AMEPA Warns New NCB Payment Rates Will Cost Beneficiaries More

In response to claims that new national competitive bidding single-payment rates will save money for Medicare beneficiaries, the Accredited Medical Equipment Providers of America (AMEPA) has issued a bulletin showing that costs borne by consumers will actually increase.

"Medicare has some vocal supporters of its re-imposed competitive bidding program," said the July 23 AMEPA bulletin. "Organizations such as AARP have explained their support based on one thing: out-of-pocket savings for the patient."

The premise, the AMEPA memo said, is that reduced reimbursement rates for DME will result in "an equal reduction in patients' out-of-pocket expenses." In reality, the organization says, "the program is a true 'cost shift' to the beneficiary. The vast majority of patients will see huge increases in their out-of-pocket expenses related to the equipment and supplies they need and want to keep them healthy, compliant and independent in their homes."

Among the reasons AMEPA doesn't believe beneficiaries will enjoy savings under competitive bidding - and indeed, will end up paying more - is the fact that beneficiaries don't pay co-pays. AMEPA points out that most beneficiaries' co-pays are paid by secondary insurance, and furthermore that beneficiaries who don't have secondary insurance and fail to pay their DME co-pays can't be refused equipment and service. "Therefore, this claim to savings is more than moot," AMEPA said.

In fact, AMEPA said beneficiaries will end up paying more for upgraded DME than they pay now because there will be a bigger price difference between the Medicare-covered product - whose Medicare payment price has been reduced under competitive bidding - and the more fully featured product that the beneficiary wants instead.

As an example, AMEPA pointed out that many patients who use walkers want extra features, such as baskets, brakes and seats. Because Medicare only pays for a much more basic product, beneficiaries often choose an upgraded product and pay the cost difference between the two walkers out of their own pockets.

Because Medicare will pay significantly less for that basic three-wheeled walker in competitive bidding areas, there is now a greater gap between the prices of the basic and the upgraded walker. Currently, a Medicare beneficiary who wants the upgraded walker would pay $56.72, the difference between the price of the walker and the Medicare-paid allowable.

But under the new single-payment rates, the Medicare allowable for that walker would plunge from $102.28 to $66.48. That means the difference between the upgraded walker and the basic walker is much greater: $92.52. And that $92.52 would be the beneficiary's responsibility if he chose to upgrade to the more fully featured walker.

AMEPA says the higher beneficiary costs aren't relegated just to walkers, either. "This situation," the memo says, "is true for most Medicare-paid items, including power-operated vehicles, power wheelchairs, enteral supplies or any beneficiary-upgraded item. Patients are willing to pay out-of-pocket, minimal amounts to enhance their lives, but under the new bidding program, those out-of-pocket costs - for items patients feel are essential for quality living, will skyrocket."

The competitive bidding program, AMEPA adds, "must be stopped."

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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