Survey says: Providers criticize bidding, bundling

Friday, March 28, 2014

WATERLOO, Iowa – The VGM Group didn’t just submit its own comments to CMS last week on expanding the competitive bidding program nationwide. It also submitted the results of a survey completed by more than 850 members.

“We didn’t just want our perspective,” said Ryan Ball, director of state policy and government relations for VGM & Associates. “We wanted to incorporate the thoughts of our members.”

CMS published an advance notice of proposed rulemaking on Feb. 28 seeking comments on: 1.) developing a methodology to apply bid rates to non-bid areas; and 2.) bundling payments for certain DME, such as enteral nutrition. Stakeholders had until March 28 to respond.

Survey respondents cautioned CMS from applying bid rates to non-bid areas without considerations for geography and population. Ninety-seven percent of respondents said the costs of furnishing items and services varies based on the geographic area in which they are furnished; 97% of respondents also said the costs vary based on the size of the market served in terms of population and/or distance covered or other logistical reasons.

“The bid program was started in metropolitan areas for a reason,” Ball said. “There are some pretty severe impediments to providing care and service to beneficiaries in outlying areas. CMS needs to reexamine the makeup of the program and how they came up with these single payment amounts. It’s apples to oranges.”

Ninety-two percent of respondents also said CMS should use a different methodology to adjust payment amounts for items that have not yet been included in the program, such as TENS devices.

As for bundling, 91% of respondents said there would be negative impacts associated with continuous monthly payments for enteral nutrition and other DME, though they acknowledged the impacts depended on the type and price of the equipment involved. The main reason: For enteral nutrition, for example, the cost and amount of formula varies greatly, making it difficult to determine the appropriate reimbursement.

“It’s outside the provider’s control,” said Mark Higley, a vice president at The VGM Group. “When a patient needs formula and it costs more than the reimbursement or they need more per month than is covered by the reimbursement, it’s referred to as stinting, which is a hospital term. It incentivizes the provider to reduce clinical care to patients.”

In addition to CMS, VGM is also sharing the survey results with members of Congress and it’s asking providers to do the same.

“We’re pushing hard,” Ball said. 

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