Options for Medicare Beneficiary with Diabetes?

Community pharmacists maintain one of every three Medicare Part B supplier billing numbers; thereby, providing easy access to necessary supplies for patients with diabetes. What if the number of DMEPOS pharmacy suppliers is reduced by 50 percent? That’s exactly what CMS expects with the implementation DMEPOS competitive bidding.

Even though there are more than 150,000 billing numbers out there, if you look at the supplier breakdown link on the DME Resource Center (http://www.pharmacistelink.com/medicaredme/nsc.asp), it is clear that without community pharmacists, access is severely restricted, unless you want to use mail order! (Hmm …never heard of that before).

One of the first questions I asked as a member of the PAOC was what affect did limiting access in the demonstration areas of Polk County and San Antonio have on shifting beneficiary DMEPOS expenses to the Medicare Part A benefit. I was particularly interested in diabetes testing supplies. CMS has their eye on that category as it represents 9.5 percent of all Medicare DMEPOS expenditures.

Incredibly, I was told this assessment was not part of the original plan design. Additionally, and much to my dismay, diabetes testing supplies were not even part of the original competitive bidding demonstration projects.

Respected 2006 studies shared with CMS indicate that if Hemoglobin A1c levels rise slightly in just 5 percent of beneficiaries with diabetes, then CMS should expect a 10 fold increase in Medicare Part A expenditures in the form of increased hospitalizations for diabetes related complications.

NCPA continues to petition CMS to exempt diabetes testing supplies from competitive bidding. At the very least, a demonstration project is warranted to assure that limiting diabetic testing supplies in community pharmacies will not trigger the cost shifting described. The jury is still out.

After all, I thought the number one reason for competitive bidding was to protect the beneficiary.

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DME Questions…

I traversed the snow covered Appalachian Mountains last Friday to visit PRS Pharmacy Services (www.prsrx.com) in Latrobe, Pa., 30 miles outside of Steel City. As a Baltimore boy, it was a little uncomfortable running into so many black and gold Pittsburgh Steeler fans, but I pressed on and found it was worth the trip.

I was in search of products and services that may assist pharmacists in understanding the economics of competitive bidding and how to streamline the accreditation application and survey processes.

If I put on my 22-year-old independent pharmacy owner hat, the first questions I would ask regarding accreditation and competitive bidding include:

1. Is it still profitable for me to be in the DME business?
   
2. Can I handle the additional, lower margin business? (CMS expects that winning bidders should be able to increase service capacities by an additional 20%)
   
3. If I exit the DME marketplace, what will be the economic impact on my prescription business?
   
4. Who can assist me in creating or updating my business policy, protocol, and procedure manuals that will serve as evidence to accreditation agencies that my facility complies with the new CMS quality standards?

Check PRS out. See if what they have fits your business needs. Remember, manuals are more than just the paper on which they are written. Surveyors will expect the pharmacist in charge (PIC), or other designee, to be able to discuss the standards and provide evidence that the policies are woven into the fabric of your business.

Stay tuned…

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Don’t Lose Sight of the Big Picture

CMS estimates that 90% of suppliers in the top 10 metropolitan statistical areas (MSA) will competitively bid on DMEPOS in an effort to hold on to or grow their Medicare business. They also estimate that 50% would likely become “winning bidders,” representing approximately 18,000 suppliers located in the top 10 MSAs.

(Keep your eyes open Miami!)

According to NCPA surveys, less than 10% of independent community pharmacies are accredited – allegedly the first step to competitively bidding. Accreditation agencies have a big, and possibly insurmountable, challenge in meeting CMS accreditation deadlines.

I wish I knew what those deadlines were so I could share them with you, but CMS has not been clear in sharing that information. One thing is sure, while CMS would “like” suppliers to obtain facility accreditation PRIOR to submitting a bid to provide DMEPOS to beneficiaries, CMS has the authority to proceed with competitive bidding whether suppliers are accredited or not.

Stay tuned!

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Welcome to the DME blog

Hello Friends!


I’m William “Bill” Popomaronis, R.Ph., vice president, long term and home health care services for the National Community Pharmacists Association (NCPA). Welcome to my DME Blog. This is where we will discuss the latest information on CMS’s DME Accreditation and Competitive Bidding programs. My goal is to answer your questions, provide the facts, and clear up the rumors and innuendo related to these topics.

I have special insight because I am the only pharmacist member of Medicare’s Program Advisory and Oversight Committee (PAOC), which provides advice on the development and implementation of the DME Competitive Acquisition Program, and in my role at NCPA, it is my job to study these regulations so you don’t have to.

This blog is part of a bigger DME Resource Center located on Pharmacist e-Link ™ (www.pharmacistelink.com/medicaredme). The Resource Center is provided by NCPA with support from Bayer HealthCare, Diabetes Care. It includes fast facts and resources concerning accreditation, competitive bidding, NSC supplier standards, as well as the DMe-Alert service providing you the latest, fact-based information via an email newsletter once each week.