Medicare CPAP reimbursement cut 47% for DMEs

Could someone explain SPA (Single Payment Amount)? Does that mean Medicare patients will not longer have to RENT their machines for 13 months. Just gets paid all at once?

I know at least two regions in the country have already gone to competitive bidding for DME. The biggest complaint I heard was that in some cases, the new supplier wasn't even the same state as CPAP users. A supplier could bid to provide all the DME equipment for 6 states. Then nobody can go for a mask-fitting. You just have to take what they mail you. Forget choosing your machine. All eqipment packs will be identical. No more customization to fit the patient's needs.

It's called austerity over in Europe. Not sure what they plan to call it over here in the US.

It's time to get rid of the prescription/licensed DME requirement and let the big retailers begin selling CPAP machines and supplies OTC. Make the CPAP menus easier to access and let the patients set up the machines when they get home. Is setting up a machine really anymore difficult than checking your blood sugar level with a glucose meter or preparing your colon for a colonoscopy? Or hooking up a DVR?

VVV wrote:It's time to get rid of the prescription/licensed DME requirement and let the big retailers begin selling CPAP machines and supplies OTC. Make the CPAP menus easier to access and let the patients set up the machines when they get home. Is setting up a machine really anymore difficult than checking your blood sugar level with a glucose meter or preparing your colon for a colonoscopy? Or hooking up a DVR?

Hmmm ... hooking up your DVR and DIY home colonoscopy kits?

It's hard to get more free market than that.

Will Medicare pay for a new CPAP machine? Mine is seven years old and I want a top-of-the-line machine.

Careful what you wish for, you just might get it.

On average, Medicare will beginning reimbursing $50/month for a capped rental period of 13 months. Keep in mind, Medicare only pays 80% of that amount AND they depreciate the payment by 20% starting the fourth month of the rental period. So, what does that mean? It means that after a DME jumps through all the hoops that Medicare puts in place, such as not only obtaining YOUR doctor's notes that state exactly what Medicare says they must say, making sure YOU go back to YOUR doctor for your follow up visit, and that YOU are actually using the equipment, the DME will eventually collect $550. That is assuming that every T is crossed and every i is dotted and the Medicare beneficiary actually pays the co-pay/deductible. Now go to CPAP.com's website and price a cpap. If they can't sell a top-of-the-line CPAP for that price without having to have a brick and mortar store and all the expense that comes with that, and having the luxury of receiving FULL payment before the CPAP actually leaves their premises, what do you think your Medicare insurance is going to get you?

At the end of the day, DME's will be forced to put out the minimum required, and to most of you that is not acceptable, so you will forgo Medicare and buy your own, which is EXACTLY what the bureaucrats want you to do in the first place.

VVV wrote:It's time to get rid of the prescription/licensed DME requirement and let the big retailers begin selling CPAP machines and supplies OTC. Make the CPAP menus easier to access and let the patients set up the machines when they get home. Is setting up a machine really anymore difficult than checking your blood sugar level with a glucose meter or preparing your colon for a colonoscopy? Or hooking up a DVR?

Great idea! While we're at it, why don't we just make all drugs OTC and let people determine their own dosage.

You have no idea how many times after spending up to an hour going over a machine, fitting a mask, etc, a customer comes back with complaints about their mask not sealing, only to find out they are putting it on upside down. Just because things seem simple to you or me, there are literally millions of people who can't set-up a DVR. Care to guess which demographic these people predominately fall in? I'll give you a hint, it's not the recently graduated from high school crowd.

Maybe a little text could be added to the mask: Maybe, "THIS SIDE UP"
Nearly everyone can watch TV. DVD's are easier to use than previous media.
A video how-to should be available for bedtime reference.
Problems are there to be solved. I think it can be done.

Good!

Let them bid.

Fascism? Excuse me?

All these ignorant wankers want to whine and moan about socialism just to score some points? Well duh! Competitive bidding is the absolute ideal of free market capitalism!

Let the free market decide. If a DME or manufacturer wants to overcharge for CPAP equipment or whatever, then fine, they will be cut out by more competition from others who will provide the same product for less. It works for pharmaceuticals and hospital supplies, and it should work for DME products as well.

And as long as that saves the taxpayers money on Medicare, I am all for it. Saving even one cent on a CPAP product sold to Medicare patients could translate into huge dollars when you consider the number of payments made each year.

I check the new SPA reimbursements for my city against what my DME has been receiving for my purchases.....Under the new SPA they will be receiving a higher reimbursement for everything I normally purchase except for Tubing. I checked FF Mask, Headgear, Silicone Insert, Humidifier Cup, Filters and Tubing.

mcdover wrote:Careful what you wish for, you just might get it.

On average, Medicare will beginning reimbursing $50/month for a capped rental period of 13 months. Keep in mind, Medicare only pays 80% of that amount AND they depreciate the payment by 20% starting the fourth month of the rental period. So, what does that mean? It means that after a DME jumps through all the hoops that Medicare puts in place, such as not only obtaining YOUR doctor's notes that state exactly what Medicare says they must say, making sure YOU go back to YOUR doctor for your follow up visit, and that YOU are actually using the equipment, the DME will eventually collect $550. That is assuming that every T is crossed and every i is dotted and the Medicare beneficiary actually pays the co-pay/deductible. Now go to CPAP.com's website and price a cpap. If they can't sell a top-of-the-line CPAP for that price without having to have a brick and mortar store and all the expense that comes with that, and having the luxury of receiving FULL payment before the CPAP actually leaves their premises, what do you think your Medicare insurance is going to get you?

At the end of the day, DME's will be forced to put out the minimum required, and to most of you that is not acceptable, so you will forgo Medicare and buy your own, which is EXACTLY what the bureaucrats want you to do in the first place.

Actually, to most Americans, a basic CPAP brick and a simple nasal mask is probably pretty darned acceptible.

To CPAP-philes, likely no. People who want to track their treatment and fine tune it demand more. But most Americans with apnea and the choice of basic, but perfectly, clinically proper therapy, or going without -- they would probably be elated to have even a basic, brick machine.

And boy oh boy, I could tell you about a DME putting out the bare minimum effort. The DME I was first sent to refused to fill my MD's rx for a PR560 APAP. She simply said no, they wouldn't/couldn't help me because their profit margin would have been much slimmer than if I just took the cheaper DeVilbiss APAP that that particular DME always put their patients on. And I have a Blue Cross PPO. So I took my business to a competitor DME who gladly filled the Rx for the PR machine.

hyperlexis wrote:Good!

Let them bid.

Fascism? Excuse me?

All these ignorant wankers want to whine and moan about socialism just to score some points? Well duh! Competitive bidding is the absolute ideal of free market capitalism!

Let the free market decide. If a DME or manufacturer wants to overcharge for CPAP equipment or whatever, then fine, they will be cut out by more competition from others who will provide the same product for less. It works for pharmaceuticals and hospital supplies, and it should work for DME products as well.

And as long as that saves the taxpayers money on Medicare, I am all for it. Saving even one cent on a CPAP product sold to Medicare patients could translate into huge dollars when you consider the number of payments made each year.

You obviously have no idea what you are talking about.

None of the bids are binding, but Medicare used them anyway to set pricing. If you really want to save taxpayer money, stop covering DME altogether.

What you are FAILING to take into consideration is the law of unintended consequences. A lot of people will now get the minimum service and a basic machine. Compliance is surely to drop, just as sure as your quality of care from a doctor required to see 50 patients a day is more likely to be worse than from a doctor who only has to see 25. More untreated or undertreated seniors will be behind the wheel of cars, more hypertension, more strokes, more ICU visits, etc.......

I not sure I want the lowest bidder being the one supplying me with anything.

hyperlexis wrote:

mcdover wrote:Careful what you wish for, you just might get it.

On average, Medicare will beginning reimbursing $50/month for a capped rental period of 13 months. Keep in mind, Medicare only pays 80% of that amount AND they depreciate the payment by 20% starting the fourth month of the rental period. So, what does that mean? It means that after a DME jumps through all the hoops that Medicare puts in place, such as not only obtaining YOUR doctor's notes that state exactly what Medicare says they must say, making sure YOU go back to YOUR doctor for your follow up visit, and that YOU are actually using the equipment, the DME will eventually collect $550. That is assuming that every T is crossed and every i is dotted and the Medicare beneficiary actually pays the co-pay/deductible. Now go to CPAP.com's website and price a cpap. If they can't sell a top-of-the-line CPAP for that price without having to have a brick and mortar store and all the expense that comes with that, and having the luxury of receiving FULL payment before the CPAP actually leaves their premises, what do you think your Medicare insurance is going to get you?

At the end of the day, DME's will be forced to put out the minimum required, and to most of you that is not acceptable, so you will forgo Medicare and buy your own, which is EXACTLY what the bureaucrats want you to do in the first place.

Actually, to most Americans, a basic CPAP brick and a simple nasal mask is probably pretty darned acceptible.

To CPAP-philes, likely no. People who want to track their treatment and fine tune it demand more. But most Americans with apnea and the choice of basic, but perfectly, clinically proper therapy, or going without -- they would probably be elated to have even a basic, brick machine.

And boy oh boy, I could tell you about a DME putting out the bare minimum effort. The DME I was first sent to refused to fill my MD's rx for a PR560 APAP. She simply said no, they wouldn't/couldn't help me because their profit margin would have been much slimmer than if I just took the cheaper DeVilbiss APAP that that particular DME always put their patients on. And I have a Blue Cross PPO. So I took my business to a competitor DME who gladly filled the Rx for the PR machine.

Isn't it nice that your insurance afforded you the luxury of going somewhere else? Too bad a Medicare beneficiary won't have that choice. Well, unless they forgo Medicare benefits and pay 100% out of pocket. Here's something else to chew on, insurance companies take their reimbursement cues directly from Medicare. How long do you think before your Blue Cross PPO drops their reimbursement down to Medicare levels? Do you think you'll still be able to find any provider willing to put out a PR560 APAP at those prices? Simple economics, they can't.

LSAT wrote:I check the new SPA reimbursements for my city against what my DME has been receiving for my purchases.....Under the new SPA they will be receiving a higher reimbursement for everything I normally purchase except for Tubing. I checked FF Mask, Headgear, Silicone Insert, Humidifier Cup, Filters and Tubing.

You are 100% wrong.

What we have to consider is the difference between Medicare suppliers and CONTRACTED Medicare suppliers.
Only the contracted DME has to accept the Medicare allowable as full payment;
Those not contracting have NO LIMIT to how much extra they may charge to Medicare patients.
(This is from my SHIIP contact--if there is a limit, she is unaware of it)
Guess which ones will simply NOT carry all the supplies and machines we need.
The contracted supplier is only required to tell us where we can go. Yeah, I know!
Maybe even to a "competitor", who can demand his pie in the sky--or pound of flesh, as it were!