Medicare Competitive Bidding and What it Means For the Consumer

Chances are, you or someone you know have purchased or will have to purchase Durable Medical Equipment at some point. What is "Durable Medical Equipment"? According to Wikipedia.com, Durable Medical Equipment (DME) is a term used to describe certain Medicare benefits/items. The exact items are defined by Title XVIII the Social Security Act. Some examples are wheelchairs, iron lungs, hospital beds, blood testing strips, and only the seat-lift mechanism of a lift chair (why the seat, back and frame is not covered is still a mystery).

Competitive Bidding, or HR 6331, states among other things, that Medicare recipients will receive their DME from medical suppliers who have agreed to accept the lowest prices paid by Medicare for equipment and supplies they sell to Medicare recipients. Medicare’s intention is to reduce fraud and overall cost of DME, thus reducing the national deficit.

What they dont tell you, is that the reimbursement rate to suppliers is so minimal that only large, chain type suppliers will be able to participate in competitive bidding. In fact, all verbage in the application to be a provider is geared toward having many, many locations with one corporate office to make billing with Medicare simple. Volume, huge volume, is the only way to make any type of profit with this program. This eliminates any mom-and-pop medical supply shop from participating. Isnt that shame?

What does this mean to the Medicare Recipient? They still get the DME covered by Medicare, however where they get it from will likely change. In our experience, convenience is important for the population that Medicare serves, however recipients may no longer be able to patronize their neighborhood supplier unless that supplier is a competitive bid winner.

Another issue that has arisen with round one of the competitive bidding process is where consumers go for warranty issues for their DME. Because HR6331 is not clear on who is supposed to cover these issues, competitive bid winners are refusing to help consumers because if they do, any profit they made will be lost, and non-bid winners didnt sell the item in the first place, so why should they help? Imagine Joe, who is not able to get around without his walker, and on a fixed income, having to run around to get his broken walker fixed.

Round two of competitive bidding is in the works, because Medicare has decided it is working well. Are the best interest of our elderly population being served?

For more information from HME News, our industry voice, and CMS, visit:
Repairs
Competitive Bidding
Centers for Medicare & Medicaid Services