Words are great, but now let’s see some action

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05/18/2018

Ever since the interim final rule was published in the Federal Register last week, there has been a cloud of disappointment hanging over the HME industry.

But for those of you who took the time to read the IFR in full, you’ll find some interesting language from CMS acknowledging issues with the competitive bidding program and the agency’s ability to monitor the program’s impact on access.

If you didn’t take the time to read the IFR in full, AAHomecare provided a CliffsNotes version in its “Wednesday in Washington” email bulletin this week.

Here is CMS, in its own words:

·      Given the rapid changes in health care delivery that may disproportionately impact rural and more isolated geographic areas, we are concerned that the continued decline of the fees and the number of suppliers in such areas may exacerbate the already emergent access concerns faced by beneficiaries.

·      Our monitoring data, by its very nature, would not alert us to the present and imminent threats to beneficiary access that stakeholders have raised in recent months. If CMS continues to pay the fully adjusted payment rates in rural and non-contiguous areas, it could further jeopardize the infrastructure of suppliers that beneficiaries rely on for access to necessary items and services in remote areas of the country.

·      Also, as noted earlier, our systematic claims monitoring only looks backward in time and may not detect rapidly emerging trends, particularly in isolated or rural areas. We also referenced the GAO’s acknowledgement that there are challenges associated with monitoring the CBP.

·      We recognize that reduced access to DME may put beneficiaries at risk of poor health outcomes or increase the length of hospital stays.

·      Given the strong stakeholder concern about the continued viability of many DMEPOS suppliers, coupled with the Cures Act mandate to consider additional information material to setting fee schedule adjustments, it would be unwise to continue with the fully adjusted fee schedule rates in the vulnerable rural and non-contiguous areas for 7 months. Any adverse impacts on beneficiary health outcomes, or on small businesses exiting the market, could be irreversible.

This is a big deal, as a number of stakeholders have told me, because to date, CMS has portrayed the program with nothing other than rose-colored glasses.

Tom Ryan at AAHomecare: “Some of the words they used to express concern are the exact words we’ve used. They’re aware of the real-time crisis that is beginning to become apparent. It’s a first.”

Cara Bachenheimer at Invacare: “This is a huge step forward. There are many, many more steps forward that need to be made, but this is a huge step forward.”

But this big deal poses a big question: What will CMS do now?

In a press release at the time of the release of the IFR, CMS said it is “continuing to engage with stakeholders” and it “intends to undertake subsequent notice-and-comment rulemaking to address the rates for DME and enteral nutrition furnished in 2019 and beyond.”

Words are great, but now let’s see some action.

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