The US House of
Representatives has included Durable Medical Equipment
(DME) Competitive Bidding in
its Medicare bill; and the Senate is considering
doing the same, and may include
it in a larger Medicare provider bill
this week.
Under the current
Medicare program, the reimbursement level for DME,
orthotics, prosthetics and supplies is set by fee
schedule and providers and
suppliers compete for Medicare patients based on the
quality of the service
they provide to the beneficiary, how quickly service
calls are performed, how responsive
the company is to the physician who refers the patient, and
how functional the patient is with the service and/or
device provided.
Advocates argue that
under government-imposed competitive bidding:
* Price becomes the
sole and determining factor in securing Medicare
referrals and the quality of care and
range of services provided to the
patient are sacrificed in order to put forth a low bid;
* The quality of care
is bound to suffer as providers search
for ways to cut corners and costs so they can
make ends meet. It will not
take long before providers discontinue product lines that are no
longer sufficiently profitable
or that require extra time or attention to
the beneficiary, to the detriment of patient
outcomes;
* DME that is
customized to the patient is nearly
impossible to competitively bid as one is not comparing
identical products.
Customizing DME entails the skills of the provider, the
experience of the provider with
similar or complex patients, and
different techniques for achieving
particular therapeutic goals. This is evident in wheelchair
design that requires customization and other DME such as
oxygen therapy that
requires a high degree of
service.
* Competitive bidding
should never be considered for professional orthotic
and prosthetic care due to the
uniqueness of the service, the high degree
of clinical/professional care
involved, and the customization
entailed in providing orthotic
(orthopedic braces) and prosthetic (artificial limbs)
care. Even competitive bidding
of "prefabricated" orthotics is
problematic because it treats orthotic
care as the provision of a commodity
rather than
recognizing the clinical/professional judgment required to
provide quality care;
* Medicare
beneficiaries under the fee-for-service program will be
restricted in accessing the provider of
their choice. Long-standing
relationships between beneficiaries and familiar providers will
be interrupted
causing disruption in service and dissatisfaction for
patients. Small,
community-based providers will be
displaced by larger chain providers
that can take advantage of economies of scale, but which
may not be in the
interests of beneficiaries. Beneficiaries who do not
value choice of provider have the
option of joining the Medicare Plus
Choice program, but the key feature of
Medicare's fee-for-service program is choice of
provider and this must be
vigilantly safeguarded;
* The efforts of
companies, entrepreneurs, and researchers to innovate in
this area will be significantly
curtailed if there is not an adequate
funding stream to reward innovation; and
* Implementation of
Medicare competitive bidding is premature in that the
impact on beneficiaries of the two
competitive bidding demonstration
projects has not been adequately assessed. In fact, the
only study that assessed this issue
stated, "It is premature to declare that competitive
bidding is either an appropriate or an
inappropriate reimbursement
mechanism for durable medical
equipment and related items."
Advocates are calling
for consumers to immediately contact the following
members of the Senate Finance
Committee who, if convinced by messages from constituents, can
withdraw Competitive Bidding from the
Medicare bill.
[Senator]
[Legislative
Director(s)]
[Phone]
[Fax]
Max Baucus (D-MT) --
Chairman, Senate Finance Committee
Kate Kirchgraber
202-224-4515
202-228-2316
John Breaux (D-LA)
1) Sarah Walter
202-224-4623
202-228-2577
2) Sara Traigle
202-224-4623
202-228-2577
Kent Conrad (D-ND)
Neleen Eisinger
202-224-2043
202-224-7776
Thomas Daschle (D-SD)
Jane Loewenson
202-224-2321
202-224-6603
Bob Graham (D-FL)
1) Lisa Layman (Rx)
202-224-3041
202-224-2237
2) Jocelyn Moore
202-224-3042
202-224-2237
Phil Gramm (R-TX)
Russ Vought
202-224-2934
202-228-2856
Charles Grassley
(R-IA) - Ranking Republican Member
Hope Cooper
202-224-3744
202-228-1703
Orrin Hatch (R-UT)
1) Bruce Artim
202-224-5251
202-224-6331
2) Patti DeLoatche
202-224-5251
202-224-6331
James Jeffords (I-VT)
Sean Donahue
202-224-5141
202-228-0574
John Kerry (D-MA)
Kelly Bovio
202-224-2742
202-224-8525
Jon Kyl (R-AZ)
Don Dempsey
202-224-4521
202-228-1239
Blanche Lincoln
(D-AR)
Elizabeth MacDonald
202-224-4843
202-228-1371
Trent Lott (R-MS)
John Mashburn
202-224-6253
202-224-2262
Frank Murkowski
(R-AK)
Joel Gilbertson
202-224-6665
202-224-5301
Don Nickles (R-OK)
Bini Zomer
202-224-5754
202-224-6008
John Rockefeller IV
(D-WV)
Yvette Shenouda
202-224-6472
202-224-7665
Olympia Snowe (R-ME)
Mark Hayes
202-224-5344
202-224-1946
Craig Thomas (R-WY)
Linda Rouse
202-224-6441
202-224-1724
Fred Thompson (R-TN)
Rachel Jones
202-224-4944
202-228-3679
Robert Torricelli
(D-NJ)
Lona Valmoro
202-224-3224
202-224-8567
ACT NOW!!! Remember:
if you can't contact this entire list, at least
contact Senators Daschle, Baucus and
Grassley!!
Thank you!
John D. Kemp
President & CEO
HalfthePlanet
Foundation
1875 Eye St., NW,
12th Floor
Washington, DC 20006
202-429-6810 v
202-429-6813 f
jkemp@halftheplanet.org
