AAHomecare: Separate insulin, external infusion pumps

Friday, September 7, 2012

BALTIMORE – CMS appears committed to including home infusion in the Round 1 re-compete, but that hasn't stopped stakeholders from trying to persuade the agency to do otherwise.

"CMS feels comfortable with the product categories as they are laid out," said Walt Gorski, vice president of government affairs for AAHomecare.

Still, the association met with CMS officials in late August to propose breaking the infusion category into two separate categories. When CMS announced the list of product categories in April, it lumped together insulin pumps with external infusion pumps and infusion supplies. 

The problem, Gorski says: Infusion pumps are typically provided by infusion pharmacies while insulin pumps are typically provided by HME providers that specialize in diabetes products and supplies.

"The marketplace currently isn't designed the way CMS is bidding these categories," he said. "Now you are going to have insulin pump providers that are going to have to enter the infusion market? We foresee a significant problem here."

Home infusion is a particularly service-intensive therapy that deals with an often-frail population. Competitively bidding the therapy—and requiring that insulin pump providers bid on it—creates patient safety risks and access issues, Gorski says.

With bidding scheduled, at press time, to open Oct. 15, time is running short to change CMS's stance, he says.

"There's always an opportunity, but once the bidding starts, then we have a problem," Gorski said. "I think our next steps are really to reach out to the endocrinologists and the American Diabetes Association and get them involved in this issue."