Editor's Note

Bigger Picture, CMS, Bigger Picture

Everyone — private citizens, families, businesses — needs to stay solvent to survive. I get it. Despite my general indifference to numbers and math, I do a good job of staying within my Mobility Management editorial budget, for instance.

But maintaining a balanced budget is only part of the equation, right? And if saving money comes at the cost of everything else, what’s the point?

Example: Could I honor a budget of $100 a month in my personal life? Sure.

But I couldn’t pay my mortgage. Or my utility bills, phone bills, homeowners’ association fees or insurance fees. I couldn’t put gas in my car to get to work or anywhere else. That $100 would leave me $25 per week for food, and I’d have to walk to the store to buy it.

By the end of the month, I’d be so chronically hungry and possibly ill that doing my job well would be very difficult. No matter, because I’d be unemployed — unable to afford the gas to drive to the office, unable to pay the electricity bill to work from home. If I prolonged my $100 monthly budget, I’d eventually have my utilities turned off , and I’d lose my home.

Could I spend no more than $100 a month? Yes. But it would cost me everything else. Budgets are part of a bigger picture, and when you lose sight of the bigger picture, a balanced budget becomes useless.

Why all the talk about penny pinching? Because the Centers for Medicare & Medicaid Services (CMS), in its zeal to save Medicare money, has lost sight of the bigger picture.

A couple of examples are discussed in our cover feature story (page 22). The new face-to-face exam rule for DME and the proposed rule for a lengthy new list of capped-rental items, including plenty of complex rehab products, suggest that CMS has put cost savings ahead of serving its beneficiaries.

Add in the ongoing Medicare competitive bidding fiasco, and I can’t help but wonder: Is CMS intentionally creating policies and processes so difficult to navigate that its beneficiaries turn elsewhere for help?

Think about it: Competitive bidding drastically cuts the number of providers CMS has to work with, thus reducing beneficiary access to local providers and to more fully featured, more costly equipment. How many seniors will reach into their own pockets to pay for a more efficacious product than what Medicare will provide? How many seniors will spend their own money to buy from a local provider because they can’t drive 40 miles to reach a competitive bid winner?

Once CMS demands an exam for routine DME, thus convoluting that process, sons and daughters of seniors will pull out their checkbooks: “My mom can’t wait for Medicare. I’ll just pay for it.”

Other seniors — confused by “local coverage determinations” and “detailed written orders” and perhaps without other financial resources — will quietly decide they don’t need that wheelchair: “I’ll just stay home. It’s fine.”

All of this saves Medicare money, but at the expense of what should be the agency’s ultimate goal: to serve its beneficiaries.

Every fair-minded person understands the need to prevent abuse of the Medicare system, and to responsibly manage the Medicare trust funds so the program can continue to serve beneficiaries in the future. But there is such a thing as going too far. Medicare’s policies are making it so difficult to access services and technology that seniors, their families and Medicare’s professional partners — from DME suppliers to CRT providers to physicians — are giving up.

Does that save Medicare money? Yes. But really, isn’t there a bigger picture?

This article originally appeared in the November 2013 issue of Mobility Management.

About the Author

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

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