Medicare Competitive Bidding Program and the Possible Effects on Wound Care
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by Glenda Motta RN, MPH
Medicare is now beginning round two of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. Congress mandated this through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). This applies to a number of items used by beneficiaries on an outpatient basis. The intent is to reduce beneficiary out-of-pocket expenses and save the Medicare program money, but still ensure beneficiary access to quality items and services.
Basically, Medicare must replace the current Part B fee schedule payment method for selected DMEPOS items with a competitive bid process. Although the process is rather complex, clinicians need to be aware of how this will impact some of the equipment and wound care treatments that their patients may need.
Right now, certain designated areas in a total of 11 states are involved. Suppliers who operate in these areas are required to submit a bid electronically through a web-based application process, and then mail required documents. Bids are evaluated based on the supplier’s eligibility, financial stability, and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount.
From the list of items included in the bidding process, you can see a number of products and supplies that may impact your patients.
- Oxygen Supplies and Equipment
- Standard (Power and Manual) Wheelchairs, Scooters, and Related Accessories
- Enteral Nutrients, Equipment, and Supplies
- CPAP Devices, Respiratory Assist Devices, and Related Supplies and Accessories
- Hospital Beds and Related Accessories
- Walkers and Related Accessories
- Support Surfaces (Group 2 Mattresses and Overlays)
- Negative Pressure Wound Therapy (NPWT) and Related Supplies and Accessories
What does this mean for wound care providers? Quite possibly, many of the products you now use may no longer be available. Suppliers will substitute items that are less expensive for them to obtain. How the changes will impact patient outcomes remains to be seen. Clinicians should certainly monitor what impact, if any, that substitutions have on wound prevention and treatment.
More detailed information is available at: http://www.dmecompetitivebid.com/palmetto/cbic.nsf.
About The Author
Glenda Motta RN, MPH is a reimbursement consultant and wound care expert, publishing over 125 articles and books, serving as the President of the WOCN (1987-1989), and founding GM Associates, Inc., a healthcare marketing and reimbursement firm.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
Comments
Wound care is essential in
Wound care is essential in the healing of our individuals. To cut it from our Medicare budget is notrious..Education, higher standards and mobility is something Medicare is missing...
I agree, and this is why
I agree, and this is why healthcare professionals must
contact their Congressional representatives and educate
them on this subject. It is imperative that we provide
input to the Medicare contractors as well so that policy
reflects the science and current standards of practice.
wound care Medicare
The basic question is patient value. Are all patients equal? Can one size fit all? Maybe not. As a SCI patient on whom over a MILLION US dollars has been spent on wound care, is it smart to cut corners on equipment that will reduce future costs?
Decisions must be made by individual doctors and patients, NOT Medicare accountants!
Competitive Bidding Program and the Possible Effects on Wound Ca
The administration has failed to recognize that implementing a competitive bidding program on a national basis is not possible if it truly wants to ensure a choice of providers for beneficiaries. Regions, states, and even counties vary significantly, and it would take a whole new corps of bureaucrats to determine which providers of home medical equipment could serve particular locales under such a system.
Competitive Bidding History
I am concerned about beneficiary access and how this will impact quality of care in terms of the items available in some areas of the country. However, in light of your comment regarding “the administration” a bit of history on the Competitive Bidding Program might be useful for our readers.
Section 302 of the Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the MMA, the program was to be phased in so that competition would first occur in 10 areas in 2007. As required by law, CMS conducted the Round One competition in 10 areas and for 10 DMEPOS product categories, and successfully implemented the program on July 1, 2008, for two weeks before the contracts were terminated by subsequent law.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) temporarily delayed the program, terminated the Round One contracts that were in effect, and made other limited changes. As required by MIPPA, CMS conducted the supplier competition again in 2009, referring to it as the Round One Rebid. On January 1, 2011, CMS launched the first phase of Medicare's competitive bidding program in nine different areas of the country for nine product categories.
MIPPA requires the competition for Round Two to occur in 2011 in 70 additional metropolitan statistical areas (MSAs) and authorizes competition for national mail order items and services after 2010. The Affordable Care Act of 2010 expands the number of Round Two MSAs from 70 to 91 areas and mandates that all areas of the country are subject either to DMEPOS competitive bidding or payment rate adjustments using competitively bid rates by 2016.
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