Imagine this scenario. A 75-year-old patient presents to a podiatric surgeon for treatment of a fracture of the fifth metatarsal base tuberosity. Instead of placing the patient in a walker, the podiatrist gives the patient crutches so he or she can see a CMS-approved durable medical equipment (DME) supplier in order to get the walker. The DPM just hopes the walker is correctly sized, modified when necessary and applied correctly.
Indeed, this may become the new reality as the Centers for Medicare and Medicaid Services (CMS) has proposed a competitive bidding system that will limit the number of suppliers of certain DME items to Medicare patients in a given area (see “CMS To Begin Competitive Bidding Process For DME,” News and Trends, page 10). This system could potentially impact the ability of podiatrists to provide diabetic supplies and equipment, prefabricated orthoses, walkers and negative pressure wound therapy, all of which are on the short list of products and services being considered by the CMS for competitive bidding.
The CMS says it has noble intentions for the competitive bidding program, citing a desire to have suppliers “ … provide quality (DME) items and services in an efficient manner and at reasonable cost.”
Podiatrists and practice management consultants say the potential impact of this program could have damaging repercussions. One consultant says older practitioners derive a significant portion of their revenue from DME and will likely be hit the hardest. A DPM from a large group practice estimates a financial hit in the low six figures if his practice is not one of the chosen DME suppliers.
In the aforementioned “News and Trends” article, Bret Ribotsky, DPM, says competitive bidding may create a situation in which patients question why they should see podiatrists if they can get DME from other providers or suppliers.
“We have made an extra burdensome step for patients to go to podiatrists,” suggests Dr. Ribotsky, who lectures frequently on practice management issues. “We are kind of in a situation that it is not very effective for us to survive in.”
Aside from the potentially serious financial ramifications, DPMs believe competitive bidding will have a negative impact upon patient care. One podiatrist says this system “certainly will hamper patient access to DME” and questions whether there needs to be additional obstacles and inconvenience for a Medicare patient population already confused by Medicare Part D.
William McCann, the President of the American Academy of Podiatric Practice Management, says the lack of timely access to DME products is another key issue.
“Removing our ability to have durable goods available for patients when medically necessary can seriously jeopardize a desired outcome,” notes Dr. McCann in the aforementioned News and Trends article.
One DPM is also dubious about the price breaks for patients. He says this may happen the first year but wouldn’t be surprised to see a commonly utilized walker go from $45 to $65 in the second year of the program. As he points out, with fewer companies and providers providing DME, there will be a small chance of reduced expenses. The DPM adds that the CMS is unlikely to have a yearly bidding process.
While large group practices may have the wherewithal to get involved in the competitive bidding process, one podiatrist says it is not a reality for most of the profession.
“The majority of practices cannot afford to take on this legal and financial burden,” he laments. “That is a shame for the one-practitioner practices and the two DPM groups that serve the great majority of the Medicare population.”