that would implement a bidding program based on actual market pricing, rather than the unfair reimbursement rates currently used.
Physicians, patient advocates, economists, and DME providers support the action that Congress is taking.
In expanding the program to 91 new locations last July, the Centers for Medicare & Medicaid Services (CMS) announced that the new prices amounted to an average 45 percent cut for many products, such as oxygen therapy, wheelchairs, hospital beds, and walkers. Price cuts for diabetic testing supplies were even steeper—more than 70 percent.
However, the methodology used to set prices is a fundamental problem of the program. Under this methodology, which lacks transparency because CMS won't release its specific formula for establishing prices, the government can set the reimbursement rate at any point between the highest and lowest bids.
But what really taints the prices is that the bids are non-binding. Thus, a provider can submit a "suicide" bid at an impossibly low price in a desperate attempt to win. Yet, a provider is under no obligation to sign a contract for that amount if it is chosen as a winner.
CMS compounds its error by using these rejected contract prices to set the reimbursement rates. In addition, CMS includes bids from unqualified bidders when it sets the rates. According to a report on the Round 1 Rebid issued recently by the Department of Health and Human Services Office of Inspector General, 19% of the rates the OIG studied were affected by bids from providers that did not meet program requirements.
More than 240 auction experts and economists have warned that the bidding program is unsustainable in its current form.
"While the CMS system does involve bidding, it is far from competitive," says Dr. Brett Katzman, chair of the Department of Economics, Finance & Quantitative Analysis at Kennesaw State University. "Yes, there are winners and losers, but winners are chosen based on their willingness to game the system rather than their cost competitiveness. The problem is that the CMS system entices providers to "low-ball" bid whereas a true competitive bidding system would reward providers for being cost efficient."
Even the so-called bid winners can struggle with this unfair pricing. All-States Medical Supply, a North Carolina based company, won a contract to provide diabetic testing equipment via mail orders. But recently, the company announced that it had to lay off eight employees and blasted the bidding program in a press release, saying the cut in reimbursement rates and a 250% increase in audits were too much to sustain.
Tom Ryan, president of AAHomecare, said that in addition to not holding bidders accountable for their submissions, the program produces reimbursement rates that are financially unsustainable.
"The program is dismantling the DME infrastructure that seniors and people living with disabilities rely upon," says Ryan. "It has forced bankruptcies and business closures, leaving beneficiaries adrift to find businesses that can provide the home medical equipment prescribed by their physicians. It has also been challenging for many patients to find a provider to repair or replace their life-sustaining medical equipment."
Furthermore, Ryan says there are other reasons for lawmakers to reject the proposals to expand the troubled bidding program. For instance, in many states the Medicaid rates are already lower than the rates under the Medicare bidding program. And, certain state laws allow Medicaid to pay only 80 percent of the Medicare rate for items and services, while other states waive the 20 percent beneficiary co-payment because many Medicaid patients can't afford it. "Some states combine both of these provisions," Ryan says. "Therefore, if the Obama administration's proposal was enacted by Congress, many state Medicaid payment rates would be up to 40 percent below the already low rates established by the Medicare bidding program."
The President's 2015 budget says that having Medicaid mirror the Medicare bidding rates would save nearly $1.1 billion over the next 10 years, but at what cost?
Already, there is substantial evidence about seniors and people living with disabilities are suffering because of the bidding program. People for Quality Care, a patient advocacy organization, has received complaints from several thousand Medicare beneficiaries who can't obtain the home medical equipment that they need or can't get it repaired. AAHomecare is working with Congress to fix these problems, so that these patients can enjoy a reasonable quality of life.
The last thing the nation needs is for a new category of patients—children and people living in poverty on Medicaid—to endure these same problems. Stakeholders, as well as consumer and children's advocates, must work to prevent this proposal from being enacted.
The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community that serve the medical needs of millions of Americans who require oxygen systems, wheelchairs, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org.
SOURCE American Association for Homecare
When it comes to the Internet of Things, hooking up will get you only so far. If you want customers to commit, you need to go beyond simply connecting products. You need to use the devices themselves to transform how you engage with every customer and how you manage the entire product lifecycle. In his session at @ThingsExpo, Sean Lorenz, Technical Product Manager for Xively at LogMeIn, will show how “product relationship management” can help you leverage your connected devices and the data th...
Feb. 27, 2015 11:15 AM EST Reads: 794
SYS-CON Events announced today that CodeFutures, a leading supplier of database performance tools, has been named a “Sponsor” of SYS-CON's 16th International Cloud Expo®, which will take place on June 9–11, 2015, at the Javits Center in New York, NY. CodeFutures is an independent software vendor focused on providing tools that deliver database performance tools that increase productivity during database development and increase database performance and scalability during production.
Feb. 27, 2015 11:00 AM EST Reads: 2,321
The IoT market is projected to be $1.9 trillion tidal wave that’s bigger than the combined market for smartphones, tablets and PCs. While IoT is widely discussed, what not being talked about are the monetization opportunities that are created from ubiquitous connectivity and the ensuing avalanche of data. While we cannot foresee every service that the IoT will enable, we should future-proof operations by preparing to monetize them with extremely agile systems.
Feb. 27, 2015 11:00 AM EST Reads: 1,049
There’s Big Data, then there’s really Big Data from the Internet of Things. IoT is evolving to include many data possibilities like new types of event, log and network data. The volumes are enormous, generating tens of billions of logs per day, which raise data challenges. Early IoT deployments are relying heavily on both the cloud and managed service providers to navigate these challenges. Learn about IoT, Big Data and deployments processing massive data volumes from wearables, utilities and ot...
Feb. 27, 2015 11:00 AM EST Reads: 916
Even as cloud and managed services grow increasingly central to business strategy and performance, challenges remain. The biggest sticking point for companies seeking to capitalize on the cloud is data security. Keeping data safe is an issue in any computing environment, and it has been a focus since the earliest days of the cloud revolution. Understandably so: a lot can go wrong when you allow valuable information to live outside the firewall. Recent revelations about government snooping, along...
Feb. 27, 2015 11:00 AM EST Reads: 6,825
In his session at DevOps Summit, Tapabrata Pal, Director of Enterprise Architecture at Capital One, will tell a story about how Capital One has embraced Agile and DevOps Security practices across the Enterprise – driven by Enterprise Architecture; bringing in Development, Operations and Information Security organizations together. Capital Ones DevOpsSec practice is based upon three "pillars" – Shift-Left, Automate Everything, Dashboard Everything. Within about three years, from 100% waterfall, C...
Feb. 27, 2015 11:00 AM EST Reads: 2,531
RingCentral Inc., has unveiled the RingCentral Connect Platform™, a set of tools and services to build, deploy, and manage custom integrations using RingCentral APIs. With this platform, developers can build out-of-the-box integrations with RingCentral to add powerful communication capabilities to business applications. "This is a significant step forward because businesses want to better connect with customers – and communications is at the heart of every customer interaction," said Vlad Shm...
Feb. 27, 2015 10:45 AM EST Reads: 841
The explosion of connected devices / sensors is creating an ever-expanding set of new and valuable data. In parallel the emerging capability of Big Data technologies to store, access, analyze, and react to this data is producing changes in business models under the umbrella of the Internet of Things (IoT). In particular within the Insurance industry, IoT appears positioned to enable deep changes by altering relationships between insurers, distributors, and the insured. In his session at @Things...
Feb. 27, 2015 10:30 AM EST Reads: 2,285
SYS-CON Media announced that IBM, which offers the world’s deepest portfolio of technologies and expertise that are transforming the future of work, has launched ad campaigns on SYS-CON’s numerous online magazines such as Cloud Computing Journal, Virtualization Journal, SOA World Magazine, and IoT Journal. IBM’s campaigns focus on vendors in the technology marketplace, the future of testing, Big Data and analytics, and mobile platforms.
Feb. 27, 2015 10:15 AM EST Reads: 740
NaviSite, Inc., a Time Warner Cable company, has opened a new enterprise-class data center located in Santa Clara, California. The new data center will enable NaviSite to meet growing demands for its enterprise-class Cloud and Managed Services from existing and new customers. This facility, which is owned by data center solution provider Digital Realty, will join NaviSite’s fabric of nine existing data centers across the U.S. and U.K., all of which are designed to provide a resilient, secure, hi...
Feb. 27, 2015 10:00 AM EST Reads: 756
SYS-CON Events announced today that Intelligent Systems Services will exhibit at SYS-CON's 16th International Cloud Expo®, which will take place on June 9-11, 2015, at the Javits Center in New York City, NY. Established in 1994, Intelligent Systems Services Inc. is located near Washington, DC, with representatives and partners nationwide. ISS’s well-established track record is based on the continuous pursuit of excellence in designing, implementing and supporting nationwide clients’ mission-cri...
Feb. 27, 2015 10:00 AM EST Reads: 1,056
PubNub on Monday has announced that it is partnering with IBM to bring its sophisticated real-time data streaming and messaging capabilities to Bluemix, IBM’s cloud development platform. “Today’s app and connected devices require an always-on connection, but building a secure, scalable solution from the ground up is time consuming, resource intensive, and error-prone,” said Todd Greene, CEO of PubNub. “PubNub enables web, mobile and IoT developers building apps on IBM Bluemix to quickly add sc...
Feb. 27, 2015 10:00 AM EST Reads: 4,538
The major cloud platforms defy a simple, side-by-side analysis. Each of the major IaaS public-cloud platforms offers their own unique strengths and functionality. Options for on-site private cloud are diverse as well, and must be designed and deployed while taking existing legacy architecture and infrastructure into account. Then the reality is that most enterprises are embarking on a hybrid cloud strategy and programs. In this Power Panel at 15th Cloud Expo (http://www.CloudComputingExpo.com...
Feb. 27, 2015 10:00 AM EST Reads: 3,870
There has been a lot of discussion recently in the DevOps space over whether there is a unique form of DevOps for large enterprises or is it just vendors looking to sell services and tools. In his session at DevOps Summit, Chris Riley, a technologist, discussed whether Enterprise DevOps is a unique species or not. What makes DevOps adoption in the enterprise unique or what doesn’t? Unique or not, what does this mean for adopting DevOps in enterprise size organizations? He also explored differe...
Feb. 27, 2015 10:00 AM EST Reads: 2,247
“In the past year we've seen a lot of stabilization of WebRTC. You can now use it in production with a far greater degree of certainty. A lot of the real developments in the past year have been in things like the data channel, which will enable a whole new type of application," explained Peter Dunkley, Technical Director at Acision, in this SYS-CON.tv interview at @ThingsExpo, held Nov 4–6, 2014, at the Santa Clara Convention Center in Santa Clara, CA.
Feb. 27, 2015 10:00 AM EST Reads: 3,130