National mail-order program: Too much to handle?

Friday, April 5, 2013

YARMOUTH, Maine – Regardless of who accepted contracts for the national mail-order program for diabetes supplies, providers predict “chaos” on July 1.

“There is going to be a big tsunami of customers looking for supplies,” said Samuel Kim, COO of Chatsworth, Calif.-based Louisiana Care Concepts. “There are going to be issues with types of supplies, the brands available. There’s a lot of confusion and I don’t think anyone is really prepared.”

There’s not much time to get prepared, either. The program is supposed to kick off July 1, but CMS hasn’t announced the contract suppliers or ramped up educational outreach yet.

If his Round 1 experiences are anything to go by, it’s going to take a lot longer than that to transition patients, says provider Dan Gooch.

“We were still getting calls six and nine months after the contract period began from beneficiaries that did not even know the term ‘competitive bidding,’” said Gooch, owner of Pal-Med in Columbia, S.C. “We spent an exorbitant amount of time trying to find these folks a new home.”

Exacerbating the situation: CMS offered contracts to only 15 providers—and several sources confirm that not all of these providers have accepted the contracts. With an estimated 6 million beneficiaries expected to be impacted by the change, there may not be enough providers, says provider Mark Gielniak.

“There’s not a lot of time for so few companies to get new prescriptions, file setups and meters in patients’ hands,” said Gielniak, vice president of Diabetes Plus in Warren, Mich.

That’s not to mention the other headaches that come with being a Medicare provider, says industry consultant Tom Milam.

“Once these people start filing claims, the audits and the oversight comes down,” said Milam, a former mail order provider. “It’s going to be chaos.”