GAO: Non-Bid Areas Didn’t See Patient Access Problems in 2016

GAO conflicts with various studies, including those involving case managers and discharge planners, as well as CMS’s recently proposed rulemaking.

Non-bid areas did not experience significantly reduced patient access to home medical equipment after the national expansion of bidding-derived reimbursement, according to a recently released report from the Government Accountability Office (GAO).

The GAO report, available at bit.ly/2C1Q7hK, stated that “there were no widespread effects on beneficiary access in the year after the adjusted rates went into effect,” but added that “some effects may take longer to appear, underscoring the importance of CMS’s continued monitoring activities.”

In its report highlights, the GAO dismissed reports of reduced patient access to medical equipment from HME stakeholders such as beneficiary groups, hospital organizations and HME associations. The GAO noted that it had “reviewed several publicly released studies that assessed the effect of the implementation of adjusted rates on beneficiaries, DME suppliers, and others.” The GAO went on to say that “We found these studies did not provide persuasive evidence.”

“We would assume the ‘others’ they reference would include the highly credible input of 358 hospital case managers/discharge planners, more than 75 percent of whom said they 'experienced difficulties with the ease and timeliness of the discharge process for patients who require HME since July 2016,'” the American Association noted in a statement regarding the GAO report.

AAHomecare commissioned healthcare research group Dobson DaVanzo & Associates to carry out a survey of HME providers, Medicare beneficiaries, caregivers and hospital case managers, discharge planners and staff on the negative impacts of bid expansion they were witnessing.  A highlights page of the report is available at bit.ly/2LHoY2Q.

AAHomecare also underscored that the report is in “stark contrast” to the rural relief IFR implemented earlier this year and CMS’s proposed ESRD and bidding rule current reality at CMS. Simply put, why would CMS scramble to protect patients’ access if there were no problems with access, per GAO’s contention?

“In the Interim Final Rule on non-CBA reimbursement rates released in May, CMS provided emergency relief to providers in rural non-CBA areas and noted problems with its monitoring efforts,” AAHomecare noted. “In the recent ESRD/DMEPOS proposed rule, CMS acknowledges competitive bidding flaws, including the use of median bid pricing, and is delaying the next round of bidding until major fixes can be implemented.  CMS is also proposing an extension of the relief in rural areas through 2020.  

“CMS’ language in these two recent rules, coupled with what hospital case managers, beneficiaries, and DME suppliers are saying about patient access problems, indicates that there are still major problems with the bidding program and non-bid area reimbursement rates that need to be addressed,” the association’s statement added.

That said, there are two upsides to the report, according to AAHomecare:

“First of all, it confirms that payment rate decreases in non-bid areas are consistent with what our industry has been reporting: approximately 50 percent reductions since the new rates went into effect over the course of 2016,” the association noted. “GAO’s report also tracks closely with our own findings on the significant erosion of the DME supplier base since the bidding program went into effect, with more than 35 percent losses in DME suppliers from 2010-2016, including an 8 percent drop from 2015 to 2016.”

About the Author

David Kopf is the Executive Editor of HME Business and DME Pharmacy magazine. Follow him on Twitter at @postacutenews.

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