Medicare Savings vs the Lobbyists, an editorial in the NY Times today has some interesting comments which reflect a much broader understanding of the issues involved than I've seen in other discussions.
In the comments, that is, not the editorial.
Unfortunately there seems to be a school of thought out there that buying products on the internet and the prices reflected there are a fair comparison for a basis of competitive bids for dealers, with utter disregard for the consumer's need for service and the dealer's commitment to provide service. When a consumer purchases a power chair, for example, whether with his/her own money or the government's, we are also buying in home service from a dealer. These are the kinds of issues that need to be considered in the mix.
It is in my vested interest as a consumer of durable medical goods to work toward affordable prices. On the other hand, I don't expect a dealer to work for free or not make a profit. And I don't want dealers to go out of business when I need to depend on them to service what I buy. Nor do I want to buy equipment that I can't get serviced.
Real solutions will entail far reaching changes to the system itself as well as a recognition that people with disabilities and wheelchair users are a far more diverse group than many think.
Our current system fails to work for those who are not on Medicare and also fails to work for those who are. In my circle of friends, more than half of them bought their current wheelchair on ebay- a chair that was not even measured for them. Most of them work full time. Their insurers denied their claims even though they have used wheelchairs for many years. Let's talk about that issue too, while we're bandying about words like entitlement and milking the system, a sad commentary on assumptions run wild about those of us who use wheelchairs.
Our system is so broken because of piecemeal approaches for so many years that an overhaul of unprecedented proportions is called for. Congress needs to consider the needs of the elderly and the disability community, the dealers, the manufacturers - the profit quotient is a reality, by the way, because without it no one would make wheelchairs - and we all need to face the fact that to get rid of overspending, we cannot just pull the rug out from under an existing system people rely upon to survive.
Have we taken a look at what role dealers play in the system, how many gaps they fill in between manufacturers and consumers? If we undercut dealers' necessary profit, the already difficult task of finding someone to fix equipment will become impossible on local levels.
Congress needs to listen to wheelchair users, to people who are consumers of this equipment to find out how to enact changes that will not destroy the current system without replacing it.
Because having a broken wheelchair is like not having one.
[HR 6331, passed in the House yesterday, includes provisions to delay the first round of implementation of competitive bidding.]
4 comments:
The current legislative fight over one of the small elements of the behemoth Medicare -- competitive bidding for durable medical equipment or DME – hardly qualifies as even a skirmish in the overall debate about restraining health care costs while improving quality and accountability.
But it does provide a convenient allegory regarding reform. The new DME program uses the old-fashioned competition to bring the best possible – and most efficient – care and services to Medicare beneficiaries. All the elements are here: free market forces replacing a woefully outdated price-fixing fee schedule; financial and quality accreditation requirements where none existed, in an arena the Government Accountability Office and the Inspector General have castigated for rampant fraud and abuse; and., best of all, substantial savings to Medicare beneficiaries, and taxpayers.
Could you address the issue of how dealers can continue to provide service on equipment they sell for lower prices? You appear to speak with authority in this area but you posted as anonymous. I appreciate your comment but since you're anonymous, I'd like to see you identify if not who you are, from what perspective you speak and address that particular concern if you have the information. Thanks again for your input.
As a member of United Spinal and a wheelchair user, there are five concerns which cause me to oppose competitive bidding.
United Spinal Association and other disability groups have five primary concerns with the new program:
• Decreased quality of devices, products, and technologies. Medicare has said that it expects to lower reimbursement rates by 26 percent. A lower reimbursement rate will almost surely mean lower quality equipment.
• Decreased service. Suppliers who bid and win contracts may not fully understand the time that goes into equipment being fitted or programmed for use for each individual’s needs.
• Decreased accessibility to suppliers. fewer suppliers available to people who need services. People will be forced to travel further to get needed services
• Diminished relationships with suppliers. Unless their supplier is one of the chosen contractors people will be forced to give up the relationship and trust and go to a stranger who does know their condition, history, or related needs.
• Decreased access to brands of equipment. People may find that they no longer have access to brands of equipment that they need.
This can lead to secondary health problems if you can't get the right wheelchair or get it serviced and wind up housebound or in bed for months at a time.
True competition is open to everyone. Medicare is stacking the deck by picking a price no one can go over (this guarantees a savings and allows them to claim success) and then will eliminate 90% of those who are competiting (this also helps stack the deck in their favor as businesses will bid extremely low for fear they will not be one of the lucky 10%). This is nothing more than a PR event disguising the fact Medicare is putting thousands of small Mom & Pop providers out of business.
As I have stated many times before this, if Medicare wanted to lower prices they could do so without any bidding. They did this in 2006 when they lowered power wheelchair pricing by 20%. Despite all the rules and regulations on the books, Medicare fails to contain fraud because of their own ineptitude.
I would love to see Medicare make a set fee of $2500 for a power wheelchair, but then allow the dealer to charge whatever they wanted above that cost. Medicare would pay 80% of the $2500 and the patient would be responsible for the rest.
This way Medicare gets it savings and the market gets to work how it should. If a dealer wanted to accept the $2500 and give minimal service he could. If a dealer wanted to accept $3800 and provide 5 star service they could. Patients buying these items would ultimately choose what they wanted to pay and eventually you would see the market come to a fixed price and an acceptable amount of service.
They do this with lift chairs now and it works just fine. Medicare pays on average $320 for a lift mechanism. Lift chairs are being sold out in the market for anywhere between $500 and $2500. People get to choose their lift chair based on their individual needs.
Now if Medicare really wants to show us they want to cut spending, let's see them go after Big Pharm. Oh yeah, they wouldn't cut the hand that feed them!
Post a Comment