Why traditional Medicare might thrive in a more competitive program: Under competitive bidding among Medicare plans, private health insurers and traditional Medicare would offer bids (their cost) for providing a defined benefit to an average risk beneficiary. The government would then set subsidies (premium support) at some level that is a function of the bids (like the minimum, second lowest, or average). To enroll in a plan that cost more, a beneficiary would pay more out of pocket…. [M]any people consider such an arrangement (e.g., the Domenici-Rivlin proposal)… a way to drive traditional Medicare out of the market, or at least some markets…. an adverse selection death spiral for the public option…. [T]raditional Medicare will become a high risk pool because private plans will outbid the public option and/or find clever ways to select good risks. However, it is not a foregone conclusion things would play out that way….
Video: How to prepare for the Medicare Competitive Bidding Program
Competitive Bidding in Medicare
Establish a Medicare Competitive Bidding Committee, composed of individuals from the private sector with acquisition experience and experts in competitive bidding. Since proper implementation of competitive bidding is complex and technical, the committee- rather than government staff at the Centers for Medicare & Medicaid Services -would oversee the process. The committee would monitor the market response to ensure product quality and access, and have authority to add and/or subtract goods and services subject to competitive bidding. For instance, it might be possible to extend competitive bidding to outpatient radiological examinations such as CT scans or MRIs.
Expand Competitive Bidding in Medicare
Establish a Medicare Competitive Bidding Committee, composed of individuals from the private sector with acquisition experience and experts in competitive bidding. Since proper implementation of competitive bidding is complex and technical, the committee— rather than government staff at the Centers for Medicare & Medicaid Services —would oversee the process. The committee would monitor the market response to ensure product quality and access, and have authority to add and/or subtract goods and services subject to competitive bidding. For instance, it might be possible to extend competitive bidding to outpatient radiological examinations such as CT scans or MRIs.
Medicare Competitive Bidding Threatens Access to Seating and Mobility Products
I know this could also be posted under the CareCure Legislative forum, but since it is specific to the seating and mobility equipment that you are passionate about I thought it would be appropriate to post it here in the Equipment forum. For those Forum members in the US, Medicare is pursuing a cost savings strategy of competitively bidding critical DME devices including major categories of manual and power wheelchairs as well as wheelchair seat cushions. The details of the Competitive Bidding Program are complicated, but it is clear that government bidding of these individualized, specialty items will no doubt limit choice and make access to top performing seating and mobility products more difficult. I have been involved in industry lobbying efforts to try and convince Medicare officials of the negative impact such a bidding program will have on individuals who rely on high performance wheelchairs, but it seems clear that many top level government officials see wheelchairs and seat cushions as commodity DME items, not realizing the critical importance these devices have on those who rely upon them for both mobility and skin protection. Perhaps the most scary part of Medicare pursuing this strategy is that the negative impact won’t only be restricted to the Medicare market. We are already seeing many state Medicaid programs and private insurance programs grab on to lower payments rates and access restrictions that resulted from a Round 1 pilot program of Competitive Bidding. And this is before the Medicare bidding program becomes a national program in 2013. I can’t see any scenario where the Medicare Competitive Bidding program will not ultimately limit your access and choice to critical seating and mobility equipment. It is not too late to convince Medicare officials and Members of Congress that this is a bad program – but to accomplish this we need individuals who use and rely upon this equipment to add your voice to lobbying efforts. Here is a great posting on the ROHO blog site from Bob Vogel about how to engage with your Members on Congress on this important topic. Your Members of Congress work for you. They are your elected officials. Part of their job is to listen and respond to your concerns. I encourage you to make your voice heard with the same passion that you show in participating in this Forum! http://blog.therohogroup.com/index.p…-and-senators/ Thank you! Tom Borcherding The ROHO Group firstname.lastname@example.org
Medicare Announces Prepayment Review And Prior Authorization Demonstration Project For Power Mobility Devices
The prior authorization demonstration does not create new documentation requirements for providers and suppliers – it simply requires them to provide the information earlier in the claims process. After receiving the prior authorization request, Medicare will conduct a medical review and communicate the coverage decision (based on Medicare policies such as National Coverage Determinations (NCD) and Local Coverage Determination (LCD) to the patient, provider and supplier within 10 business days of receiving the request. Under rare, emergency circumstances, Medicare must complete this process in 48 hours. Physicians or treating practitioners can make unlimited requests, but Medicare has 30 days to consider any resubmitted requests. Claims with approved prior authorization requests will be paid if all other Medicare coverage and documentation requirements are met.
Poorly Designed Medicare Auctions Could Disrupt Device Marketplace
“Instead of looking at other agencies, they have designed a program that is highly flawed and will lead to supply shortages and lack of proper service support for equipment, such as Negative Pressure Wound Therapy,” Turner said. “Used properly, this device can save limbs and even lives and can be used at home if there is service support. But the new competitive bidding program disregards the essential need to build in proper payment for this support and will likely lead to worse health outcomes, more hospitalizations, and higher costs.”
Medicare Expands Competitive Bidding Program
The Hill: Medicare Says Competitive Pricing Will Save $28B Medicare is dramatically expanding a program that it says will save billions of dollars and serve as a model for other cost-cutting efforts. The Centers for Medicare and Medicaid Services (CMS) on Friday announced the second round of a program that uses competitive bidding to set prices for certain medical products. Medicare now uses competitive bidding in nine cities and will expand to 91 areas, according to the Friday announcement. In its first six months, the nine-city competitive bidding program has saved roughly $130 million, CMS officials said. The agency expects to save $28 billion over the next 10 years, roughly a third of which would be savings to patients (Baker, 8/19).
Medicare expands competitive bidding
The competitive bidding program encourages suppliers to set lower prices for certain medical equipment and supplies. “We’re taking steps that will save Medicare, seniors and taxpayers $28 billion over 10 years,” said CMS administrator Donald M. Berwick. “Medicare is paying much more than the private sector for equipment like wheelchairs and walkers. By expanding our successful competitive bidding program, we can ensure that Medicare pays a fair rate for these goods.”
High costs for home medical equipment persist
Medicare’s Fierberg says the agency is working on its severe overspending on home medical equipment, on which it spent $8 billion in 2009. After investigations (http://www.gao.gov/new.items/d11337r.pdf) by Congress’s General Accounting Office (http://www.gao.gov/new.items/d1156.pdf) and others, Medicare started competitive bidding on various equipment in nine cities last January, resulting in a 30 percent savings, he said.
Disabilities: Saving Medicare billions: Trying too hard can get in the way
The Obama administration’s penny-wise-and-pound-foolish cutbacks on availability to durable medical equipment, rehabilitation services, and home health care are forcing residents of independent living facilities into the Centre Crests of this country. For example, the narrow focus is apparent in Medicare’s frequent citations of the Congressional Budget Office’s competitive bidding estimates of relatively insignificant savings for Medicare Part B ignoring the astronomical costs that will result to Part A when disabled individuals like me can no longer pick up the phone and call my local medical equipment provider. Instead, I must wait for a competitive bidding winner (several have unsavory reputations and some are based out of state) to provide a battery. Delays could easily force me into Centre Crest as a result of falls, problems getting to the bathroom, etc. Delays would rob me of the ability to work as an adviser on virtual reality models for construction of future aging in place housing–construction which will result in significant Medicare savings.
Medicare, Test Strips and Competitive Bidding
Lowell was previously using the Bayer Contour meter. He was sent the Prodigy meter. Lowell was nice enough to send me pictures of the boxes he had. I don’t know exactly how Bayer rated in that study, but I do know the Contour was listed and was a pretty accurate meter. I know a lot of people like the Contour meter. The supply company sent Lowell a Prodigy meter. I was not familiar with the Prodigy meter so I Googled it. I did find a bunch of bad reviews that said the Prodigy is frequently 30 points off. Lowell mentioned the logs required by Medicare. Medicare only requires logs from people getting more than 3 test strips a day. Medicare will only give people using insulin more than 3 test strips a day so I think it is safe to “assume” Lowell is using insulin. It is important that Lowell have an accurate meter so why is he forced to use a meter that is not accurate?
“Comment on Cramton and Katzman: Medicare Competitive Bidding Lowered E” by Thomas J. Hoerger
In contrast to Cramton and Katzman’s assertion that Medicare encountered serious problems with its pilot competitive bidding program, Thomas Hoerger of RTI International cites his early evaluations that suggested strikingly positive results.
Competitive bidding [podcast]
Support The Incidental Economist Blog is supported in part by the Robert Wood Johnson Foundation. Who We Are, What We Do This is a blog (mostly) about the U.S. health care system and its organization, how it works, how it fails us, and what to do about it. All blog authors have professional expertise in […]more →
Medicare Expands Competitive Bidding Program
CMS announced the next steps for a major expansion of a competitive bidding program that helps lower costs for quality durable medical equipment, prosthetics, orthotics, and supplies. The competitive bidding program uses competitions between suppliers to set new, lower payment rates for certain medical equipment and supplies, such as oxygen equipment, walkers, and some types of power wheelchairs. The first phase of the program was successfully implemented for nine product categories in nine areas of the country on January 1, 2011.