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Thread: Medicare Competitive Bidding Threatens Access to Seating and Mobility Products

  1. #1
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    Exclamation 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
    tomb@therohogroup.com

  2. #2
    Senior Member rdf's Avatar
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    Thanks for the heads up, Tom. We need to be proactive on this matter. Thanks for the link.
    Please donate a dollar a day at http://justadollarplease.org.
    Copy and paste this message to the bottom of your signature.

    Thanks!

  3. #3
    Quote Originally Posted by rdf View Post
    Thanks for the heads up, Tom. We need to be proactive on this matter. Thanks for the link.
    We need to be extremely proactive.


  4. #4
    what gets me iis they do some sort of bidding

    some big wig nurse told me special necessary rims were not allowed

    Took me 2 yrs to get my custom cushion
    bidding Crap this political medical necessary mumbo jumbo
    I feel they DME's need a lobotomy


    Our Medical system totally needs a overhaul political change reform
    I am fed up

  5. #5
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    Quote Originally Posted by GL View Post
    what gets me iis they do some sort of bidding

    some big wig nurse told me special necessary rims were not allowed

    Took me 2 yrs to get my custom cushion
    bidding Crap this political medical necessary mumbo jumbo
    I feel they DME's need a lobotomy


    Our Medical system totally needs a overhaul political change reform
    I am fed up
    You are preaching to the choir in this forum! Go back to the original message in this thread and make your voice heard by contacting your Members of Congress and make sure they understand your frustration and the impact their decisions will have on your access to necessary wheelchairs, cushions and other equipment that you use and depend upon on a daily basis. You have the perfect story and passionate concern for the future that our elected officials need to hear!

  6. #6
    Read the blog, adapted the letter to my circumstances, printed out 5 letters, addressed and stamped envelopes, will be in this afternoon's mail.

    Thanks

    All the best,
    GJ

  7. #7
    We all know how outrageously priced medical supplies are. Especially the big ticket items from our friendly DMEs, like wheelchairs and cushions. Maybe this program will finally knock these rip-off prices down towards earth a little bit more.

    The only thing that got hospitals to take nosocomial infections seriously was when Medicare started to refuse paying for them. As we all know- it's all about the money. There needs to be more competition in the healthcare system. It's difficult to do but this program may be a start.

    Hopefully this program (Section 302 of the Medicare Modernization Act of 2003 (MMA) ) will have the same effect on DMEs and the companies/corporations who supply them as Medicare's refusal to keep paying hospitals to keep people sick did.

    This is a tad off-topic but why in the hell does this wheelchair cost 18 times more than this one? If you put these two chairs side by side and asked any ol' Joe or Josephine, not familiar with wheelchairs, most would probably think the "hospital-style" chair cost more. There's so much more to it! I remember when Fuentes and another person posted their scanned receipts for their new, loaded to the max, manual wheelchairs. And since Fuentes was so cool- no armrests thank you very much! I believe they were a few bucks over $10,000! Of course they were bragging about it because some insurance company was footing the bill.... otherwise any sane person would feel embarrassed for getting so ripped-off so royally.

    We've probably all seen the look on able-bodied people's faces when ya tell 'em how much your cushion cost. It never fails to amaze people of the exorbitant price of such an item. If medical suppliers didn't charge so damn much for their products there would be little to no need for a Section 302 of the MMA.

    PROGRAM OVERVIEW

    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 program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items. The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas. All contract suppliers must comply with Medicare enrollment rules, be licensed and accredited, and meet financial standards. The program sets more appropriate payment amounts for DMEPOS items while ensuring continued access to quality items and services, which will result in reduced beneficiary out-of-pocket expenses and savings to taxpayers and the Medicare program.
    That's my say on it. Obviously I won't be writing my Members of Congress on this important topic except perhaps to say "Up n' at 'em!"

    I'm just about due for a new chair (every 5 years) and cushion. Maybe the taxpayers (actually FICA payers) will catch a break this time on my Quickie GPV and Jay2. I don't need nuttin' fancy. And I'll catch a small break on my 20% of it.

    The debate is on. Let's hear from everyone who's interested in this thread. And maybe my bud Bob (rdf) will have a change of mind. Or set my mind right.

    The other Bob.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  8. #8
    @Bob Clark, Bob Vogel here--I wrote the blog about contacting senators and representatives and ask that they stop competitive bidding.

    The current paradigm for DME suppliers (dealers) is provide the best equipment and service possible under razor thin Medicare margins--if you don't like their service you can always go to another DME supplier in your area. At least that USED to be the paradigm. With Competitive bidding a DME Dealer can submit a lowball bid and win the contract and become the only game in town. Under competitive bidding the winning DME dealer can stick unsuspecting wheelers you with the cheapest equipment allowable undr Medicare guidelines. Don't like it? Too bad! Competitive bidding takes away your choice! You are stuck with the dealer that submits the lowest bid.

    It is good to hear you are up for a new chair and cushion! However if you are in an area with competitive bidding I wouldn't count on the Jay2. Under Medicare Competitive guidelines there are 915 cushions under the category the Jay2 is in--a DME with a winning bid can legally stick you on a foam cushion with a gel cover that sells for $39 bucks. Medicare guidelines say the $39 cushion is the same as a Jay2.

    Careful what you wish for...

    http://blog.therohogroup.com/index.p...-and-senators/
    Last edited by Bob V; 11-15-2011 at 10:12 PM.

  9. #9

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    Quote Originally Posted by Bob V View Post
    @Bob Clark, Bob Vogel here--I wrote the blog about contacting senators and representatives and ask that they stop competitive bidding.

    The current paradigm for DME suppliers (dealers) is provide the best equipment and service possible under razor thin Medicare margins--if you don't like their service you can always go to another DME supplier in your area. At least that USED to be the paradigm. With Competitive bidding a DME Dealer can submit a lowball bid and win the contract and become the only game in town. Under competitive bidding the winning DME dealer can stick unsuspecting wheelers you with the cheapest equipment allowable undr Medicare guidelines. Don't like it? Too bad! Competitive bidding takes away your choice! You are stuck with the dealer that submits the lowest bid.

    It is good to hear you are up for a new chair and cushion! However if you are in an area with competitive bidding I wouldn't count on the Jay2. Under Medicare Competitive guidelines there are 915 cushions under the category the Jay2 is in--a DME with a winning bid can legally stick you on a foam cushion with a gel cover that sells for $39 bucks. Medicare guidelines say the $39 cushion is the same as a Jay2.

    Careful what you wish for...

    http://blog.therohogroup.com/index.p...-and-senators/
    Hi Bob V,

    Medicare only recently (ten years ago??) began paying for any type of "sport chair" like a Quickie. And you had/have to have a narrative written out by a doctor with the correct wording on it to show medical necessity. A simple prescription won't cut it. I'm not sure but I think the only chair Medicare will consider nowadays is a Quickie because they're so much cheaper than the competition. A Quickie online is around $900 and the next closest chair starts at around $1500. And these prices are for the stripped-down versions. My local DME charges twice what online vendors like SpinLife charges but since they accept assignment I go with them. Plus they come out and deliver it etc. I'm too poor to afford a car/transportation.

    As far as pressure relief cushions are concerned it seems like I'll be lucky to get that foam cushion with a gel cover that sells for $39 bucks. Here's what SpinLife says about cushions and Medicare. I've been lucky and in 33 years of being SCI'd I've never had a pressure sore. A criterion for being Medicare eligible for a cushion of any type.

    What is the reimbursement criteria for wheelchair cushions?

    For wheelchair cushions, the wheelchair for which the cushion will be used must already be on file with Medicare because SpinLife must submit the manufacturer, model and the date of purchase of the wheelchair on file when courtesy billing for the corresponding cushion. The beneficiary must also either have a current pressure sore or have a pressure sore on record as Medicare will not cover any preventative items. This information must be submitted to SpinLife with the prescription.
    Oh well. Medicare always paid for my Roho and Jay2 cushions in the past. Why they don't cover ANY cushions any longer, no matter the price or efficacy, I don't know. I would just appreciate it if life were a bit fairer!

    Thanks for the info Bob V.

    Bob.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  10. #10

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