Home Health & Hospice Week

A project that gives Medicare beneficiaries control over how Medicare spends their allotted money has stumbled in its opening months.

Many providers and beneficiary advocates cheered for the consumer-directed durable medical equipment demonstration when it was announced a few years ago. It would give beneficiaries the ability to comparison shop with DME suppliers and obtain the best price for a wheelchair. Then, if the supplier's price was less than the Medicare allowable, the difference would go into an account for the beneficiary to use to pay for something that Medicare normally wouldn't cover.

The DME regional carrier overseeing the project, Cigna Healthcare, provides prior authorization for the wheelchairs and also allows beneficiaries to buy items, such as a K0001 wheelchair, that they normally would have to rent. All claims must go to Cigna instead of the supplier's usual DMERC, and the beneficiary will show up with a certificate of medical necessity with sections B and D already filled out.

Suppliers have hoped the project would provide an alternative to competitive bidding, allowing them to compete on price without a huge overarching government-sponsored bidding system forcing them to submit all-inclusive bids for product categories. The CD-DME system would allow beneficiaries to become more like consumers, and enable suppliers to bid for each beneficiary's individual needs.

After years of planning, the project finally got off the ground in January with four Centers for Independent Living working on it. The project will run until the end of 2005, according to Cigna's Medical Director, Robert Hoover. The four CILs have been marketing the program to their clients and Cigna has started to see some claims, but so far "it hasn't been a high volume," notes Hoover.

Two CILs tell Eli they haven't yet been able to sign up a single client for the CD-DME project. "Things are very slow for us right now in that particular endeavor," says Terri Adams with TRCIL Services in Pittsburgh. Out of three candidates so far, none has turned out to be qualified. One big problem: TRCIL is seeking only beneficiaries with Part B coverage and no other insurance besides Medicare. "In Pittsburgh, Medicare HMOs are big," Adams laments.

TRCIL has marketed the program to professionals such as clinical staff members at rehab facilities and social service organizations. TRCIL recently won a contract with the state to become a community resource center covering the western part of Pennsylvania. "We're hoping that once we get consumers in the door for that reason, we can possibly refer them to the DME program," says Adams.

Similar issues have dogged South Portland, ME-based Alpha One CIL's efforts to generate interest in the demo. Alpha One publicized the project to beneficiaries and visitors to its Web site and identified some potential participants, who couldn't take part because of insurance issues, says Alpha One's Dennis Fitzgibbons.

Alpha One hopes to work out kinks involving dually eligible beneficiaries, so it can start offering the project to people with both Medicare and Medicaid, says Fitzgibbons. The CIL is marketing the project to physicians and already has sent out brochures to disabled beneficiaries across the state.

Ability Resources in Tulsa, OK has had somewhat more success, according to CD-DME Director Denise Bandl. So far the CIL has three people participating in its project and several others have requested applications. The CIL publicized the program through direct contact with consumers, DME suppliers and other providers.

It's too soon to judge the success of CD-DME, insists Bandl. "After a few months I'll have a better feel for how this demonstration is going." But she adds that it's "pleasing to see the opportunities arise for more individuals with disabilities to be given greater control over their health care."