Round two competitive bidding for enteral nutrition: continued access for vast majority of beneficiaries
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, May 2018
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Competitive Bidding Durable Medical Equipment -- economics Enteral Nutrition -- economics Health Services Accessibility Insurance, Health, Reimbursement Medicare -- economics Fraud -- prevention & control Humans United States United States. Department of Health and Human Services.
- Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. The Competitive Bidding Program changed the way Medicare pays for DME and it is important to understand how this change may have affected beneficiary access to needed DME. Medicare established the program to combat fraud, waste, and abuse in the provision of DME. The program replaced a fee schedule with a competitive bidding process to set Medicare reimbursement amounts for certain types of DME. In a letter to the Office of Inspector General (OIG), Members of Congress expressed concerns about the program's effect on access to DME and requested that OIG study this issue. How OIG Did This Review. We used Medicare claims to identify a population of beneficiaries for whom Medicare paid claims for enteral nutrition supplies before Round 2 of the Competitive Bidding Program began in 2013. Using discontinued payments after Round 2 began as a proxy for disrupted access, we compared the rates of discontinued payments in Round 2 CBAs and non-CBAs. We also analyzed Medicare claims data from 2012 to determine the percentage of beneficiaries receiving enteral nutrition supplies for whom Medicare payments stopped in the last full year prior to Round 2 of the program. We then surveyed the physicians who had ordered the enteral nutrition supplies for a sample of these beneficiaries. In cases in which physicians reported a continued beneficiary need, we surveyed those beneficiaries to learn about their experiences after Round 2 began. What OIG Found. The vast majority of beneficiaries who received enteral nutrition supplies in 2013 continued to do so after Round 2 of the Competitive Bidding Program for durable medical equipment (DME) began in July 2013. (In this report, we use the term "enteral nutrition supplies" to refer to daily feeding supply kits, tubes, and nutrients.) Medicare payments for enteral nutrition supplies continued for 91 percent of beneficiaries in Round 2 competitive bidding areas (CBAs) and for 94 percent of beneficiaries in areas that were not CBAs (which we refer to as non-CBAs) after Round 2 began. These rates are only slightly lower than the percentage of beneficiaries--95 percent--for whom Medicare payments for enteral nutrition supplies continued over the same timeframe in 2012, 1 year prior to Round 2 of competitive bidding. Our surveys of physicians and beneficiaries provided some insights for a sample of beneficiaries for whom payments for enteral nutrition supplies stopped. For example, physicians largely told us that beneficiaries without continued payments still had a prescribed need for the nutrients or supplies, and three of the six responding beneficiaries reported continuing to receive them even though Medicare payments stopped. What OIG Concludes. The Competitive Bidding Program aims to combat fraud, waste, and abuse; improve the methods for setting payments for DME; and create cost savings for Medicare and its beneficiaries, all while maintaining beneficiary access to needed DME. Our analysis for this report supports the conclusion that the vast majority of beneficiaries had continued access to enteral nutrition supplies after Round 2 began. However, we did find that the percentage of beneficiaries for whom Medicare payments for enteral nutrition supplies did not continue was slightly higher in Round 2 CBAs than in non-CBAs. This difference may or may not indicate disruptions in receiving needed enteral nutrition supplies. For example, this difference may indicate that the program reduced the provision of unnecessary enteral nutrition supplies, as the Centers for Medicare & Medicaid Services determined to be the case with Round 1 of the program.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (22 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101738020 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101738020