‘Right this wrong,’ providers tell CMS

Callers to forum outline problems related to drastic rate cuts
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Friday, March 24, 2017

WASHINGTON – From Martha’s Vineyard to the Pacific Northwest, rural HME providers are struggling to survive in a post-competitive bidding world, they told CMS officials during a call March 23.

CMS was mandated by the 21st Century Cures Act to take into account stakeholder input on future pricing in non-bid areas, which got their first taste of the program in 2016.

“We’ve been forced to dig into our personal savings to keep our business afloat this year and continue to provide much needed supplies and services in our area in anticipation that Medicare will right this wrong,” said Rebecca Erickson of Star Valley Medical Supply in Afton, Wyo.

Signed into law in December, the Cures Act rolled back cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments.

With that cut, and a first round of cuts that went into effect on Jan. 1, 2016, it’s unrealistic of Medicare to expect providers to be able to absorb cuts of 50% or more, say providers.

“It’s devastating to us, but, more importantly, the beneficiaries,” said one provider from Washington state. “When I tell them it will be billed on assignment, they walk out without the item and end up having further issues. CMS is forcing non-adherence. As a medical provider, I can’t even grasp where that makes sense.”

During the call, CMS sought input on: average travel distance and costs associated with furnishing items and services in an area; and average volume of items and services furnished by suppliers in the area.

Providers argue that, in rural areas, you can’t make up for reduced reimbursement with volume.

“One of the keystones of the program is that your volume goes up,” said Josh Shields of BetaMed in Bryan, Texas. “We are serving the same volume, but at a lower price.”

As a result, beneficiaries must wait longer for deliveries, and they have less choice in equipment, Shields said.

CMS also sought input on the number of suppliers in an area. Most callers said, in their area, they are it.

“I’m the sole provider of oxygen, CPAP and DME for Martha’s Vineyard,” said John Curelli of Island Home Medical. “We are hoping we don’t have to leave Martha’s Vineyard (located seven miles off the coast of Massachusetts) without a provider. The Cures Act needs to help cure this industry.”

While CMS has set an implementation date of July 3 to make repayments, that’s too long of a wait, say providers.

“Beds in central Virginia are down to $8.46 a month,” said Ronnie Rankin of Culpepper Home Medical in Culpeper, Va. “We can’t get out the door for that. We’d like to see a fast resolution to the Cures Act and definitely a better reimbursement rate based on a lot of factors that you deal with in a rural area.”