Stakeholders push for comments on bid-related IFR

‘CMS refers to comments all the time,’ says VGM’s Gallagher
Friday, June 22, 2018

WATERLOO, Iowa – With only two weeks left until a July 9 deadline, a paltry 56 comments have been submitted in response to a competitive bidding-related interim final rule.

“And we wonder why (nothing changes),” John Gallagher, vice president of government relations for VGM, told attendees at last week’s Heartland Conference. “CMS refers to comments all the time. Take the time when you get back to your office to do the comments.”

The IFR, published in the May 11 Federal Register, reinstates 50/50 blended reimbursement rates, but only from June 1, 2018, to Dec. 31, 2018, instead of retroactively from Jan. 1, 2017, and only in rural and non-contiguous CBAs instead of all non-bid areas.

No one should be sitting on the sidelines at this point in the game, says Jay Witter, senior vice president of public policy for AAHomecare.

“This IFR goes far beyond relief in rural areas,” he said. “For the first time, CMS has acknowledged there are problems. They are agreeing with us.”

Industry stakeholders continue to press lawmakers for bid relief. In addition to ramping up the number of co-sponsors for H.R. 4229, they’re also seeking to introduce a Senate companion bill ahead of the August recess.

To boost their efforts, VGM is launching two new surveys in the coming weeks, a cost-shifting survey and a delivery cost survey, says Gallagher.

“We want to know what your cost is to send that vehicle out of the gate,” he said.

Stakeholders are also keeping an eye on an upcoming proposed rule, CY 2019 Changes to the End-Stage Renal Disease Prospective Payment System, that is expected to be released just ahead of the July 4 holiday.

“Health and Human Services Deputy Secretary Eric Hargan has said changes are coming,” said Witter. “The ESRD is the most viable vehicle for those changes. If that doesn’t happen, we will have to go back to Congress.”


I was able to comment; however, I do not think that CMS gives a rip!!

For 35 years my company has been providing full range of DME to rural Western Kentucky. For most of those 35 years our industry has seen nothing but fee CUTS [75 to 80%] while at the same time hospital and drug reimbursement has gone up over 1000%. It's ironic that the smallest segment of healthcare has had the most [if not only] fee cuts all in the name of saving Medicare while the other 99% of Medicare expenditures have for the most part had nothing but increases.  When congress voted on the IFR the intent was to increase accessability to services while at the same time correcting CMS's mistake of cutting reimbursement to the point that over 40% of the DME companies have closed their doors especially in the rural areas.  Unlike the urban provider, rural companies have a much higher operating expense and less population to service per square mile.  It is common for us to have to drive a 60 mile round trip just to deliver a bedside commode which means our company LOST over $50 to service this patient. Our operating overhead is about 53% with the remaining cost being the product itself.   When Medicare cut the reimbursement 44-82% this resulted in our company having to make some hard decisions about what products could we afford to provide AND bill for and not be servicing at a lose.  The result was eliminating accepting asignment on over 500 items which means patients now have to pay cash for.  I was holding off cutting even more wishing the IFR would bring relief. For 20% of the country it has helped some but for our company in rural western KY, we got no relief as CMS classified TRIGG [14,000] and CHRISTIAN [64,000] counties as non-rural even though every federal government agency classifies these 2 counties as rural.  We are not in a competitive bid area nor contingous to a competitive bid area so we are suppose to be classified rural.  But not so says CMS?    Not only do we get paid 25% less than every county around us but also another 10% less because CMS says we aren't rural [previos penalty].   How much longer can I keep providing services to Medicare patients?  Starting August I will stop accepting assignment on another 500+ products.  Now I ask you, is Medicare serving the patients with the current policies OR denying them benefits they earned and paid for?  Its obvious their is a major problem.  Unless the IFR is made permanent to all non-competitive bid rural areas I forsee another 20-40% of companies cutting their services or going out of business.  Our company is the only local company in a 90 mile radius that provides high end respiratory and rehab product services now.  Do you care if Wesrern Ky has access?   Not only has CMS hurt Medicare patients but also all Medicaid and private insurance companies have followed suit and all those patients are suffering as well.  We are the ounce of prevention and solution but CMS seems to want to pay for the pound of cure which is their current process.  Just use common sense.