News and Trends

By Brian McCurdy, Senior Editor

CMS To Begin Competitive Bidding Process For DME

   Changes are underway at the federal level to the durable medical equipment (DME) system for Medicare patients and may have an effect on podiatry practices and patient care. The Center for Medicare and Medicaid Services (CMS) proposes a system that will open up the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) system to competitive bidding. As part of the plan, only those suppliers chosen through the bidding will be permitted to supply items to Medicare beneficiaries in product areas covered by competitive bidding.

   The rule applies to physicians as well as larger DME suppliers, according to an American Podiatric Medical Association (APMA) e-news update. The CMS will designate certain product categories for bidding, such as high-volume products and those that have the highest potential cost savings for Medicare, according to the APMA. The CMS will then choose winning bids for each category in certain metropolitan areas and set a single price for each product in the category.

   The CMS will begin phasing in the plan next year, starting with the 10 largest metropolitan areas, continuing in 2009 with the next 80 biggest areas and concluding after 2009 with the remaining areas, according to the Federal Register. It notes the CMS will initially exclude the New York City, Los Angeles and Chicago areas from the program until it has more experience with implementing competitive bids. The Register also anticipates that DME bids will start this year and prices will take effect in October 2007.

   The CMS lists the top 20 eligible DME policy groups and among those are diabetic supplies and equipment, orthotics (excluding custom orthotics), walkers and negative pressure wound therapy. Although the CMS notes it has not yet chosen the products affected by competitive bidding, it notes that the products will probably be chosen from the top 20 DME groups, according to the Federal Register. The CMS foresees the DMEPOS suppliers to be “significantly affected” by the policy but notes that only companies that supply products in at least one category selected for competitive bidding will be affected.

How Will Competitive Bids Affect Patients And DPMs?

   When it comes to patient care, the CMS predicts that although the number of DME suppliers will decrease, there will be a sufficient number of suppliers to ensure access for patients. As the Register notes, CMS expects an improvement in quality because it will more closely scrutinize the suppliers throughout the program. The government’s analysis of the program showed “minimal adverse results” on patient access to care and quality, notes the Register.

   In contrast, William McCann, DPM, feels competitive bidding will negatively affect patient care, particularly if physician practices are included in the process. As he notes, about 3 percent of physicians participate in the DMERC program, which he says demonstrates the small number of healthcare providers who require durable medical equipment. Furthermore, Dr. McCann feels that physicians can now carry a small selection of high-quality DME in the office for patients with a wide range of conditions.

    “This is critical in practices such as podiatry and orthopedics. Removing our ability to have durable goods available for patients when medically necessary can seriously jeopardize a desired outcome,” says Dr. McCann, the President of the American Academy of Podiatric Practice Management.

   While Bret Ribotsky, DPM, says patients will still be able to receive durable medical equipment, he suggests that some patients may ask why they should turn to podiatrists since they will be able to get the equipment from doctors in other disciplines. He believes the competitive bidding program will set up a potential situation in which DPMs are not perceived as being at the level of other doctors.
“We have made an extra burdensome step for patients to go to podiatrists,” asserts Dr. Ribotsky, a Fellow of the American College of Foot and Ankle Surgeons. “We are kind of in a situation that it is not very effective for us to survive in.”

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