Medicare Compliance & Reimbursement

Therapists, docs lobby for exclusions.

Small suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS)--led by hand therapists and other niche suppliers--delivered a strong case for exclusion from competitive bidding in the weeks leading up to the June 30 close of comments on the DME competitive bidding rule.

"We're suppliers in that we have DME supplier ID numbers," explains Ginger Clark, a hand therapist and owner of Hand Rehabilitation Services in Bradenton, FL. But in most ways, therapists, physicians and other direct health care providers--individuals who supply products such as wrist splints and air casts--are more "practitioner" than "DME supplier."

One size doesn't fit all: That makes bidding a poor match for such individuals, says Seth Lundy, attorney with Fulbright & Jaworski in Washington, DC.

"The proposed rule on competitive bidding does not fit well with most direct health care providers," says Lundy, adding that the rule may cause the biggest headaches for orthopedists. "It is unlikely that [these players] would be competitive enough to win a contract," says Lundy.

And without a contract, direct health care providers may have to send patients out the door of their practices without the cane, crutch, cast or brace the patient needs.

"The Centers for Medicare & Medicaid Services [CMS] is saying that in many cases patients have to leave the practitioner's office without protection," says Lundy, adding that the agency is bound to implement provisions of the Medicare Modernization Act.

Cheaper not better: Because Medicare would not require winning bidders to supply all brands of products within a product category, for example, patients will likely wind up with the cheapest alternative--not necessarily the most medically appropriate product. Patients will also be handed the product without counseling on how to use it, a reality that could taint outcomes.

Status quo: Clark now arms patients referred to her for orthotics with information about how to adjust the product, what do in the event of swelling, what hand and arm positions to avoid to promote healing, and so on--services she often provides at no charge to Medicare as a therapist.

If Clark's thrust by competitive bidding into a situation in which she's not billing Medicare as a DME supplier, however, she'll have to bill Medicare for her services as a therapist in such a counseling situation. "Medicare could wind up paying more for the same product" under competitive bidding, she says.

Watch for: Those calling for bidding exclusions that would leave docs and therapists unscathed may appeal to Congress. Another bill, H.R. 4994, already calls on Congress to exempt complex rehabilitation products and assistive technology products from the Medicare competitive acquisition program.