Medical Equipment Suppliers' Ongoing Opposition to the Competitive Bidding Program and Consequences for Beneficiaries
Report prepared by Mario Ramsey, Center for Medicare Advocacy Summer Health Policy Fellow
Under Medicare Part B, Medicare will pay for wheelchairs, hospital beds, some walkers; Certain customized items; prosthetic and orthotic devices; capped rental items; oxygen and oxygen equipment. These items fall under the categories of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).
Hoping to address chronic overpayments for DMEPOS, the government initiated a Competitive Bidding Program (CBP) for these items. Trade organizations representing the billion dollar DMEPOS industry have been opposed to the new program since its introduction. In fact, they managed to delay initial implementation of the CBP for several years.
Stories of contract suppliers failing to meet their obligations under the CBP continue to grow. There is also a growing fear of the emergence of an anti-DMEPOS campaign that suggests the industry's opposition to competitive bidding includes a conscious strategy to see it fail. Unfortunately, while supplier organizations seek to dismantle the structure of the bidding process, beneficiaries suffer. This paper reports about industry responses to the Competitive Bidding Program and the consequences for beneficiaries.
Center Submits Comments In Response to CMS Requests for Information
1. Impact of Dual Eligibility on MA and Part D Quality Measure Scores
The Center for Medicare & Medicaid Services (CMS) recently released a request for information regarding the relationship between dually eligible status and lower MA and Part D quality measure scores, as part of CMS' effort to review, and possibly update, the MA and Part D Star Ratings program. The CMS request included reference to a National Quality Forum (NQF) report that found that the socio-economic and socio-demographic status of patients has an impact on quality performance, and that risk adjustment may be necessary to raise the performance scores for those treating disadvantaged patients.
The Center for Medicare Advocacy responded to this request for information.
The Center expressed support for CMS' interest in improving the quality of care all patients receive, with a particular focus on improving care for disadvantaged populations, who are currently disproportionately afflicted by lower quality care. We also agreed with CMS that performance measures should aim to identify disparities in care and strive to eliminate these disparities.
However, we urged CMS to approach changes to quality measurement and risk adjustment with caution. We also expressed our serious concerns regarding the NQF report, and the notion of incorporating socioeconomic status (SES) and sociodemographic status (SDS) like income, education, race and ethnicity, in quality performance measures, and performing risk adjustment for these factors in accountability applications.
The Center stated in the response to CMS that the existing disparities in quality of care are best resolved by identifying them and creating systems that work to improve care, rather than potentially masking these differences through artificial inflation of performance scores through risk adjustment. Quality measurements are designed to reveal disparities in care, and spur changes in order to address those disparities. Risk adjustment could mask these disparities and disincentivize healthcare units (such as health plans, hospital systems, etc.) from making the changes that could equalize care, making quality analysis and quality ratings less meaningful .
Our response to the CMS request outlined these concerns, described an example of a high performing plan serving low income people, and pointed to alternative approaches that could lead to improvements in care for disadvantaged patients.
The Center's complete response to the CMS request is available at: http://cma.benfredaconsulting.com/center-for-medicare-advocacy-comments-on-the-impact-of-dual-eligibility-on-ma-and-part-d-quality-scores/
The CMS request for information notice is available at: http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/Request-for-Information-About-the-Impact-of-Dual-Eligibles-on-Plan-Performance.pdf
2. Health Plan Innovation Initiatives
The Centers for Medicare and Medicaid Innovation (CMMI), a division of CMS, recently released a request for information seeking input on a variety of policy proposals that CMMI might test through demonstrations. In collaboration with several other advocacy organizations, including the Medicare Rights Center and the National Senior Citizens Law Center, the Center submitted comments on several topics, including:
- Value based insurance design (VBID) in Medicare Advantage. We cautioned against incorporating VBID – a concept that seeks to incentivize individuals to use higher value care and providers through altering cost-sharing – in the MA program, particularly if increased cost-sharing would be implemented;
- Care coordination by Medigaps or retiree supplemental plans. While strongly encouraging the development of more comprehensive care coordination for Medicare beneficiaries in general, we questioned whether secondary insurers, particularly Medigap plans, are the appropriate entities to manage such programs;
- Integrating hospice benefits with curative care for Medicare Advantage plan enrollees. We asserted that safeguards would have to be put into place, and neither patient autonomy nor enrollee's choice of providers should be limited.
The RFI is available at: http://innovation.cms.gov/Files/x/HPI-RFI.pdf.
Kaiser Family Foundation Releases Report on Medicare Advantage Access and Quality
On November 6, 2014, the Kaiser Family Foundation (KFF) released a literature review of research evidence on health care access and quality in Medicare Advantage and Traditional Medicare published between 2000 and 2014.
While the report notes that there are substantial limitations on available evidence, it does highlight some key findings. For example, on the one hand, available evidence indicates that Medicare HMOs "tend to perform better than [T]raditional Medicare in providing preventive services and using resources more conservatively.” On the other hand, the report notes that “beneficiaries continue to rate [T]raditional Medicare more favorably than Medicare Advantage plans in terms of quality and access …. [and] Among beneficiaries who are sick, the differential between [T]raditional Medicare and Medicare Advantage is particularly large (relative to those who are healthy), favoring traditional Medicare."
The full report is available online at: