U.S. Rehab, a division of the VGM Group, Waterloo, Iowa, recently released a seven-page white paper that evaluates the present state of the durable medical equipment, prosthetics, orthotics and supplies, (DMEPOS) industry. The paper, “The Delivery of DMEPOS is in Jeopardy,” asks Congress and the Center for Medicare & Medicaid Services (CMS) to address the issues that could threaten the delivery system for O&P care and rehabilitation, including competitive bidding and the coding structure. The paper suggests that the agency put a stay on the bid program, and review the coding structure, which it says pigeonholes certain products into codes that seemingly don’t fit, reducing reimbursement payment amounts.
According to Greg Packer, president of U.S. Rehab and the author of the white paper, if CMS fails to address the current reimbursement issues, as price levels fall below sustainable margins, the damage done to the system could be permanent. Noting that DME and complex rehabilitation technologies are “cost-saving programs when administered correctly, a reduction in selection along with quality of products and services due to price pressure, there will be an increase of the ancillary cost to other areas of the system over time, mainly in hospital readmissions and premature disease-state deterioration,” he writes.
Because of the adverse effects of competitive bidding, DMEPOS reimbursement rates have been driven down to a level of unsustainability, and the rationing of healthcare as well as patients unable to receive products and services that were once guaranteed and readily available by Medicare is already prevalent, the paper states.
