Medicare, DME suppliers, and CPAP

[idamtnboy]

I decided to make this a new post rather than tagging onto a current related thread.

I just found this document on the Medicare site. http://www.medicare.gov/Publications/Pubs/pdf/11307.pdf

As of 1/1/11 DME suppliers in certain areas of the country will have to engage in competitive bidding to continue to supply DME to Medicare patients. Your current supplier may be grandfathered in, so the actual impact may not be much in a particular case. Here's an interesting quote from the brochure re: getting a specific brand of CPAP machine. It's going to be tougher in the future.

"If you need a specific brand of equipment or supplies, or you need an item in a specific form, your doctor must prescribe the specific brand or form in writing. Your doctor must also document in your medical record that you need this specific item or supply for medical reasons. In these situations, a Medicare contract supplier is required to: furnish the exact brand or form of item you need; help you find another contract supplier that offers that brand or form; or work with your doctor to find an alternate brand or form that is safe and effective for you."

To find Medicare approved suppliers for all DME in your area go to http://www.medicare.gov/Supplier/Includ ... teria.asp?

The brochure doesn't say if this is a test program that eventually will apply to all of the US, or if this is being implemented in specific areas of the country because of Medicare fraud and abuse in those areas. It does say it's being done to cut costs.

[msla]

Just what I want, some pinhead bureaucrat deciding what is "best" for me. It is bad enough dealing with the DME. I wonder if the government will deny us the ability to purchase our own equipment with our own money???

[Janknitz]

Just what I want, some pinhead bureaucrat deciding what is "best" for me. It is bad enough dealing with the DME

Nope, it won't be "some pinhead bureaucrat"--it will be the DME. The typical way that the government
"saves" money is deliberately creating conflicts of interest between patients and healthcare providers. Guess who loses? Profit over patient. They will submit bids based on the cheapest equipment possible and that's what they will provide unless you can convince a doctor to write a very specific script for what you want.

AND, the only DME's that are going to enter this "competitive bidding" process are going to be the big players who can still make profits by volume like Crapria and LinkNOCare. Goodbye locally owned mom and pop DME's.

[The Texan]

Here is the timeline for implementation of the "NEW" socialism health care and take note of all the Medicare cuts and their dates. We are on the losing end, BIG time.

•Medicare Advantage cuts begin
•No longer allowed to use FSA, HSA, HRA, Archer MSA distributions for over?the
counter medicines
•Medicare cuts to home health begin
•Wealthier seniors ($85k/$170k) begin paying higher Part D premiums (not indexed
for inflation in Parts B/D)
•Medicare reimbursement cuts when seniors use diagnostic imaging like MRIs, CT
scans, etc.
•Medicare cuts begin to ambulance services, ASCs, diagnostic labs, and durable
medical equipment
•Impose new annual tax on brand name pharmaceutical companies
•Americans begin paying premiums for federal long?term care insurance (CLASS
Act)
•Health plans required to spend a minimum of 80% of premiums on medical claims
•Physicians in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare
payments
•Prohibition on Medicare payments to new physician?owned hospitals
•Penalties for non?qualified HSA and Archer MSA distributions double (to 20%)
•Seniors prohibited from purchasing power wheelchairs unless they first rent for
13 months
•Brand name drug companies begin providing 50% discount in the Part D "donut
hole"
•10% Medicare bonus payment for primary care and general surgery (5 years)
•Employers required to report value of health benefits on W?2
•Steps towards health insurance administrative simplification (reduced
paperwork,etc) begins (5 yr process)
•Additional funding for community health centers (5 years)
•Seniors who hit Part D "donut hole "in 2010 receive $250 check (3/15/11)
•New Medicare cuts to long?term care hospitals begin (7/1/11)
•Additional Medicare cuts to hospitals and cuts to nursing homes and inpatient
rehab facilities begin (FY12)
•New tax on all private health insurance policies to pay for comp. eff. research
(plan years beginning FY12)

2012
•Medicare cuts to dialysis treatment begins
•Require information reporting on payments to corporations
•Medicare to reduce spending by using an HMO?like coordinated care model
(Accountable Care Organizations)
•Medicare Advantage plans with a 4 or 5 star rating receive a quality bonus
payment
•New Medicare cuts to inpatient psych hospitals (7/1/12)
•Hospital pay?for?quality program begins (FY13)
•Medicare cuts to hospitals with high readmission rates begin (FY13)
•Medicare cuts to hospice begin (FY13)

2013
•Impose $2,500 annual cap on FSA contributions (indexed to CPI)
•Increase Medicare wage tax by 0.9% and impose a new 3.8% tax on unearned ,
nonactive business income for those earning over $200k/$250k (not indexed to
inflation)
•Generally increases (7.5% to 10%) threshold at which medical expenses, as a %
of income, can be deductible
•Eliminate deduction for Part D retiree drug subsidy employers receive
•Impose 2.3% excise tax on medical devices
•Medicare cuts to hospitals who treat low?income seniors begin
•Post?acute pay for quality reporting begins
•CO?OP Program: Secretary awards loans and grants for establishing nonprofit
health insurers
•$500,000 deduction cap on compensation paid to insurance company employees and
officers
•Part D "donut hole" reduction begins, reaching a 25% reduction by 2020

[idamtnboy]

Here is the timeline for implementation of the "NEW" socialism health care and take note of all the Medicare cuts and their dates. We are on the losing end, BIG time.

I'll accept your timeline at face value since I don't have the inclination right now to verify or disprove any of it. What it does say to me, is what I have been spouting for years. With globalization, manufacturing going to 3rd world countries, the diminishing of natural resources, such as iron and aluminum, within our borders, our aging population, the standard of living in this country is going down. If what you have in your timeline is accurate, that is a reflection of the drop in living standards more so than a move to socialism, in my opinion. Thirty years ago already I was saying the folks who retired between the years 1980 and 2000 are going to have the best retirement ever, before or after. We are upset over our unemployment rate and one way to fix it is to increase exports and reduce imports. But, I've heard on the news recently that both Japan and China have said they don't want the American dollar to weaken because that would hurt their efforts to increase employment in their countries. We are in a world wide competition for employment. Our heretofore high standard of living makes it hard to compete with those who are willing to work just above subsistence level. We are on the losing end, but not because of socialism. It's more fundamental and dire than that.

'Nuff said. I don't want this thread to become an all out brouhaha.

[PST]

Just what I want, some pinhead bureaucrat deciding what is "best" for me. It is bad enough dealing with the DME. I wonder if the government will deny us the ability to purchase our own equipment with our own money???

Well, at least you don't have to worry about that. The document idamtnboy linked to says quite clearly on page 6 that you can spend your money any way you like. It simply warns that in the cities where this method of purchase is on trial, if you don't buy from a DME that has been approved based on competitive bidding, Medicare won't pay. Why should anyone want to stop you from paying for your own equipment?

I am dismayed, but not surprised, that a simple free-market idea like competitive bidding would be damned as a pinhead bureaucrat deciding what is best for us. Opponents of healthcare reform have thrown consistency to the wind throughout the debate over the PPACA. Any measure that attempts to save money is attacked at an unconscionable limitation on benefits, while any measure that does not is attacked for its unconscionable expense.

In the year I have been a member here I must have read a thousand posts commenting on the extraordinary difference between the prices charges by the brick-and-mortar DMEs that Medicare and other insurers purchase CPAP equipment from and the actual cost as reflected by prices on cpap.com and other internet providers. A little experiment in competitive bidding sounds like just what the doctor ordered. Don't forget, a lower cost means a lower 20 percent coinsurance payment.

Unfortunately, common sense doesn't rule here, only hostility. If someone hates and despises the President and the Democratic Party enough, then every aspect of healthcare reform is susceptible to one claim or the other -- either it injures the patient or it wastes money. The height of this was the vile and disgusting libel about "death panels." I try to keep politics and friendship separate, but that one ruptured some relationships for me for good. Who wants to be told that they are part of a conspiracy to kill their parents? The effect of these attacks was to scare some legislators from reasonable efforts to reduce costs and give us a less good bill than we could have had.

It seems wise to me that this idea is being tested in a few cities to be sure that the advantages outweigh the disadvantages. Surely that ought to merit cutting the number of frowny faces from four to one.

[Patrick A]

Here it comes time to grab your ankles......Thanks to the Three Stooges Barrack, Harry & Nancy.

[LSAT]

Patrick.....The code word is...BOHICA.....(Bend over, here it comes again)

[PST]

Here it comes time to grab your ankles......Thanks to the Three Stooges Barrack, Harry & Nancy.

I just want to remind everyone that Patrick and LSAT are real people, not secondary identities I posted under to prove my point. At issue in this thread is a trial program to require companies that sell billions of dollars of medical equipment that taxpayers must pay for to submit competitive bids. When someone compares that to being anally gang-raped by the President, Senate Majority Leader, and Speaker of the House, it is safe to say that we are listening to pure, id-driven rage and hatred toward those responsible for the proposal, not rational consideration of whether the proposal might have merit.

[LSAT]

Obviously...based upon last Tuesday's election...the majority of the population is not happy with the overall Health Care Reform Bill that very few of our representatives actually read before voting. This is not 'hatred' toward the president but a disagreement with the way the liberals pushed this program through congress.

[msla]

I called my senator and made the comment that if the medical system is broken before the HCRA passed, it will still be broken after it passed. They said that I was against reform. I said that was not what I said but they did not want to hear it. They had to pass it so we can find out what is in it. And it still needs reform!

I read the Norwegian news papers and have had relatives and friends in the Norwegian single payer system. Do they get emergency service, treatment and surgery? Yes. But a nation as rich as Norway still has a problem with the expense of health care. So you have to get on a waiting list. A cousin had to wait several years before she could have cataract surgery because the system would only budget so many operations a year. Another friend needed chelation therapy for heavy metal exposure. He had to pay the costs out of pocket the state would not cover it. An 84 year old women gets sent home alone quickly after major abdominal surgery. (Sounds like a soon to be former Florida Congressman comments) Lately articles have been about the value of a life. One man who required too much medical care was used as the example that it cost society too much to let him keep his medical care at home. The ministry of health is looking for an amount of money that they are willing to pay, what a life is worth. The amount decreases with age. Cost too much, tough. Additionally, people who are unsatisfied with the amount or timeliness of health care, take out insurance and pay for their own medical needs. This is an egalitarian society where the less wealthy have to make due with what the state deems what is necessary and acceptable with in the budget while those who can afford it get the care they want.

Is single payer health the answer? For some things, perhaps. But beware of the problems associated with state run medicine. Budgets still need to made and met. Dictating the cost of a procedure seems to be a folly. Look at any Dr. bill that has gone through Medicare. Original Dr. bill for ER visit. $721.00. Medicare approved $165.82; paid $132.66. Gap insurance paid $33.16. Was the Dr bill too high? Probably. Was the medicare approved amount enough to pay the Dr and his overhead expenses? Probably not. But do not believe that the government is controlling the cost of medicine by rather arbitrary reductions in the payment to a Dr., DME, or hospital. What will we do when the system will approve a ZZZ-pap silent traveler and pay the manufacturer $50.00, for all of us? And we can have a Nasal-Pap Freestyle mask $15.00. If you think that the insurance companies are bad, just wait to deal with the government. One word describes the situation, SNAFU. Is that better PST?

[idamtnboy]

The ministry of health is looking for an amount of money that they are willing to pay, what a life is worth. The amount decreases with age. Cost too much, tough.

I fear we will be unable to avoid facing that same issue eventually.

This is an egalitarian society where the less wealthy have to make due with what the state deems what is necessary and acceptable with in the budget while those who can afford it get the care they want.

Change 'egalitarian' to 'capitalist' and 'the state' to 'those who control the purse strings' and you have a description of the US.

Is single payer health the answer? For some things, perhaps. But beware of the problems associated with state run medicine.....If you think that the insurance companies are bad, just wait to deal with the government.

I worked for Uncle for 22 yrs. It's not all bad, and in my experience often the gov't staff was more competent than private contractors. Quite often inefficiencies in gov't operations were the resulting response to private industry being ready to pounce on bureaucrats, by way of their congressmen, if they didn't get their way, even if the private contractor was incapable of performing. As for state run health care, Germany is reported to have one of the best health care systems in the world. Everyone there is covered, but the system is operated by private companies under the direction of the government. Sweden has 100% coverage at almost 1/2 the cost of US. Their system is managed by local councils, and they are working to make sure everyone gets an elective procedure done within 90 days. If not, the local council has to pay for the patient to get the care wherever they can.

Is single payer the best? Maybe, maybe not. But single manager apparently loses out to distributed management even in those systems that provide 100% coverage. What we need is to reduce the drive for profit and avarice in the health care industry and replace it with compassion, wise money management, and a willingness to take care of everyone.

[PST]

Obviously...based upon last Tuesday's election...the majority of the population is not happy with the overall Health Care Reform Bill that very few of our representatives actually read before voting. This is not 'hatred' toward the president but a disagreement with the way the liberals pushed this program through congress.

1. I truly do not understand what people mean when they talk about the way liberals "pushed" the program through Congress. We had an election in which the Democratic nominee for President and the party as a whole made this a major issue, and the people voted them in. The process took over a year. Amendments were available on the web on a day-by-day basis. The debates were carried on CSPAN and discussed in every news outlet in the nation. We have been fed a lie by Fox News and its subsidiary, the Republican Party, that there was something illegitimate about the way it was passed, but that claim does not correspond to reality. Nothing disappears from the internet, so a person can go back today and see how open the process was. It was the longest and most public national debate about legislation I can remember in my lifetime. There is no excuse for any representative claiming that he did not know what was in the bill.

2. Tuesday's election was not a referendum on the PPACA. That was one issue, but the economy dominated.

3. The unpopularity of the PPACA is ambiguous. Polled provision by provision, people tend to favor what's in it. Taken as a whole, they are somewhat against it. They especially like guaranteed issue and the prohibition against the exclusion of pre-existing conditions, but don't seem to accept that you cannot have these benefits without making coverage universal, since otherwise people could wait until they were sick to buy coverage. The most recent average of polls I have seen, at the usually reliable pollster.com, is 49 to 42 percent disapproval over approval. One reason people like the individual parts but are dubious about the whole is the enormous amount of money spent attacking it. A group that tracks advertizing spending on political issues says that opponents have spent $108 million since March. (http://www.nytimes.com/2010/10/27/us/po ... f=politics)

4. One result of the propaganda campaign is that people have been misled about what is in the act. Look at msla's post about problems with single payer systems. The PPACA is most emphatically NOT a single payer system. Even the option of government coverage was eliminated from the bill. The health insurance options presented to the uninsured will be solely private. Right now, the percentage of those with coverage who are covered by government is almost 50 percent (Medicare, Medicaid, Tricare, government employees, etc.). The PPACA, by adding to the rolls of the privately insured, will actually reduce this percentage. The whole idea of a single payer system has been rejected in the U.S. and we aren't getting one.

5. I stand by my comments about hostility and hate. When a simple proposal to experiment with competitive bidding to try to save some money for Medicare -- from an industry almost every one of us has some doubts about -- is presented as "grab your ankles," can comparisons to Hitler be far behind?

[PST]

Is single payer health the answer? For some things, perhaps. But beware of the problems associated with state run medicine. Budgets still need to made and met. Dictating the cost of a procedure seems to be a folly. Look at any Dr. bill that has gone through Medicare. Original Dr. bill for ER visit. $721.00. Medicare approved $165.82; paid $132.66. Gap insurance paid $33.16. Was the Dr bill too high? Probably. Was the medicare approved amount enough to pay the Dr and his overhead expenses? Probably not. But do not believe that the government is controlling the cost of medicine by rather arbitrary reductions in the payment to a Dr., DME, or hospital. What will we do when the system will approve a ZZZ-pap silent traveler and pay the manufacturer $50.00, for all of us? And we can have a Nasal-Pap Freestyle mask $15.00. If you think that the insurance companies are bad, just wait to deal with the government. One word describes the situation, SNAFU. Is that better PST?

We are not getting single payer under the new act. For the majority of us who have coverage through our employer, life will go on as always. We will not even be allowed to buy insurance through the health insurance exchanges established by the PPACA. The act went to great lengths not to dismantle the current system in the course of covering those now uninsured. And the only policies offered on the exchanges to those without employer coverage will be from private companies. For what it's worth, though, judging from what I see on cpaptalk.com, there isn't much difference between Medicare and the private insurers. I've seen plenty of complaints about both, but I have no sense that those using Medicaid face greater difficulty getting decent care and equipment than we youngsters do.

[Slinky]

Medicaid and Medicare are NOT the same thing. Medicaid is administered under the states and the benefits and generosity of the benefits range from state to state. There are considerably more younger people receiving Medicaid than Medicare. I've seen quite a few complaints about Medicaid.