'This is what needs to be written about'

I had a provider email me this week who was asking if we could use our trusty HME Databank to show how the competitive bidding program has affected access to home medical equipment.

“I am reading about CMS boasting about saving so much money through the bid process,” he wrote. “I believe the savings are bogus and the real savings are coming from Medicare clients finding it easier to pay cash than deal with Medicare.”

The provider suggested that we take a look at three items that have been put out to bid—walkers, wheelchairs and hospital beds—and compare the number of claims submitted two years before and after the original Round 2 kicked off on July 1, 2013.

I took a common code for walkers, E0143, and dug in. Here's what I found:

2014: 705,831 Medicare beneficiaries received the product

2013: 781,894 Medicare beneficiaries received the product

2012: 859,767 Medicare beneficiaries received the product

2011: 860,736 Medicare beneficiaries received the product

2010: 878,973 Medicare beneficiaries received the product

2009: 874,265 Medicare beneficiaries received the product

A few notes:

• The most recent year for which we have data right now is 2014, so I could only look one year past the Round 2 implementation date (technically a year and a half, since Round 2 kicked off in July). When we update the Databank with 2015 data in October, we'll have a better post-picture.
• I also looked farther back than two years prior to the Round 2 kick off to include 2010 and 2009, because, well, we have the data.

You'll notice that the number of bennies who received the product was relatively stable until Round 2 hit, then we saw a 9% decrease from 2012 to 2013 (the bid program would have been in effect for only half of 2013), and another 9.7% decrease from 2013 to 2014.

I shared the data with the provider.

“The 2014-2015 full year will probably show a 30% to 40% reduction in beneficiaries served,” he wrote. “So obviously, the need is increasing not decreasing (due to demographics), but the new rules have restricted access to the point where clients are paying cash. The dollar amount is at least $20 million to $40 million just on one item. Surely, nothing to brag about from a federal agency: Stealing $20 million to $40 million from beneficiaries.”

For total reimbursement for E0143, I found:

2014: $38,313,467

2013: $49,818,669

2012: $61,249,335

2011: $59,594,543

2010: $61,915,859

2009: $61,072,838

That's a 18% decrease in reimbursement (or savings in Medicare parlance) from 2012 to 2013, and another 23% from 2013 to 2014.

The provider continued: “This confirms what I see as a DME dealer who is not taking the bid. There has to be pushback against these stupid policies. The average Medicare client will not complain, but the government is wrong. This is what needs to be written about.”

Yes sir. Yes sir, indeed.