More Information on the Medicare Competitive Bidding Program

After I posted the Medicare 2011 DME Changes,  I found out a few more things that I wanted to share. 

I know a lot of you are thinking that because you are not on Medicare, this stuff does not affect you.  Well, it does.  A lot of insurance companies follow Medicare guidelines so other insurance companies can start doing this same thing.  My friend Mary’s husband works for a very large corporation and his company switched insurance policies the first of the year.  Mary’s daughter has an intellectual disability and uses the Omni Pod pump and the Dexcom CGMS.  The Omni Pod is one of the easiest pumps to use and she is able to use it without having to make complicated decisions on what she should bolus.  Although Mary makes the important management decisions for her daughter, her daughter having a pump that she is able to use and give herself meal boluses with ease is something that is very important to both of them.  A CGMS is a very important part of her control and Mary does not have to worry 24/7 about her daughter having severe lows.  They were informed that their new insurance follows Medicare guidelines and they will not cover the Omni Pod or the Dexcom.  Now Mary has to start her year off fighting to try and keep the Omni Pod and Dexcom for her daughter.

Last Thursday, Beth Cox from the People for Quality Care posted a comment on the other article I wrote.  People for Quality Care is working to get these Medicare changes reversed.  Beth also asked if I (or anyone else I know) would be interested in being an advocate for them.  I am very concerned about these changes so I would like to do what I can to help.  I would encourage you to check out their website here.

They also have a Facebook group that you can check out here.

People for Quality Care has several videos of some of the patients that are being affected by this on the Facebook link.  If you only have a couple minutes and are only going to watch one, I especially encourage you to watch Erik Gedusky’s video.  Erik has muscular dystrophy and uses a ventilator to help him breathe.  Erik, his mother and his home health aide discuss what these changes will mean to him.  Please take a couple minutes and watch the video! 

I also came across a website for the American Association for Homecare.  They are trying to track problems anyone has with this new program.  They have a form on their website to report any problems that you may have.  Check out their website here.

The American Association for Homecare also has a report discussing the patient impact of the competitive bidding program.  You can read that here.

Besides the concern I mentioned above about other insurance companies following what Medicare is doing, this ruling is going to put a lot of medical supply companies out of business.   I read that for a lot of these supply companies, Medicare makes up approximately 40% of their business.  If they are no longer able to sell equipment to Medicare customers, that will be a pretty big hit that their business probably won’t survive.  That means less choices for everyone.

Some of the companies being selected have severe financial problems, including bankruptcy.  The report mentions one company in particular that won 17 contracts.  I actually read one report that gave a percent of companies that were selected that have financial problems but I have not been able to verify that number so I am not going to state that until I can verify it.  However, if a company has financial problems and they are placed on a credit hold with their suppliers, they are going to have a hard time getting the equipment for Medicare customers. 

The CMS site has a page that contains the lists of providers that are able to provide DME services.  You can look at those lists here  (they are grouped by area). 

The Pittsburgh list contains 3 companies that you can order test strips from.  One of those companies does not even carry test strips so that leaves two other companies.  The company listed that does not carry test strips is Seeley Medical.  When I checked out their website, they had a link that said “store.”  I clicked on that expecting to see a listing of their products.  I was taken to their Amazon webstore.  It doesn’t exactly make me all warm and cozy to think of buying medical supplies thru an Amazon store!  They did not even have test strips listed as an item they are selling so I am not sure how they made the list as a provider that we have to get supplies from.

There seems to be a lot of confusion about the program and I am sure that once we get a little deeper into January, more people will be finding out what they are up against.  Last week after I posted my article on my blog here, I decided to also post it on TuDiabetes because I know there are a bunch of people on Medicare there.  A guy responded to my post saying that although he did not fully understand what was going on, he felt that competitive bidding was a good thing.  He has a pump and he called Medtronic and another national supplier that he gets supplies from.  Right now, pump supplies are not on the list that we have to get from one of the competitive vendors but test strips are.  The supplier he called told him that they are a Medicare provider.  They might be a Medicare provider, but they cannot sell test strips to anyone living in the 9 areas of the country that are under these new rules.  I posted the link that has the list of providers by area and pointed out that the supplier he mentioned was not on that list.  If they do send him test strips, they are going to have a nice surprise when they try to get paid for those test strips. 

I have an appointment next week with one of the doctors I see in Pittsburgh.  He has a lot of elderly patients so I am anxious to ask him what he thinks about this new program. 

Right now, only 9 areas of the country are under this new program, but after January 1, 2012, over 90 areas of the country will be included.  It is only a mater of time before this hits you.  Don’t sit back and wait until it is too late to say something.