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Medicare's competitive bidding program for durable medical equipment is far behind schedule, according to AdvaMed. David Nexon, the association's senior executive vice president, sent a letter to CMS in December voicing concern over the program's January 2007 start date.

Medicare currently reimburses suppliers of durable medical equipment based on a fee schedule. Under the new program, it will reimburse major types of such equipment through a competitive bidding program, which is scheduled to begin in 10 of the nation's largest metropolitan areas. According to CMS's timeline, a proposed rule was supposed to be published last spring, but still has not been. A public comment period was scheduled to follow last summer, along with CMS completing its review of comments last fall.

“If CMS rushes to the finish line to implement the competitive bidding program, there will be increased potential for beneficiary and provider confusion, reduced beneficiary access to critical healthcare services, and unnecessary disruption of the [durable medical equipment] marketplace,” Nexon stated in the letter. AdvaMed is also worried that CMS won't be providing enough opportunities for stakeholder input.

If the January 2007 start date remains in place, “[many] months of important work will be condensed into a few short months,” which is counterproductive, wrote Nexon. Nexon outlined several issues that CMS must address before beginning the program. These include the following:

• Creating a process for accrediting suppliers.

• Developing and issuing requests for bids.

• Assessing and choosing participating suppliers.

• Selecting the metropolitan areas.

• Educating the beneficiaries, suppliers, and health professionals who order durable medical equipment for patients.

AdvaMed urged CMS to provide enough time for notice and comment periods, and for operational and industry changes. The association recommended that the program be implemented sometime near the end of 2007, rather than at the beginning of the year.

Nexon also offered some suggestions that might ensure a smooth implementation of the program:

• Carefully choose the first geographic areas to “avoid the largest, most complicated metropolitan areas that cross multiple state lines.”

• Limit the amount of products subjected to competitive bidding during the program's early stages.

• Allow as many suppliers as possible to join in the early phases of the program to lower the risk of compromised beneficiary access.

If CMS's timeline doesn't change, the competitive bidding program will expand to 80 metropolitan areas in 2009, and then nationwide.

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