Medicare to begin competitive bids

[chunkyfrog]

From the Medicare site, my area will only be under competitive bid for mail order diabetes supplies;
with the implication that local pharmacy supply will be unaffected; but there seems to be no way to determine
if the local co-pays will change at the same time. I will check with my local SHIIP tech for clarification.

[NateS]

Advantage plans lose their advantages next year also, because this new law wants a level playing field, which will cause their premiums to go up for all that stuff like gym memberships, vision care and dentists . Only the worst dentists will participate, at least in my area, and the vision care is always for companies that do not even exist here!.

The government has decided to stop using your tax money to pay private insurance companies the subsidies they demanded to provide benefits, at greater cost, similar to what Medicare provides at less cost, so that they have more money available to pay for healthcare to people on Medicare, and you are opposed to this?

In my area, we already have plenty of doctors who won't take Advantage patients…I had one doctor tell me he was only seeing me because I was on straight Medicare. That scared me away from Advantage Plans

Doctors are telling you they will not take Advantage (private health insurance company) insurance but will take Medicare (government health insurance), and you feel that's the government's fault?

If you can't afford a Medicare supplement, and I can't, you are SOL.… I've found with my long term chronic illness that having the best possible doctor is the whole ball game, and it's the best ones who can afford to turn away patients they don't get reimbursed well for seeing.

If you have a long term chronic illness, isn't it likely that the monthly premium for a Medicare Supplement is going to be far less than the cost to you of the annual deductible and 20% balance of your annual medical expenses out-of-pocket?

The whole thing sucks and is typical of the government.

See above.

I see a lot of contradictions in your conclusions.

Respectfully, Nate

[NateS]

Bloomberg Businessweek
Companies & Industries


The Reason Health Care Is So Expensive: Insurance Companies
By Jeffrey Pfeffer
April 10, 2013

As Congressional budget battles heat up—or roll along, depending on your time perspective—the cost of health care in America receives a lot of attention. Unfortunately most of the discussion is largely off the mark about where the preventable, unnecessary costs really are. Yes, there is certainly over treatment, particularly of people in their last days of life. Yes, doctors under a fee-for-service arrangement do have financial incentives to do too much, and the fear of malpractice can lead to overtesting and overtreatment. As the recent article in Time by Steven Brill illustrated, pricing of medical care is neither invariably transparent nor sensible. And it would certainly be nice if care were better coordinated across functional specialties.

But the thing that few people talk about, and that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries.

More than 20 years ago, two Harvard professors published an article in the prestigious New England Journal of Medicine showing that health-care administration cost somewhere between 19 percent and 24 percent of total spending on health care and that this administrative burden helped explain why health care costs so much in the U.S. compared, for instance, with Canada or the United Kingdom. An update of that analysis more than a decade later, after the diffusion of managed care and the widespread adoption of computerization, found that administration constituted some 30 percent of U.S. health-care costs and that the share of the health-care labor force comprising administrative (as opposed to care delivery) workers had grown 50 percent to constitute more than one of every four health-sector employees.

What remains missing even in the discussion of the enormous administrative burden is not just how large, both in absolute dollars and as a percentage of health costs, it is, but also how few incentives there are for insurance companies to stop wasting their and everyone else’s time. Most large employers, including mine, Stanford University, are self-insured, which means they pay for their own medical claims. These large employers invariably hire health insurance companies to “administer” their health-care dollars, doing things such as paying claims. Employers typically reimburse the insurers the amount of money they pay out to health-care providers plus a percentage of these costs. In Stanford’s case, we pay Blue Shield 3 percent of the amount, about $3 million a year. (Note that the overhead costs of Medicare are less than one-third as much at slightly less than 1 percent.)

Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence. To take one small personal example, I have reached the age of Medicare eligibility but, because I continue to work full time, have primary health insurance coverage through my employer. Blue Shield, of course, wants to be sure it doesn’t pay for any claim it doesn’t have to, so I was asked to attest to the fact that I have no other insurance. No problem there, except such attestations seem to be required on almost a monthly basis—requiring my time on the phone (and on hold) with Blue Shield’s customer service, an oxymoronic term if there ever was one, and also requiring my doctor and laboratory to call me, call Blue Shield, or both, and thus also waste their time and resources.

This story and the many others of the same sort but even worse, magnified across the millions of people subjected to private health insurance companies, is why American health care costs so much and delivers so little. Unless and until we as a society pay attention to the enormous costs and the time wasted by the current administrative arrangements, we will continue to pay much too much for health care.

http://www.businessweek.com/articles/20 ... s#r=lr-fst

[6PtStar]

Unfortunately it appears that the patient and maybe our doctors also will be caught in the middle of the fight between the insurance companies and the government. If Obamacare and the government wins it will have to become a single payer system which I am still not convinced will be good for the patient either. All I know is how it is effecting me and so far I don't like it.

Jerry

[avi123]

Is it fair to assume those haughty DME's we've had to deal with will change their attitudes?

What fantasy planet do you live on?

The competitive bidding winners now have captive audiences with fewer or NO Choices of other suppliers. And since they'll be making LESS money per unit, they are going to pass the pain on to US, by supplying only the cheapest bricks they can find under the HCPCs codes. Data for straight CPAP will be a thing of the past, and APAPs will will be the cheapest ones out there. No ResMed S9 autos, auto escapes if you're lucky. I looked at one area with competitive bidding and several of the vendors didn't even list ResMed.

It's going to be even more nasty, I would think, except now they can just thumb their noses at us and invite us to go elsewhere to pay out of pocket if we don't like their offerings.

BOHICA--bend over, here it comes again.

[NateS]

While I am trying to be optimistic about how this is all going to turn out, it is too soon to know one way or the other.

Keep in mind that, while the health insurance industry and the pharmaceutical industry were screaming and wailing in opposition to the PPACA, they were also working behind the scenes to mold and shape it to suit themselves, meaning that there are probably of a multitude of loopholes written into the law. Not only can we count on the insurance companies and the DMEs to find every opportunity for new ways to scam the government and the insured public notwithstanding the best intentions of this reform legislation, they probably already know exactly where to look because their lawyers and lobbyists no doubt planted them there as the price for toning down their pretended opposition to the legislation.

See: "Deadly Spin" by Wendell Potter
http://www.amazon.com/Deadly-Spin-ebook ... eadly+spin

I guess we can only keep our fingers crossed and be vigilant and skeptical about what we read and what we hear.

Regards, Nate

[chunkyfrog]

This document shows provisions for exceptions to be made to the formulary on your doctor's specifications,
in order to prevent adverse health effects. See the first paragraph on page 3 --(started on Page 2)

http://www.cms.gov/Outreach-and-Educati ... 900924.pdf

[idamtnboy]

I am guessing this crap is part of the Affordable Care Act.

Actually the competitive bidding program started close to 10 years ago under W. ACA did, however, mandate that it be moved along faster than what was the case.

[renatae]

Is it fair to assume those haughty DME's we've had to deal with will change their attitudes? Of course, some of them will now disappear from the scene; good riddance.

In my case, it looks all bad. I had been reading up on suppliers long ago and saw all sorts of bad reviews about Apria. Well, guess who is top of the list in my area? And the closest. Ugh.

My current DME has always done right by me - got me the machine I wanted, no hassle, no pressure for a brick, brought it to my home, set me up, actually spent time with me. My only complaint was there was not much teaching on the actual mask - she just told me to put it on and see how it felt, worked on some paperwork, and after 5 minutes, asked me if it seemed okay. I didn't know from anything, all I knew was that it was not prohibitively uncomfortable. Other than that, everything was good. Since then they have mailed my supplies to me and I barely have to lift a finger.

Now I may wind up with cranky cheapsters who will probably make me go to them, and they are in some out of the way rabbit warren I never heard of. Sorry, /rant.

[renatae]

I finally got through; the nearest supplier of diabetes testing supplies only carries ONE meter/strips,
and say it is the only one covered by Medicare: ("at all!"---are they lying?)(edit; yes, they were)
(Omnis Health Embrace--exceptionally poorly rated from what I can see elsewhere.) This is so sad.

Yep, they sure are lying! Although the places I checked don't cover too many brands - I think I only saw one mail order place that covered the ubiquitous One Touch. I use a Bayer USB Contour and none of the mail order places supplies that. Lucky for me, Target is on the list, and I'm pretty sure they carry that because they seem to carry most of the popular items.

I just realized the last place I bought supplies from must have billed Medicare for the battery, control solution, lancet and lancet strips they said they were sending but didn't - time to make that right... Stuff like that and sending too many hoses and stuff was probably what resulted in this new crappy system.

[MagsterMile]

I found out ( and I hope they are right since they do make a lot of billing mistakes with codes and such) that my DME is grandfathered in for me. Just for kicks I checked via phone calls and the internet, where my closest supplier would be and if I didn't have Humana Medical Advantage, it would be about 7 miles away. Since I do have HMA, the closest suppliers are 25 and 26 miles away. Guess who they are? Two of the least liked from what I've read on this forum. Lincare and Apria. I'm surprised that so many vendors dislike Human Medicare Advantage. Could it be they are difficult to work with? I know if I call them on different occasions I will get different answers to the same question.

[renatae]

I just received notice from my company that supplied my diabetes testing supplies that they did not win the bid and would no longer be able to supply my needs. Talked to one local company that may still provide the supplies but was told that they would not supply the Accu-Chek that I was using. Said medicare just cut the reimbursement for test strips from $30 per pox to $10. The only one that can be supplied is a Meter called the Prodigy, made in China special. I found the strips for it at Amazon for $12 a box. So far reports on the accuracy are not looking good. Wondering if it is worth testing if the accuracy is that bad. Have not gotten much of an answer on CPAP supplies yet. Most of what I have bought for the past year has come from cpap.com so that may be the only option. I used to get my insulin syringes free with the insulin, jut found out that they are no longer supplied and require a separate co-pay which is higher than what I can get them at the local pharmacy. How do you spell Affordable Health Care............let somebody else pay for it. My local pharmacy just refused to fill my prescription for my cholesterol meds, said their cost was $150 over what medicare would pay. Still trying to find a mail order place that might supply them.

Jerry

Good Lord, and it isn't even July. This is worse than I ever dreamed. I'm glad you mentioned Amazon, though - they usually have diabetic supplies at low cost.

If you are not on a generic cholesterol med, check that out. The most expensive is still Lipitor/Atorvastatin, so you might want to ask your doctor if they can change your med if you are on that, because it is substantially higher than the others. I have Part D coverage and I pay nothing and the plan pays $15 for a 90 day supply. I checked regular prices online to see if that was cheap just because Medicare doesn't pay anything, but the across the board prices were about what my plan paid for the med I am currently on. I used to be on Lipitor and then its generic, but my Plan D wouldn't pay for it, so my doctor switched me over to a different one.

[renatae]

I got the same slick brochure today and spent the afternoon on the phone.

My lovely little personable DME lost the bid, and the only choice I have in my area is the dreaded Lincare, with their one star out of five customer satisfaction status. I was told by another small DME I called that was just bought by Lincare that my particular office of Lincare is an exception and really good, and is now run by their former boss. I talked to them today. The RT was super nice, but told me I will have to give back the brand new machine I just worked so hard to get, after getting the same machine from them, so that I am paying rent to them, not some other company. How stupid is that? Why not just transfer some paperwork so I pay rent to the right place? A machine is a machine. It's exactly the same.

That is when I called my present DME that lost the bid and found out about the grandfathering clause. My old DME is not going out of business, and will be able to supply me until I am done paying rent on my new machine, which they say will be in 13 months. Then I will be forced to change to Lincare, but who knows what will happen in the next year, while I'm still paying rent. If it applies to you, check out grandfathering before you freak out like I did.

I am guessing this crap is part of the Affordable Care Act. Under the Affordable Care Act premiums are going to go up 100-400% according to a poll of the top 17 health insurance companies. In a poll of healthy people under age 40, they said if their premiums go up even 20% most of them will drop their insurance and go without. After all, that generation is making much less now and many have college loans that will hold them down for life. The fee for not having ins. is not much. That will cause the whole thing to fall apart, since the young are supposed to help pay for the old in this plan, so maybe this whole ill conceived boondoggle will all go away.

Advantage plans lose their advantages next year also, because this new law wants a level playing field, which will cause their premiums to go up for all that stuff like gym memberships, vision care and dentists . Only the worst dentists will participate, at least in my area, and the vision care is always for companies that do not even exist here!. In my area, we already have plenty of doctors who won't take Advantage patients, and a few who won't take Medicare at all. If you can't afford a Medicare supplement, and I can't, you are SOL. I had one doctor tell me he was only seeing me because I was on straight Medicare. That scared me away from Advantage Plans, since I've found with my long term chronic illness that having the best possible doctor is the whole ball game, and it's the best ones who can afford to turn away patients they don't get reimbursed well for seeing.

The whole thing sucks and is typical of the government.


klutzo

Oh, I'm so glad you got the facts on the bit about having to get a whole new machine! I am in the same position and it would be horrible without the grandfather clause - I would not want to have to start from scratch again, and especially not from one of the dismal choices I have here. I'm going to hang on to my present DME as long as possible.

I checked out Advantage plans when I first went on Medicare, and I could not find the Advantage at all. The ones available to me in my area were expensive - like 80 or more dollars a month, (even though I keep hearing ads and people say they pay nothing, there is no such plan in my area) and they are often very restrictive and the worst were HMOs. IIRC, they didn't pay much more than 10% of your bill, leaving you still with 10% on most things.

I found that for me, Plan G supplement is great. It is about 100 a month, but it pays everything and all I pay is the part B deductible of 148 or whatever it was this year, and I can go to any doctor I want. It has almost the identical coverage as the Cadillac of plans, Part F, except for that deductible, and it's way cheaper. At least before the wonderful Affordable (NOT) Care Act gets its grimy claws into it.

Yeah, thanks ACA.

[midnight_skulker]

I called my DME today. The lady I talked to said that they didn't win the bid for CPAP equipment, but they did win for oxygen equipment. She said that if I were still in the rental phase (I'm not), I could continue with them until the rental was completed. She will immediately ship to me all the supplies that Medicare will pay for before July 1, 2013.

[DMEOwner]

Competitive Bidding was launched under Bush, its not part of ACA. However, the method of bidding was introduced by Obama admin.