Medicare CPAP reimbursement cut 47% for DMEs

[Denial Dave]

I'm disappointed ...... only 5 pages of arguments & sniping at each other??

heck, there is 9 pages of arguments over a sleep center closing.

come on people.... we need more passion!!!

[49er]

I'm disappointed ...... only 5 pages of arguments & sniping at each other??

heck, there is 9 pages of arguments over a sleep center closing.

come on people.... we need more passion!!!

You ain't seen nothing yet.

[DreamStalker]

Meh.

The other thread has trolls.

So they say ...

[ChicagoGranny]

Medicare CPAP reimbursement cut 47% for DMEs

When the government provides for you, it makes the rules. It decides what equipment you will get.

When you talk about only stripped down CPAP models available, a story 35 years old comes back to me. I took a new immigrant from USSR to the grocery store. He had a problem when I took him down the shampoo aisle. There were probably 50 choices of shampoo and he had no idea. Back home there was only one choice of shampoo - and it usually wasn't in stock.

[The Choker]

When the government provides for you, it makes the rules. It decides what equipment you will get.

... or if you get any equipment at all.

[The Choker]

The doc may "suggest" but with the requirement of an Rx, you still are forced to obtain his "suggestion". With the premise that was posed, you eliminate the expert and leave people with absolutely no guidance except for internet message boards.

I can see it now, no Rx requirement for CPAP, Wal-Mart has them on the shelf next to the adult diapers. George's wife nags him about snoring, so he picks up a CPAP while getting some dog food, bread and milk. He doesn't have any idea what pressure he needs, so he just guesses. George ends up with a stroke, paralysis, and confined to a bed for the rest of his short life because he never consulted a professional because he didn't have to. A little learning is a dangerous thing.....

You remind me of a distraught man watching flames from the kitchen spreading toward the rest of his house. When the fire truck arrives, he will not allow them to use the hoses because the water might damage the ceiling, walls and floor.

[BlackSpinner]

Medicare CPAP reimbursement cut 47% for DMEs

When the government provides for you, it makes the rules. It decides what equipment you will get.

But now you have insurance companies deciding how much profit they are willing to give up. So what is the difference?

When you talk about only stripped down CPAP models available, a story 35 years old comes back to me. I took a new immigrant from USSR to the grocery store. He had a problem when I took him down the shampoo aisle. There were probably 50 choices of shampoo and he had no idea. Back home there was only one choice of shampoo - and it usually wasn't in stock.

Most countries in Europe were like that in the 50's due to rationing post WWII necessities . We were shocked back in '58 at all the choice on the shelves in Canada and the ridiculous lack of universal health care.

[chunkyfrog]

All this sympathy for DME's simply floors me!

[Wulfman...]

All this sympathy for DME's simply floors me!

+1

Every time I read the horror stories about the DMEs, it makes me so glad I bypassed the brick & mortar DME establishments in the beginning and ever since. Other than the initial purchase through CPAP(dot)COM, which my insurance provider reimbursed me for, I've purchased everything out-of-pocket ever since. I'm stocked up for a very long time.......probably longer than I will be alive.

Den

.

[DreamStalker]

Medicare CPAP reimbursement cut 47% for DMEs

When the government provides for you, it makes the rules. It decides what equipment you will get.

When you talk about only stripped down CPAP models available, a story 35 years old comes back to me. I took a new immigrant from USSR to the grocery store. He had a problem when I took him down the shampoo aisle. There were probably 50 choices of shampoo and he had no idea. Back home there was only one choice of shampoo - and it usually wasn't in stock.

I used to work as a grocery stocker exactly 35 years ago. The shampoo shelf space was probably only 3 feet wide and 5 shelves high with maybe 5 choices per shelf. Today, I would agree that there are 50 to 60 different choices of shampoo, but 35 years ago, not so much.

I never been to the USSR but from what I heard/read, I don't think they began having severe post WWII shortages (like no shampoo) until the late 1980's to early 1990's, about 25 years ago. That's just before the USSR collapsed in 1991. So now we know when the USA will collapse ... when the shampoo isle only has one choice -- and it is out of stock.

When you bring up the USSR, an old quote I once read comes to mind.

The psychologist Carl Jung notes in his observations of collectivism in Nazi Germany and Stalinist Russia that most citizens of those nations did not necessarily want the formation of a tyrannical oligarchy, but, they went along with it anyway because they feared for their own comfort and livelihoods.

Kinda reminds me of what I see going on today.

[ChicagoGranny]

But now you have insurance companies deciding how much profit they are willing to give up. So what is the difference?

No, the discussion is about Medicare and what they are currently willing/capable of paying for:

Subject: Medicare CPAP reimbursement cut 47% for D

[DreamStalker]

But now you have insurance companies deciding how much profit they are willing to give up. So what is the difference?

No, the discussion is about Medicare and what they are willing/capable of paying for:

Subject: Medicare CPAP reimbursement cut 47% for D

Actually, the Spinner is right. What's the difference?

WELL!!

SPIT IT OUT!!


I can say that cuz she can't hear me ...

[Janknitz]

If I learned anything with dealing with governmental agencies like Medicare, it's "wait and see". Rumors abound, but it's hard to find out the truth until the changes are fully implemented. As someone pointed out, they won't even announce who has "won" the competitive bidding and what the reimbursement rates will be until July. So until then, we just don't know. Remember this competitive bidding approach is not new. Two years ago it was on the eve of implementation and it was stopped.

I'm not saying that it won't happen or that it won't be bad, but I am saying that until it happens I'm not going to get my knickers in a snit. I've seen too many things like this drag on and on and never have the anticipated impact. Or once they do finally get implemented, they are so fundamentally changed that it's very different from what people panicked about in the first place. And sometimes, the house of cards falls down so quickly that the government is forced to back out.

So I'm going to wait and see what it really turns out to be, before worrying too much about it. (and I have the luxury of doing so, since I'm not on Medicare yet).

[SethW]

http://www.gao.gov/assets/600/590712.pdf

For the six CBP product categories we analyzed for CBP’s first 6 months of 2011, initial Medicare claim data trends generally indicate a decrease in the number of CBP-covered Medicare beneficiaries who were furnished certain CBP-covered items . . . For the CPAP/RAD product category, the number of distinct CBP-covered beneficiaries who were furnished these items in the nine CBP competitive bidding areas was smaller in each of the first 6 months of 2011 than in the same months of 2010 . . . In contrast, in non-CBP competitive bidding areas, more beneficiaries were served in each of the first 6 months of 2011 compared to the same months in 2010.

The flaw in most leftist thinking which produces policies like Obamacare is that markets do not change in response to bad policy. They pass a law like Obamacare and then immediately say something like "See? The world didn't end. People are still getting quality care. Costs didn't explode. Nobody is rationing care." 40 years into Medicare and what are we trying to do? Come up with a way to simulate the competitive market that government intervention destroyed.

The "competitive bidding program" that Medicare has come up with is bizarre, flawed, and will reduce competition:

http://www.cramton.umd.edu/papers2010-2 ... idding.pdf

Here is how it works. A supplier must submit a composite bid for all items in a category (e.g. 70 or so items in the CPAP category). The bids are non-binding, which is bizarre auction rule number one. The government assigns weights it determines to the bids for each item, in theory according to historical claims data. The government determines the composite price at which point the government-determined supplier capacity will clear the market (note: markets do this for free . . .). Then bizarre auction rule number two kicks in: the government determines the amount it will pay for each individual item based on the median price for each item in all winning bids. So half the companies that win will not be paid what they bid. Meanwhile, consumers have zero say and no incentive to shop around.

The fact of the matter is, given my insurance deductibles, I am paying for everything out of pocket. Lincare now tells me that I do not own my machine, in spite of their telling me when I signed the agreement that I would own the machine. That would not have been possible if markets were operating freely and I could have shopped around and purchased what I wanted. I agree with the earlier comment that these devices should be available OTC, particularly the ones that collect data on their use.

The whole system we have now is a mess, and the more government gets involved, the more of a mess it is going to become.

[NiceDMEDude]

Hello all,

Haven't posted in some time (I lurk, but only post if I feel I can add to a discussion).

Quite a bit of confusion abounds regarding the SPA and competitive bidding in general. I submitted a bid for the Louisville CBA. I only bid in the PAP and oxygen categories, as these are the only segments of DME which I provide.

As of this writing, I am unaware of any local DME/HME who received an email stating they submitted a winning bid. Likely, many companies who do not have a physical presence in the area submitted winning bids.

I am certainly not looking to come on this board and spout off or berate anyone for their beliefs or opinions. I can simply state my views and the stance of my company.

As was pointed out by several contributors to this thread, it will not be possible to provide the DS560HS (our standard unit which every patient receives), or DS760HS (our standard machine for BiLevel) at the SPA reimbursement level.

To be honest, I do not care. I am so worn out from fighting insurance companies, constantly attempting to please everyone from clients to physicians, beating up my manufacturer reps for ever-lower pricing, etc. that I am giving up. Should I receive a bid, I will decline to participate. I will not compromise the ability to provide quality service to simply maintain a losing business model. With 7 of my 12 employees being credentialed respiratory therapists (2 of whom use PAP themselves), these reimbursement amounts are unrealistic. We offer a very high level of service, as we specialize only in sleep-related equipment. Again, this is my stance; other providers may find a way to make it feasible.

However, I am the single largest customer for each of my reps from the big three. My prices from PR, F&P, and ResMed are as good as it gets. If I can't do it, I do not believe that my local competitors will either.

Fortunately for me, I also maintain a thriving website. The website has been my focus for the last couple of years, and going forward I will shift even more resources to the online business model.

Many of you on here are customers of mine, and I sincerely appreciate your business (even if you have no clue who I am).

HME is a dying business, and will soon be unrecognizable. Likely it will be some combination of scenarios already discussed in this thread. Mail order, online, local pharmacy, direct from manufacturer, I don't know.

Apologies for the rambling, but when I saw Karen's post I felt compelled to read the thread and respond.

Best to all of you in your treatment, and thanks for being educated on the healthcare system and your therapy.