Quote
Motivation is the fuel necessary to keep the human engine running.
Medical Equipment, Oxygen, C-Pap, Scrubs, Scooters
Tuesday, May 29, 2012
Monday, May 21, 2012
Tuesday, May 15, 2012
Monday, May 14, 2012
Thursday, May 10, 2012
Tuesday, May 8, 2012
Monday, May 7, 2012
Thursday, May 3, 2012
Tuesday, May 1, 2012
Sunday, April 29, 2012
Tuesday, April 24, 2012
Monday, April 23, 2012
Sunday, April 22, 2012
Wednesday, April 18, 2012
Tuesday, April 17, 2012
Monday, April 16, 2012
Sunday, April 15, 2012
Thursday, April 12, 2012
Wednesday, April 11, 2012
Monday, April 9, 2012
Sunday, April 8, 2012
Saturday, April 7, 2012
Thursday, April 5, 2012
Hospital Beds Coverage Guidelines
Hospital Beds are Covered When Prescribed by a Physician and If the Patient Meets ANY of the Following Criteria:
1. Patient Requires Positioning of the Body in Ways Not Feasible with an Ordinary Bed
2. Patient Requires Positioning of the Body in Ways Not Feasible with an Ordinary Bed to Alleviate Pain
3. Patient requires the Head of the Bed to be elevated more than 30 degrees most of the time due to COPD, CHF, or Aspiration
4. Patient Requires Traction That Can Only Be Applied to a Hospital Type Bed
5. Patient Requires a Bed Height Different than a Fixed Height Hospital Bed to Permit Transfers to the Chair, Wheelchair, or Standing Position
6. Patient Requires Frequent Changes in Body Positions And/or Has an Immediate Need for a Change in Body Position
Hospital Beds are Covered When Prescribed by a Physician and If the Patient Meets ANY of the Following Criteria:
1. Patient Requires Positioning of the Body in Ways Not Feasible with an Ordinary Bed
2. Patient Requires Positioning of the Body in Ways Not Feasible with an Ordinary Bed to Alleviate Pain
3. Patient requires the Head of the Bed to be elevated more than 30 degrees most of the time due to COPD, CHF, or Aspiration
4. Patient Requires Traction That Can Only Be Applied to a Hospital Type Bed
5. Patient Requires a Bed Height Different than a Fixed Height Hospital Bed to Permit Transfers to the Chair, Wheelchair, or Standing Position
6. Patient Requires Frequent Changes in Body Positions And/or Has an Immediate Need for a Change in Body Position
Wednesday, April 4, 2012
Tuesday, April 3, 2012
Monday, April 2, 2012
Sunday, April 1, 2012
MEDICARE COVERAGE UPDATES FOR
MEDICAL EQUIPMENT
★Medical Equipment can only be delivered 1-2 days prior to D/C from a hospital or facility if needed for training before discharge
★Compression Stockings & TEDS not covered
★Cushions are not covered if they do not have a wheelchair
★Cushions are not covered for a transport chair, Lift chair or scooter
MEDICAL EQUIPMENT
★Medical Equipment can only be delivered 1-2 days prior to D/C from a hospital or facility if needed for training before discharge
★Compression Stockings & TEDS not covered
★Cushions are not covered if they do not have a wheelchair
★Cushions are not covered for a transport chair, Lift chair or scooter
MEDICARE COVERAGE UPDATES FOR
MEDICAL EQUIPMENT
★ Most Items NOW Require a Written Physician’s Order In Hand Prior to Delivery (Walkers, Canes, Mattresses, Wheelchairs & Cushions, Scooters & PowerChairs, Oxygen, Nebulizers, C-Paps)
★ Patient must see ordering physician within 30 days of ordering equipment for a face to face visit that documents medical necessity of equipment ordered
★ There MUST be documentation to justify the Medical Need of the equipment either in the physicians progress notes, facility or home health notes.
★ Must have documentation of Medical Necessity and why equipment is Reasonable & Necessary.
★ Medicare will not cover/pay for another item that is the same or similar if they received it within 5 years.
MEDICAL EQUIPMENT
★ Most Items NOW Require a Written Physician’s Order In Hand Prior to Delivery (Walkers, Canes, Mattresses, Wheelchairs & Cushions, Scooters & PowerChairs, Oxygen, Nebulizers, C-Paps)
★ Patient must see ordering physician within 30 days of ordering equipment for a face to face visit that documents medical necessity of equipment ordered
★ There MUST be documentation to justify the Medical Need of the equipment either in the physicians progress notes, facility or home health notes.
★ Must have documentation of Medical Necessity and why equipment is Reasonable & Necessary.
★ Medicare will not cover/pay for another item that is the same or similar if they received it within 5 years.
Wednesday, March 28, 2012
Tuesday, March 27, 2012
Monday, March 26, 2012
Thursday, March 22, 2012
Tuesday, March 20, 2012
ABCMedicalandOxygen: MEDICARE COVERAGE GUIDELINES FOR MEDICAL EQUIPMENT...
ABCMedicalandOxygen: MEDICARE COVERAGE GUIDELINES FOR MEDICAL EQUIPMENT...: MEDICARE COVERAGE GUIDELINES FOR MEDICAL EQUIPMENT Medicare Part B covers Medical Equipment & Oxygen at 80% (NOT Always 100% Covered) Medi...
MEDICARE COVERAGE GUIDELINES FOR MEDICAL EQUIPMENT
MEDICARE COVERAGE GUIDELINES
FOR MEDICAL EQUIPMENT
Medicare Part B covers Medical Equipment & Oxygen at 80% (NOT Always 100% Covered)
Medicare Part B Requires a Once a Year Deductible ($140.00) to be met before covering any equipment
MUST BE PRESCRIBED BY A PHYSICIAN FOR COVERAGE (Written Order)
MUST Be Medically Necessary for Use IN THE HOME ONLY (Documentation MUST support this for coverage)
Medicare Requires a Documented Height, Weight & All Diagnoses on all Orders
Bariatric (extra-wide) equipment only covered if documented weight of over 300lbs
Commodes NOT COVERED if needed in bathroom over toilet or if patient can access their bathroom
Once a patient receives any Motorized Equipment (Lift Chair, Scooter, Powerchair) then they can Never get a cane, walker or wheelchair in the future or other motorized item.
Some items are considered a purchase and some are capped rental items
PURCHASED ITEMS (Patient Owns):
Bedside Commodes
Braces
Canes & Crutches & Walkers & Walker Seats
Foam & Gel Mattresses
Lift Chairs & Power Chairs & Scooters
Supplies- Nebulizer & C-Pap
CAPPED RENTAL ITEMS (Equipment is rented for 13 months then patient owns):
Wheelchairs
Hospital Beds & Trapeze
Hoyer Lift (Patient Lift)
Special Bed Mattress (Air Mattress & Low Air Loss)
Nebulizers, C-Pap, Bi-Pap, Suction Machine
OXYGEN CONCENTRATORS are rentals only for the first 36 months, then the DME must provide the equipment for the next 2 years without rental payment
© 2012 ABC Medical & Oxygen, Inc. Phone: (727) 863-0002
FOR MEDICAL EQUIPMENT
Medicare Part B covers Medical Equipment & Oxygen at 80% (NOT Always 100% Covered)
Medicare Part B Requires a Once a Year Deductible ($140.00) to be met before covering any equipment
MUST BE PRESCRIBED BY A PHYSICIAN FOR COVERAGE (Written Order)
MUST Be Medically Necessary for Use IN THE HOME ONLY (Documentation MUST support this for coverage)
Medicare Requires a Documented Height, Weight & All Diagnoses on all Orders
Bariatric (extra-wide) equipment only covered if documented weight of over 300lbs
Commodes NOT COVERED if needed in bathroom over toilet or if patient can access their bathroom
Once a patient receives any Motorized Equipment (Lift Chair, Scooter, Powerchair) then they can Never get a cane, walker or wheelchair in the future or other motorized item.
Some items are considered a purchase and some are capped rental items
PURCHASED ITEMS (Patient Owns):
Bedside Commodes
Braces
Canes & Crutches & Walkers & Walker Seats
Foam & Gel Mattresses
Lift Chairs & Power Chairs & Scooters
Supplies- Nebulizer & C-Pap
CAPPED RENTAL ITEMS (Equipment is rented for 13 months then patient owns):
Wheelchairs
Hospital Beds & Trapeze
Hoyer Lift (Patient Lift)
Special Bed Mattress (Air Mattress & Low Air Loss)
Nebulizers, C-Pap, Bi-Pap, Suction Machine
OXYGEN CONCENTRATORS are rentals only for the first 36 months, then the DME must provide the equipment for the next 2 years without rental payment
© 2012 ABC Medical & Oxygen, Inc. Phone: (727) 863-0002
Monday, March 19, 2012
Sunday, March 18, 2012
Thursday, March 15, 2012
Wednesday, March 14, 2012
Tuesday, March 13, 2012
Monday, March 12, 2012
Sunday, March 11, 2012
Thursday, March 8, 2012
Wednesday, March 7, 2012
Tuesday, March 6, 2012
Monday, March 5, 2012
Sunday, March 4, 2012
Saturday, March 3, 2012
Thursday, March 1, 2012
Wednesday, February 29, 2012
Tuesday, February 28, 2012
Monday, February 27, 2012
Sunday, February 26, 2012
Saturday, February 25, 2012
Thursday, February 23, 2012
Wednesday, February 22, 2012
FRAUD UPDATE:
Healthcare Fraud Prevention and Enforcement Efforts Result In Record-Breaking Recoveries Totaling Nearly $4.1 Billion: On Tue Feb 14, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius released a new report showing that the government’s healthcare fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in FY2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled. Read More...
http://ping.fm/gGP79
Healthcare Fraud Prevention and Enforcement Efforts Result In Record-Breaking Recoveries Totaling Nearly $4.1 Billion: On Tue Feb 14, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius released a new report showing that the government’s healthcare fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in FY2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled. Read More...
http://ping.fm/gGP79
HIPAA UPDATE:
Q: Is a power of attorney still effective after a patient’s death? I was told that a woman whose husband died was not allowed to get a copy of his medical record. She had his power of attorney, but the hospital told her that the power of attorney died with him. Is that true?
A. A power of attorney is only effective while the individual is living. When an individual dies, his or her legal representative is the executor of the individual’s estate, if one was named in the individual’s will. If there is no executor, state law generally establishes a priority order for next of kin who may manage the patient’s estate. Usually, this includes the decedent’s spouse (if married at the time of death), adult children, parents, the decedent’s adult brothers and/or sisters, if there are no other relatives.
Q: Is a power of attorney still effective after a patient’s death? I was told that a woman whose husband died was not allowed to get a copy of his medical record. She had his power of attorney, but the hospital told her that the power of attorney died with him. Is that true?
A. A power of attorney is only effective while the individual is living. When an individual dies, his or her legal representative is the executor of the individual’s estate, if one was named in the individual’s will. If there is no executor, state law generally establishes a priority order for next of kin who may manage the patient’s estate. Usually, this includes the decedent’s spouse (if married at the time of death), adult children, parents, the decedent’s adult brothers and/or sisters, if there are no other relatives.
Tuesday, February 21, 2012
Monday, February 20, 2012
NAHC voices opposition to copayments for home health services
The National Association for Home Care & Hospice (NAHC) last week voiced strong opposition to copayments on home health services included in President Obama’s proposed budget.
“Essential home health services are at risk,” Val J. Halamandaris, president of NAHC, said in a prepared release. “The Medicare homecare benefit, only $17 billion in 2009, has been cut by $77 billion over the next 10 years. As a result of these cuts, 53 percent of all Medicare participating agencies will be under water in 2012—that is, paid less than their costs by Medicare. Congress should therefore resist making additional cuts in homecare for any reason.”
With 78 million baby boomers reaching their 65th birthday at the rate of 10,000 per day for the next 19 years, the need for home health services will only increase, the NAHC reported. “Home health keeps families together and is overwhelmingly what patients prefer,” the NAHC said. “It is far more cost effective for Medicare than institutional options.”
The National Association for Home Care & Hospice (NAHC) last week voiced strong opposition to copayments on home health services included in President Obama’s proposed budget.
“Essential home health services are at risk,” Val J. Halamandaris, president of NAHC, said in a prepared release. “The Medicare homecare benefit, only $17 billion in 2009, has been cut by $77 billion over the next 10 years. As a result of these cuts, 53 percent of all Medicare participating agencies will be under water in 2012—that is, paid less than their costs by Medicare. Congress should therefore resist making additional cuts in homecare for any reason.”
With 78 million baby boomers reaching their 65th birthday at the rate of 10,000 per day for the next 19 years, the need for home health services will only increase, the NAHC reported. “Home health keeps families together and is overwhelmingly what patients prefer,” the NAHC said. “It is far more cost effective for Medicare than institutional options.”
4 million Americans now implanted with artificial knees.........
About 1 in 20 Americans now have artificial knee replacements, according to a recent study by researchers at Harvard’s Brigham and Women’s Hospital. That means about 4 million people have undergone the joint replacement operation, which costs about $40,000. Authorities said the data was important because many of these patients will require follow-up procedures and care as these artificial joints wear out in coming decades.
About 1 in 20 Americans now have artificial knee replacements, according to a recent study by researchers at Harvard’s Brigham and Women’s Hospital. That means about 4 million people have undergone the joint replacement operation, which costs about $40,000. Authorities said the data was important because many of these patients will require follow-up procedures and care as these artificial joints wear out in coming decades.
CMS schedules Feb. 21 call on quality reporting, electronic prescribing
The Centers for Medicare & Medicaid Services has scheduled a National Provider Call on the Physician Quality Reporting System & Electronic Prescribing (eRx) Incentive Program on Tuesday, Feb. 21, from 1:30-3 p.m. ET. Experts will provide an overview on claims-based reporting for both programs, followed by a question and answer session. Registration closes at noon the day of the call or when space has been filled. For more information, go the CMS event website.
The Centers for Medicare & Medicaid Services has scheduled a National Provider Call on the Physician Quality Reporting System & Electronic Prescribing (eRx) Incentive Program on Tuesday, Feb. 21, from 1:30-3 p.m. ET. Experts will provide an overview on claims-based reporting for both programs, followed by a question and answer session. Registration closes at noon the day of the call or when space has been filled. For more information, go the CMS event website.
HHS secretary announces delay of ICD-10 compliance date
Health and Human Services Secretary Kathleen G. Sebelius last week announced that her agency will postpone the date that certain health care entities must comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of Oct. 1, 2013. HHS has not yet announced a new compliance date.
Health and Human Services Secretary Kathleen G. Sebelius last week announced that her agency will postpone the date that certain health care entities must comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of Oct. 1, 2013. HHS has not yet announced a new compliance date.
TOP 10 WORST SMELLS IN A HOSPITAL:
There is nary a seasoned nurse who would dare show up for a shift without a nose saver, like a few Halls cough drops tucked away in the pocket.
Goodness knows there are all too many opportunities for icky smells to drift into a nurse’s workday.
Break out the peppermint oil and get a whiff of our top ten list of worst smells in the hospital!
10. Alcohol swabs
9. Benzoin tincture
8. Tube feeds
7. Cafeteria food
6. TPN
5. Code Brown
4. Bile
3. Vascular wounds
2. C. diff
1. GI bleeds
There is nary a seasoned nurse who would dare show up for a shift without a nose saver, like a few Halls cough drops tucked away in the pocket.
Goodness knows there are all too many opportunities for icky smells to drift into a nurse’s workday.
Break out the peppermint oil and get a whiff of our top ten list of worst smells in the hospital!
10. Alcohol swabs
9. Benzoin tincture
8. Tube feeds
7. Cafeteria food
6. TPN
5. Code Brown
4. Bile
3. Vascular wounds
2. C. diff
1. GI bleeds
FAVORITE NURSING GEAR MUST-HAVES:
If you’re a seasoned nurse, you may be wondering: How can I be more efficient at my job? Have I really found the best pair of shoes?
And if you’re a nursing student, you may be thinking: Can I get away with a cheap stethoscope? How do I shop for my first real set of scrubs?
Get the tips, tricks and secrets from fellow nurses about tried-and-true gear picks and how to keep everything organized (and not just in your pockets!).
Plus, find out the dream must-have items!
Stethoscope (which one?!?!)
Roll of tape (critical!)
Retractable badge holders (surprising uses for ‘em)
Nose savers (three great ideas…)
Pens (the features they must have)
Shoes (the right ones to get you through the day)
Scrubs (of course, but which kind?)
How many pockets? (one is NEVER enough…)
Dream item for Fall 2010 (hint…your kids’ll love it too)
Printable list of favorite nursing gear must-haves
COME TO ABC MEDICAL SCRUBS in HUDSON
If you’re a seasoned nurse, you may be wondering: How can I be more efficient at my job? Have I really found the best pair of shoes?
And if you’re a nursing student, you may be thinking: Can I get away with a cheap stethoscope? How do I shop for my first real set of scrubs?
Get the tips, tricks and secrets from fellow nurses about tried-and-true gear picks and how to keep everything organized (and not just in your pockets!).
Plus, find out the dream must-have items!
Stethoscope (which one?!?!)
Roll of tape (critical!)
Retractable badge holders (surprising uses for ‘em)
Nose savers (three great ideas…)
Pens (the features they must have)
Shoes (the right ones to get you through the day)
Scrubs (of course, but which kind?)
How many pockets? (one is NEVER enough…)
Dream item for Fall 2010 (hint…your kids’ll love it too)
Printable list of favorite nursing gear must-haves
COME TO ABC MEDICAL SCRUBS in HUDSON
TOP 15 SCRUBS FASHION BLUNDERS:
Let’s face it: if you want to be taken seriously, you have to look the part! But sometimes it can get a bit messy out there in a nurse’s world.
Heck, we’ve been known to safety-pin the waistband of our scrubs when we’ve worn the elastic past it’s due date, so we’re certainly not pointing fingers.
What we ARE doing to heal your fashion woes is prescribing an examination with our style doctor. Some easy style fixes may help you get more respect from your patients and coworkers.
Here are 15 tips (with visuals…ahem!) to help you be mindful of fashion blunders!
(1) Watch the cleavage
(2) Steer clear of stains
(3) Too tight ain’t right
(4) No peek-a-boo, please
(5) High waters = low marks
(6) Cleanliness is next to nurse-iness
(7) Hair-y issue
(8) More hair-y issues
(9) Tattoo snafu
(10) Makeup mania
(11) Bling
(12) Old school
(13) Goth nurse
(14) Optical illusion
(15) Skin tones, please
First, watch the cleavage…
Let’s face it: if you want to be taken seriously, you have to look the part! But sometimes it can get a bit messy out there in a nurse’s world.
Heck, we’ve been known to safety-pin the waistband of our scrubs when we’ve worn the elastic past it’s due date, so we’re certainly not pointing fingers.
What we ARE doing to heal your fashion woes is prescribing an examination with our style doctor. Some easy style fixes may help you get more respect from your patients and coworkers.
Here are 15 tips (with visuals…ahem!) to help you be mindful of fashion blunders!
(1) Watch the cleavage
(2) Steer clear of stains
(3) Too tight ain’t right
(4) No peek-a-boo, please
(5) High waters = low marks
(6) Cleanliness is next to nurse-iness
(7) Hair-y issue
(8) More hair-y issues
(9) Tattoo snafu
(10) Makeup mania
(11) Bling
(12) Old school
(13) Goth nurse
(14) Optical illusion
(15) Skin tones, please
First, watch the cleavage…
HIPAA Q&A: Encryption
Q. Would a covered entity or business associate be in violation of the HIPAA Security Rule if it sends PHI in unencrypted e-mails to an e-mail address within the same domain using a Microsoft Exchange™ server behind the organization’s firewall?
A. No. PHI can be sent unencrypted within what is called a closed network. A network that is internal to the organization and protected by a firewall is considered a closed network. If the firewall is breached and unencrypted PHI is accessed, that would be considered a breach of unsecure PHI and breach notification requirements would apply.
Q. Would a covered entity or business associate be in violation of the HIPAA Security Rule if it sends PHI in unencrypted e-mails to an e-mail address within the same domain using a Microsoft Exchange™ server behind the organization’s firewall?
A. No. PHI can be sent unencrypted within what is called a closed network. A network that is internal to the organization and protected by a firewall is considered a closed network. If the firewall is breached and unencrypted PHI is accessed, that would be considered a breach of unsecure PHI and breach notification requirements would apply.
Sunday, February 19, 2012
Saturday, February 18, 2012
Thursday, February 16, 2012
Wednesday, February 15, 2012
Tuesday, February 14, 2012
Sunday, February 12, 2012
Wednesday, February 8, 2012
Tuesday, February 7, 2012
Wall Street Journal: "How Medicare rigs competitive bidding and hurts patients"
The following editorial was in today's Wall Street Journal. It describes the flaws of the bidding program including non-binding bids, "suicide bids", creating below price arbitrary pricing and Medicare's refusal to make "basic quality control standards".
Health Reform Built to Fail
How Medicare rigs competitive bidding and hurts patients
wsj.com - February 6, 2012
Americans may not be familiar with the medical innovation called negative pressure wound therapy, though it has helped hundreds of thousands of patients with complex or chronic injuries like burns or diabetic ulcer complications that could never heal on their own. Now President Obama's Medicare team is about to severely damage this field, and many others too-all in the name of reforming how the entitlement pays for care.
Last week a Medicare competitive-bidding program went live in 91 metro regions-nearly all the U.S. population-for what's known as durable medical equipment. That bureaucratic jargon covers advanced devices like wound therapy, respiratory assist equipment for people who can't breathe, and feeding tube systems for people who can't eat. It also lumps in things like walkers, scooters and "support surfaces." Those would be beds.
The good intentions of this saga date to 2003, when Congress in a fit of sanity ended Medicare's price controls in favor of auctions. Both political parties soon rebelled when oxygen tank suppliers, scooter stores and such in their home districts started whining about being asked to compete on market prices, rather than plod along with the guaranteed revenue of the fee schedule. But the much deeper problem is that Medicare cooked up an auction process that defies all economic sense.
Normally when the government wants to buy something, it asks companies how much they can provide and to name their price. Winners are selected from the lowest bid up until the government has what it needs at the lowest possible cost, and thereby finds competitive equilibrium prices.
Under Medicare's highly unusual version of competitive bidding, it will pay the winners the median price of all the winning bids, rather than using the clearing price. Bids are also for some reason nonbinding.
This matters because it creates incentives for unscrupulous third-party companies to make low-ball "suicide bids." If the median price shakes out high enough, they automatically win the contract, buy the medical products from manufacturers and turn a profit. If it isn't, they can dump the contract since bidding involves no commitment.
Medicare will then offer the contract at the median price to the honest companies that have made bids aligned with their true costs, and they can take it or leave it. Medicare benefits because the median prices will be biased below the clearing price-in other words, the "auction" is merely another way of generating arbitrary below-cost price controls.
The Bush Administration road-tested this scheme in 2008 with pilot projects in nine cities. For illustration let's return to negative pressure wound therapy, a technique that involves a sealed dressing attached to a vacuum pump to prevent infection and improve recovery. Patients can recuperate at home but require 24/7 clinical and safety support, typically provided by the device's maker. Advanced wound treatment is far more complex than, say, a cane.
In 2008, only 17 of the 88 winning bidders bothered to supply wound therapy devices. Only 10 of them had any actual expertise in how the technology is used or in patient support. The supply crisis was so deep that for several weeks no Medicare patients in two of the cities could receive this treatment at home, and the government threw out the entire program and said it would retool competitive bidding.
Yet by one estimate, a 2011 reprise had roughly one-fifth of the bids going to companies that were on credit hold with device manufacturers-i.e., they couldn't buy if they wanted to. Medicare, meanwhile, boasts that it will reduce prices for durable medical equipment by 35% and "save" taxpayers $28 billion. All it is really doing is rewarding the fly-by-night operators while harming innovative companies and ultimately patients.
The current nationwide rollout has no substantive revisions from the failed pilots, despite the objections of 244 economists and auction scientists led by the University of Maryland's Peter Cramton. The consensus of basically everyone who knows anything about auctions is that the no-risk bids and median pricing are idiotic and designed for failure.
At a December meeting, a coalition of device makers and professional clinical groups even accepted these flaws but begged Medicare deputy administrator Jonathan Blum merely to accredit wound therapy bidders. He refused to apply any such basic quality control standards. The Administration does not care.
The larger tragedy is that market methods like auctions are the only way to rationalize the entitlement state. They're at the core of the reform ambitions of Paul Ryan and Ron Wyden-and they're already tough enough to achieve given the resistance of the providers that want more of Medicare's money. This fiasco turns on 1.4% of Medicare's annual spending, yet it risks discrediting competitive bidding for good.
Click here to leave an online comment on the Wall Street Journal website.
The following editorial was in today's Wall Street Journal. It describes the flaws of the bidding program including non-binding bids, "suicide bids", creating below price arbitrary pricing and Medicare's refusal to make "basic quality control standards".
Health Reform Built to Fail
How Medicare rigs competitive bidding and hurts patients
wsj.com - February 6, 2012
Americans may not be familiar with the medical innovation called negative pressure wound therapy, though it has helped hundreds of thousands of patients with complex or chronic injuries like burns or diabetic ulcer complications that could never heal on their own. Now President Obama's Medicare team is about to severely damage this field, and many others too-all in the name of reforming how the entitlement pays for care.
Last week a Medicare competitive-bidding program went live in 91 metro regions-nearly all the U.S. population-for what's known as durable medical equipment. That bureaucratic jargon covers advanced devices like wound therapy, respiratory assist equipment for people who can't breathe, and feeding tube systems for people who can't eat. It also lumps in things like walkers, scooters and "support surfaces." Those would be beds.
The good intentions of this saga date to 2003, when Congress in a fit of sanity ended Medicare's price controls in favor of auctions. Both political parties soon rebelled when oxygen tank suppliers, scooter stores and such in their home districts started whining about being asked to compete on market prices, rather than plod along with the guaranteed revenue of the fee schedule. But the much deeper problem is that Medicare cooked up an auction process that defies all economic sense.
Normally when the government wants to buy something, it asks companies how much they can provide and to name their price. Winners are selected from the lowest bid up until the government has what it needs at the lowest possible cost, and thereby finds competitive equilibrium prices.
Under Medicare's highly unusual version of competitive bidding, it will pay the winners the median price of all the winning bids, rather than using the clearing price. Bids are also for some reason nonbinding.
This matters because it creates incentives for unscrupulous third-party companies to make low-ball "suicide bids." If the median price shakes out high enough, they automatically win the contract, buy the medical products from manufacturers and turn a profit. If it isn't, they can dump the contract since bidding involves no commitment.
Medicare will then offer the contract at the median price to the honest companies that have made bids aligned with their true costs, and they can take it or leave it. Medicare benefits because the median prices will be biased below the clearing price-in other words, the "auction" is merely another way of generating arbitrary below-cost price controls.
The Bush Administration road-tested this scheme in 2008 with pilot projects in nine cities. For illustration let's return to negative pressure wound therapy, a technique that involves a sealed dressing attached to a vacuum pump to prevent infection and improve recovery. Patients can recuperate at home but require 24/7 clinical and safety support, typically provided by the device's maker. Advanced wound treatment is far more complex than, say, a cane.
In 2008, only 17 of the 88 winning bidders bothered to supply wound therapy devices. Only 10 of them had any actual expertise in how the technology is used or in patient support. The supply crisis was so deep that for several weeks no Medicare patients in two of the cities could receive this treatment at home, and the government threw out the entire program and said it would retool competitive bidding.
Yet by one estimate, a 2011 reprise had roughly one-fifth of the bids going to companies that were on credit hold with device manufacturers-i.e., they couldn't buy if they wanted to. Medicare, meanwhile, boasts that it will reduce prices for durable medical equipment by 35% and "save" taxpayers $28 billion. All it is really doing is rewarding the fly-by-night operators while harming innovative companies and ultimately patients.
The current nationwide rollout has no substantive revisions from the failed pilots, despite the objections of 244 economists and auction scientists led by the University of Maryland's Peter Cramton. The consensus of basically everyone who knows anything about auctions is that the no-risk bids and median pricing are idiotic and designed for failure.
At a December meeting, a coalition of device makers and professional clinical groups even accepted these flaws but begged Medicare deputy administrator Jonathan Blum merely to accredit wound therapy bidders. He refused to apply any such basic quality control standards. The Administration does not care.
The larger tragedy is that market methods like auctions are the only way to rationalize the entitlement state. They're at the core of the reform ambitions of Paul Ryan and Ron Wyden-and they're already tough enough to achieve given the resistance of the providers that want more of Medicare's money. This fiasco turns on 1.4% of Medicare's annual spending, yet it risks discrediting competitive bidding for good.
Click here to leave an online comment on the Wall Street Journal website.
Monday, February 6, 2012
Sunday, February 5, 2012
Saturday, February 4, 2012
Wednesday, February 1, 2012
Tuesday, January 31, 2012
Monday, January 30, 2012
Sunday, January 29, 2012
Thursday, January 26, 2012
Wednesday, January 25, 2012
Tuesday, January 24, 2012
Sunday, January 22, 2012
Wednesday, January 11, 2012
Tuesday, January 10, 2012
Sunday, January 8, 2012
Wednesday, January 4, 2012
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