Diabetes Access to Care Coalition Preliminary Comments to CMS Regarding Inherent Reasonableness

The Comments of the Diabetes Access to Care Coalition’s (DACC’s) initial comments in reponse to CMS’ Public Meeting on Inherent Reasonableness of Medicare Fee Schedule Amounts for Retail Diabetic Testing Supplies are attached here.

The Executive Summary of DACC’s comments states:

The DACC has long been concerned about the implications for beneficiary access if CMS required non-mail order settings to participate in the Competitive Bidding Program (CBP). Beneficiaries need to have immediate access to DTS to check their blood glucose level. As such, it would not acceptable to limit the number of retail DTS suppliers from which beneficiaries can access DTS. For that and other reasons, we continue to urge CMS to keep retail settings out of the CBP.

CMS pushing prices down for diabetes testing supplies

From: Home Care Magazine

GAO Questions Legality, Purpose of Billions in CMS Spending

Editor’s Note:  The GAO Testimony, Medicare Advantage: Quality Bonus Payment Demonstration Has Design Flaws and Raises Legal Concerns, is attached here.  Additional information about CMS’ $8 billion boondoggle, including a letter from the GAO General Counsel to Secretary Sebelius, is attached here.

From: CRE

How many billions of dollars is CMS wasting?  In yet more harsh criticism of the agency, GAO, the government watchdog, yet again blasted billions in wastefully and possibly illegal spending by Medicare.

In testimony before the House Committee on Oversight and Government Reform, GAO testified that CMS’ Quality Bonus Payment “Demonstration” Program “Is Unlikely to Achieve Its Research Goal as Designed and Raises Legal Concerns.”  Specifically, GAO explained to the Oversight Committee:

Competitive Bidding for Durable Medical Equipment: An Estimate of the Economic Impact on Iowa

Editor’s Note:  Dr. Brown’s study is attached here.

From: VGM

CB toll on Iowa: 2,500 jobs lost, $200 million in economic activity gone

WATERLOO, Iowa – A new study concludes that competitive bidding for home medical equipment will have a significant negative impact on Iowa, including the loss of 2,500 jobs and $200 million in economic activity.

“Competitive Bidding for Durable Medical Equipment: An Estimate of the Economic Impact on Iowa” was conducted by Ken Brown, Ph.D., from the University of Northern Iowa Department of Economics.

CRE Statement on “Inherent Reasonableness” for Retail Pharmacy Diabetic Supplies

The Center for Regulatory Effectiveness’ Statement, delivered at today’s CMS Public Meeting on:  “Inherent Reasonableness of Medicare Fee Schedule Amounts for Non-Mail Order (Retail) Diabetic Testing Supplies,” is attached in pdf here and reprinted below.  The Federal Register notice for the meeting is attached here.  Comments are due to CMS by July 30th although the date may be extended.

Statement of the:

Center for Regulatory Effectiveness

before the Centers for Medicare and Medicaid Services

Public Meeting Regarding Inherent Reasonableness of Medicare Fee Schedule Amounts for Non-Mail Order (Retail) Diabetic Testing Supplies

July 23, 2012

Introduction

Bloomberg Government issues report on competitive bidding

From: Home Care Magazine

WASHINGTON, July 11, 2012—Bloomberg Government, a division of Bloomberg dedicated to government news and analysis, issued a new report on competitive bidding. The report summarizes the history of the controversial program and examines criticism of competitive bidding.

• “CMS’s assertions that the program saved $202 million in its first year may be overstated for a number of reasons, including a spike in claims seen in late 2010 and CMS’s intentional selection of areas with higher-than-normal usage levels for Round 1 of the program.

CMS Exceeded Legal Authority in $8 Billion Boondoggle

In an extraordinary letter attached here, the US General Accountability Office’s General Counsel wrote Secretary Sebelius sharply questioning CMS’ legal authority for an $8 billion Medicare Advantage (MA) Quality Bonus Payment “Demonstration” program and rejecting CMS’ defense of the spending.  By way of background, the GAO letter stated:

In March 2012, GAO reported that the demonstration’s reliance on predemonstration performance data, the absence of an appropriate comparison group of MA plans, and the demonstration’s design make it unlikely that the demonstration will produce meaningful results. These facts, in combination with the demonstration’s $8 billion cost, resulted in our recommendation that HHS cancel the demonstration.

Bloomberg/Business Week Discuss Problems with Competitive Bidding, 85% Drop in Suppliers

In the video linked to below, Brian Rye, a health-care financial analyst with Bloomberg Government, discusses CMS’ competitive bidding program, including the opposition from hundreds of academicians, use of non-binding and and the use of median-bif pricing instead of the market-clearing price.  Rye also discusses the drastic decline in the number of eligible home medical equipment suppliers.

http://www.businessweek.com/videos/2012-07-10/medicare-s-competitive-bidding-moving-ahead

HHS OIG Blasts CMS Contractor Conflicts of Interest — Has Implications for Agency Management of Competitive Bidding

Attached below is a report from the Department of Health and Human Service’s Inspector General concerning CMS “uses Zone Program Integrity Contractors (ZPIC) to perform program integrity activities designed to fight fraud, waste, and abuse in the Medicare program.”

The IG found that:

Face-to-face rule

Editor’s Note:  For more about the proposed rule, please see CRE’s Competitive Bidding Blog here.

BALTIMORE – CMS issued a proposed rule this week that details its plans to require a face-to-face evaluation within 90 days of a written order for certain high-cost durable medical equipment.

The rule gives four criteria that would subject items to the requirement:

1.)    items that currently require a written order prior to delivery;

2.)    items that cost more than $1,000;

3.)    items that we, based on our experience and recommendations from the DME MACs, believe are particularly susceptible to fraud; and