Five Takeaways from CMS and SBA Session at Heartland

Posted on in Education and Events

Attendees at the VGM Heartland Conference had the opportunity to have direct discussion with and provide feedback to a panel of officials from Centers for Medicare and Medicaid Services (CMS), Medicare contractors, and the Small Business Administration (SBA). Among the panel was Tangita Daramola, competitive acquisition ombudsman at CMS, Liz Daniels of CGS, Paula Berriche with Noridian, Dr. Janet Lawrence of C2C Solutions, and Jayne Armstrong of the SBA.

Here are five takeaways from the session:

  1. The woes of competitive bidding still plague urban and rural providers alike. To no surprise, competitive bidding was the focus of the discussion: how suppliers continue to struggle to maintain quality patient care while being forced to stretch the current reimbursement rates. Suppliers had the chance to share real-world patient impacts with contractors and officials. At the time of the panel discussion, many suppliers cited the uncertainty of the future as a big worry of theirs. The industry has been anxiously awaiting the next round of competitive bidding, which is stretching checkbooks and forcing providers to run their businesses very lean.

  2. With prior authorization expanding nationwide, suppliers welcome the change. Suppliers knowing that they are going to be paid on the care they are providing is a valuable feeling. Beginning Sept. 1, 2018, prior authorization will be expanding to all states and territories. Attendees shared that the current prior authorization process is working well for their patients and their business. This gets the equipment to the patient faster, and suppliers can be largely protected from post-payment audits.

  3. Out-of-pocket costs are increasing for patients. Session moderators asked the audience what they were experiencing when it came to any increase in out-of-pocket patient expenses. The overwhelming response from the crowd was that patients are paying more out-of-pocket than ever before. With suppliers not being able to provide equipment and being strapped by competitive bidding, patients are doing anything they can to get discharged from the hospital. Daramola shared that CMS suspected patients were paying more out-of-pocket, but it is difficult to track when a contracted supplier is not fulfilling their obligations. It was suggested that the industry continues to keep CMS informed when they hear of contracted suppliers not fulfilling the requirements of a bid contract.

  4. Medicare Advantage plans open opportunity for improvement. With more beneficiaries opting in for Medicare Advantage plans, suppliers are encountering more issues with policy requirements and proper reimbursements. From this discussion, VGM has formed a working group of suppliers working directly with CMS to fix these problems. One example from a member of the working group is that Medicare Advantage plans are denying the purchase option for a Group 3 complex chair and only recognizes the chair as a rental item due to the fee schedule instead of the actual policy. The main problem being, suppliers are forced to turn away Advantage plans, which is causing access issues. CMS immediately engaged on this issue to fix these problems, and the group is optimistic that these problems will be worked out.

  5. The SBA has an abundance of resources for small businesses to help. From contracting with the government to expanding a current business with SBA-guaranteed loans, small businesses have a number of tools available through the SBA. At a federal and state level, the SBA has been extremely engaged in the issues that the DME industry has faced. It was brought up how DME was a huge topic of discussion at several Regulatory Fairness Roundtable events held throughout the United States. The SBA has advocated strongly on behalf of the DME industry to CMS and Congress for the role that DME plays in the economy and health care.

Overall, this was an extremely successful event for both suppliers and the panelists to share a productive dialogue with government officials and contractors. This direct dialogue is crucial to closing the gap of understanding between the supplier community and the government. VGM plans to continue these panel discussions at the Heartland Conference. If you didn’t have a chance to participate, save the date for next year’s Heartland Conference: June 10-12, 2019.