CMS late yesterday announced new contract payment rates for Round II of their competitive bidding program for Durable Medical Equipment. On average, Round II reduced payment rates by 45%, and by as much as 72% reduction on mail order diabetic test strips. Off-the-Shelf orthotics are eligible to be included in the controversial competitive bidding program for DME, but to this point CMS has resisted including OTS orthotics. Custom O&P are not currently able to be included in the competitive bidding program for DME. Round II of competitive bidding for DME will begin on July 1, 2013 and will expand from 9 competitive bidding areas to 100.
Now more than ever, independent orthotists and prosthetists must demonstrate the value we bring to the health care team treating at-risk patients like amputees. Orthotic and protshetic practices are, for the most part, paid for the devices we provide, not the expertise we provide to patients and physicians. As a profession, we must not be bullied out of using new technologies if we truly believe it will create a better outcome for our patient. Choosing to fit a K-2 rather than a K-3 for fear of audits will only push the auditors to continue to deny new technology that is creating better health outcomes for our patients. If orthotists and prosthetists don’t begin to quantify our value and access to new technologies, we risk being commoditized. This could lead to O&P being thrown into a program similar to DME competitive bidding where payers contract only with the lowest possible bidder, rather than the most competent or quality provider.
Visit www.Speak4OandP.com to tell your story and contact your congressional representatives to talk about the value independent orthotists and prosthetists bring to patients and payers.
More information on the DME competitive bidding program for Medicare can be found here.