OIG: Very little physician solicitation due to bid program

Editor’s Note:  Widespread ethical behavior by DME providers is no surprise to anyone familiar with the industry.  The OIG is deeply wrong, however, in claiming that the uncompetitive bidding program reduces negative behavoir when what the CMS bidding program really does is reduce consumer choice and the supply security of life-sustaining home medical equipment for Medicare beneficiairies.

From: HME News

WASHINGTON – The drastic reimbursement cuts that went into effect as part of Round 1 of competitive bidding haven’t caused HME providers to solicit physicians to prescribe a different brand or mode of delivery, according to a new government study.

The Office of Inspector General (OIG) conducted the study because, “although a prescription change in the product brand or mode of delivery would not typically result in a different Medicare payment amount, suppliers might solicit physicians to make changes.”

To examine the issue, the OIG surveyed a sample of 294 randomly selected physicians who prescribed bid items in the nine competitive bidding areas (CBAs) during the first six months of 2011.

The OIG found that 69% of physicians did not receive solicitation from providers for changes regarding to brand and 78% of physicians did not receive solicitation from providers for changes regarding to mode of delivery. It also found that many physicians did not prescribe brand (58%) or mode of delivery (35%) and, therefore, had no reason to be solicited by providers.

“Most physicians who received requests from suppliers described such requests as rare or occasional and typically approved the changes,” the OIG stated. “Physicians reported that supplier reasons for change requests included the supplier’s belief that a different brand or mode of delivery would better meet patient needs, the supplier’s not carrying the prescribed brand, and requests from patients.”

The OIG also noted that none of the nearly 37,000 hotline calls related to competitive bidding involved concerns about providers soliciting physicians regarding brand or mode of delivery.