Controversial DME Program Begins in Nine Regions

Article Highlights:
  • Controversial competitive acquisition program for durable medical equipment to be introduced by Medicare in nine regions, with additional areas to start competitive bidding later in 2011.
  • Program has been met by criticism from patients, providers, consumer advocacy groups and other organizations, including MDA.
  • MDA advocates and supporters in the nine regions are encouraged to report their experiences to the MDA Advocacy office or to the local office's health care service coordinator.
by Annie Kennedy on January 1, 2011 - 3:29pm

QUEST Vol. 18, No. 1

Like it or not, some members of the MDA community will soon be trying out Medicare’s competitive acquisition program for “durable medical equipment, prosthetics, orthotics and supplies” (DMEPOS). The controversial program goes into effect in nine regions of the country this month.

Medicare pays DMEPOS providers to serve the needs of millions of Americans who use medical supplies at home. The competitive acquisition program was intended to save money and streamline services, but tests of it have prompted a chorus of criticism by patients, providers, consumer advocacy groups and other organizations, including MDA.

Problems that came to light during the testing phase included patients being forced to go to multiple, unfamiliar providers for different items and services; non-local providers; inexperienced or unlicensed providers; and greater costs to Medicare from more emergency room visits and/or longer hospital stays as patients lost access to critical services and equipment.

Moreover, dozens of academics and members of Congress have pointed out serious flaws in the way the competitive bidding auction is conducted. They say these flaws will result in many longstanding DMEPOS providers being forced out of business. The remaining providers will then engage in a “race to the bottom,” critics say, offering inferior equipment and bad or nonexistent service to captive customers.

Despite these concerns, and despite requests from advocacy groups to delay implementation of the program, Medicare plans to introduce it in nine metro areas starting January 1. The metro areas are: Charlotte, N.C.; Cincinnati, Cleveland; Dallas-Fort Worth; Kansas City, Mo.; Miami; Orlando; Pittsburgh and Riverside, Calif. An additional 91 regions are scheduled to start competitive bidding later in 2011.

MDA is encouraging advocates and supporters in these first nine regions to report on your experiences, both positive and negative. Please send an e-mail to advocacy@mdausa.org, or call your local office and speak to the health care service coordinator. This feedback will ensure that MDA knows exactly what the problems are and what needs to be brought to the attention of Congress.

MDA and other groups have been battling competitive acquisition for DMEPOS since 2008. Opponents of competitive bidding — including MDA — have been successful in getting an exemption for customized power wheelchairs, since this equipment is highly specialized and dependent on a relationship between provider and user.

However, a bill to repeal the entire program, the Competitive Bidding Repeal Act (H.R. 3790), lost several dozen sponsors in the midterm election and was not voted on before the session expired. Some 200 of the bill’s co-sponsors remain in Congress, so it may be reintroduced. In the meantime, the exemption for custom power chairs remains, but other types of complex durable medical equipment will become subject to competitive bidding.

MDA and other advocates are still fighting for an administrative delay of the program, a delay of its more objectionable provisions, or a postponement of its expansion beyond the initial nine regions. That’s why it’s critical that we hear from you, and that you keep your elected representatives informed of your experiences.   

No votes yet
MDA cannot respond to questions asked in the comments field. For help with questions, contact your local MDA office or clinic or email publications@mdausa.org. See comment policy