Op-Ed: Medicare’s DME Bidding Policy Needs More Work

by Julian Husbands, MD: For More Info, Go Here…

Change required, and soon.

This summer, the Centers for Medicare & Medicaid Services (CMS) will implement major policy changes in Medicare that will make spending more efficient and strengthen the Competitive Bidding Program (CBP) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) such as home respiratory supplies and equipment. CMS recently released its latest educational series and will officially “open” the 60-day bidding window for Round 2021 in June.

On the whole, this major reform is welcome by both the patient advocacy community and home oxygen providers alike. The previous system of competitive bidding was flawed because it utilized a median bid methodology that forced half of home oxygen suppliers to accept payments below their best-offer bids — forcing 47% of home oxygen suppliers to close from 2013 to 2017 alone. As a result, the market became incredibly unstable and patients, particularly those in rural and underserved areas, found it more difficult to get the supplies and equipment that were prescribed by their doctors.

Round 2021 of the CBP would address these issues by implementing a “lead-item pricing” methodology. This system will approximate a market-clearing price so that suppliers who win the bids will receive fair reimbursements for Medicare, ensuring that patient access to critical supplies such as oxygen systems and CPAP machines are stable and secure. This is particularly important for patients with serious respiratory illnesses such as chronic obstructive pulmonary disease (COPD), which is the third leading cause of death in the U,S. and affects an estimated 15 million Americans, including 12% of Medicare’s rapidly-rising population.

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