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July 11, 2007

Dear Senator or Representative:

We are writing to share our strong concerns about patients and people with disabilities and access to critical medical technologies and supplies under the proposed implementation of the new competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Providing quality DME can often mean the difference of staying in one’s own home or being forced into a nursing home or hospital. DME provides essential care for many of the frailest and sickest Medicare patients, including oxygen therapy for patients with abnormal blood oxygen levels, respiratory-assist devices for persons who are at risk of acute respiratory distress, and enteral nutrition for nutritionally compromised people. That’s why we urge you to cosign the Allen/Johnson or Conrad/Roberts letter to the Centers for Medicare and Medicaid Services (CMS) to make sure they implement the program carefully.

CMS is required to begin implementing the new competitive bidding program in 2007 under section 302(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Due to its direct impact on daily patient care, it must be implemented carefully and with significant attention to all details and the effect on the person receiving services. Transitioning to competitive bidding is a significant and highly complex undertaking, and a large number of issues still must be addressed to assure that access to and quality of care will not suffer.

The Allen/Johnson or Conrad/Roberts letter raises a number of our concerns, including:

• Impact on Patients and Medicare Expenditures. CMS has not yet presented any plans to evaluate the impact of competitive bidding on clinical outcomes, beneficiaries, or Medicare expenditure in other care settings. This is concerning, especially since the program will be implemented in a shortened time frame. CMS should develop an ongoing assessment of the program, especially on clinical outcomes for people or individuals with chronic conditions or disabilities.
  
  
• Product Categories. Product codes used by CMS are too broad and inconsistent to adequately describe diverse product types designed to meet specific needs for people with disabilities, including broad ranges of quality, functionality, technology, and clinical utility. Beneficiaries may not have access to a full range of products if the accepted bidding amount does not reflect the varying costs of the range of products. There is also confusion over how people will access new technologies and products since there is no explanation of how new items will be categorized once prices are established. CMS should consider input from patient groups and other stakeholders on refinement of proposed product category subdivisions prior to completion of the bidding process.
  
  
• Patient Relationship with Suppliers. People with disabilities and patients currently using DME have established important relationships with their current suppliers for the devices and services they need. We are concerned about continuance of care and access to needed supplies during all the expected changes of suppliers, especially with small suppliers. The Final Rule is highly complex and the 60-day bidding process does not provide sufficient time for suppliers to learn about the important details and obtain answers to key questions relevant to the preparation of their bids. The Rule does not provide direction to small suppliers on how to form the provider networks that are needed for them to participate in the program. We urge Congress to make sure that a sufficient number of suppliers, including small supplier networks, are available for all people with disabilities in the final program.

In addition, we are concerned about patients and people with disabilities who have historically received care from long-term care facilities and may no longer have access to them under the new program. DME companies are not equipped to service the needs of skilled nursing facilities, which may serve 10-20 enteral patients. Suppliers not currently serving the home care market will have to make significant changes in the way they operate and serve their customers, including carrying products they are currently unfamiliar with and do not have existing relationships with manufacturers or suppliers. Patient care may be at risk as suppliers learn and adapt to new markets.

Thank you for your attention to these important issues. We look forward to working with you to address these critical patient issues under this new Medicare program.

Sincerely,

Alliance for Aging Research
American Association of People with Disabilities
National Council on Independent Living
National Spinal Cord Injury Association
United Spinal Association
WomenHeart