DMEPOS Access Down After Bidding

GAO report shows number of DMEPOS beneficiaries covered by bidding declined after Round Two implementation.

• By David Kopf
• Oct 20, 2016

The number of beneficiaries receiving DME items in Round Two competitive bidding areas generally decreased after implementation of Round Two, as well as the National Mail-Order Program, according to a newly released report from the the Government Accountability Office (GAO).

From the year before (2012) to the year after (2014) implementation, the number of beneficiaries receiving covered DMEPOS items in Round Two areas decreased 17 percent, compared with a 6 percent decrease for beneficiaries in non-competitive bidding areas, according to “CMS’s Round 2 Durable Medical Equipment and National Mail-order Diabetes Testing Supplies Competitive Bidding Programs”

Some other key findings from the report, listed in an American Association for Homecare summary:

• Out of the eight product categories covered by Round Two, seven of them experienced decreased utilization between 2012 and 2014 in both CBAs and non-CBAs, but the decreases were  generally greater for CBAs.
• CPAPs were the only product category that saw increased use between 201 and 2014, and was also the category with the largest difference between the percentage change in beneficiaries and in items.
• Ninety-five of the 100 Round Two areas experienced a decrease in the number of beneficiaries receiving items, ranging from 2 to 42 percent.

The report also acknowledge that there is a division between what CMS is reporting to Congress and the public about the bid program’s impact on access, and what hospital, industry and some patient advocacy groups are reporting. The controversy was described in this segment from the GAO report highlights:

“CMS reports that available evidence from the agency’s monitoring efforts indicates that the implementation of round 2 and the national mail-order program have had no widespread effects on beneficiary access. In particular, CMS has reported that its health status monitoring tool has not detected any changes in health measures attributable to the CBP, and the results of its 2014 post-CBP beneficiary satisfaction surveys remained positive. In addition, the number of CBP inquiries and complaints generally decreased throughout the first 2 years of round 2 and the national mail-order program. CMS officials told GAO that CMS took measures to ensure that contract suppliers met their contract obligations, such as investigating complaints using secret shopping calls, and terminating contracts of suppliers that remained noncompliant after receiving targeted education. However, some beneficiary advocacy groups and state hospital associations reported specific access issues, such as difficulty locating contract suppliers that will furnish certain items and delays in delivery of DME items.”

The findings in the report correlated with another reported released this week by the American Association for Homecare.

Link to the full report site: http://bit.ly/GAORound2Access

Link to highlights from AAHomceare: http://bit.ly/GAORound2AccessSummary