VGM fights back with data

Friday, September 23, 2016

WATERLOO, Iowa – Results from The VGM Group’s “Supplier Impact Survey” debunk CMS’s claims that its competitive bidding program hasn’t affected access to home medical equipment.

Forty-one percent of HME providers report they have reduced their patient service area 1% to 24% due to the phased-in rollout of bid pricing to rural areas on Jan. 1 and July 1.

“So many folks are saying, I’m beyond 25 miles (from the patient), I can’t go,” said John Gallagher, vice president of government relations for VGM. “And therein lies the access issue for patients.”

Thirty-eight percent of providers who completed the survey report that 75% to 100% of their patient base lives in rural areas.

More than anything, Gallagher says the survey shows that CMS is setting up a two-tiered system for Medicare beneficiaries: One tier for those who can pay out-of-pocket for the equipment they need but are having a hard time getting, and one tier for those who can’t.

“So when CMS tells Congress, ‘We cut utilization by 25%,’ sure they did, because patients are paying out of pocket or going without,” he said.

The problem is only going to get worse, Gallagher says. Only 19% of providers reported that 60% or more of their business is Medicare-related, and 74% say they are billing or plan to bill more claims non-assigned.

While CMS may turn a blind eye to these figures, Gallagher says members of Congress, particularly from the Plains states and the Midwest, aren’t.

“Those folks haven’t been engaged because competitive bidding hadn’t impacted them,” he said. “Now they’re engaged because the patient population is heavily (dependent) on Medicare.”

VGM plans to conduct the survey on a quarterly basis to brief lawmakers on the situation on a rolling basis. 

“I’m sure CMS’s response will be, ‘This is just a snapshot,’ ‘This is an industry grab,’” said Gallagher. “But if we have a good year to two-year trend, that will be important going forward.”