Build up, don't tear down

Friday, November 22, 2013

Managing Editor Theresa Flaherty and I couldn’t help but scoff at a quote from CMS Administrator Marilyn Tavenner in a recent press release touting major savings for Medicare beneficiaries. You see, the standard monthly premium for Medicare Part B will stay the same in 2014 at $104.90.

Which is good news, as Tavenner points out, for not only beneficiaries but also taxpayers.

But, in explaining why the premium will stay the same in 2014, Tavenner said:

“We continue to work hard to keep Medicare beneficiaries’ costs low by rewarding providers for producing better value for their patients, and fighting fraud and abuse.”

Are Theresa and I paranoid for thinking that when Tavenner says “keep…costs low by rewarding providers for producing better value for their patients” she’s referring to the competitive bidding program and its average reimbursement cuts of 32%, 45% and 37%, respectively, for Round 1, Round 2 and the Round 1 re-compete?

Probably not.

This reminds me of a conversation I had with provider Gene Sego at Medtrade. Sego and a coalition of other providers in Florida have had good success getting lawmakers to sign on to H.R. 1717, a bill that would replace the competitive bidding program with a market-pricing program (MPP). While CMS likes to brag about how beneficiaries are benefitting from reduced co-pays as part of the competitive bidding program, Sego says, in many cases, they end up paying more.

Why? Because beneficiaries get so frustrated with the program (having to start over with a new provider, being forced to use inferior products—it goes on and on and on), they end up throwing up their hands and paying out of pocket.

So instead of a $20 co-pay, beneficiaries end up footing an entire bill for hundreds of dollars.

Theresa, Gene and I aren’t the only ones scoffing.

Consultant Anna McDevitt emailed me recently after watching an interview with Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services (HHS), on CNN. Sebelius made a comment about a serious problem in health care of creating markets where there is none. McDevitt wrote:

“Though HME is just one corner of healthcare, there is certainly a market here and certainly an army of talented people working hard to problem-solve and provide service.”

It’s really sad that Tavenner and Sebelius don’t have kinder words for an area of health care that the government should be building up, not tearing down. HME