CMS is planning a demonstration to test models of care
management for high-cost Medicare beneficiaries. Hospitals,
physician groups and integrated delivery systems with proposals to
restructure or enhance management of care for those with costly
medical conditions are invited to submit applications to CMS by
Jan. 4, 2005. HME providers may apply as part of a consortium that
includes the above entities. Four to six contracts will be
awarded.
The Employee Benefits Research Institute found that more
Americans are cutting savings to meet skyrocketing health care
costs. In its 2004 Health Confidence Survey, the institute said
about a quarter of those surveyed have reduced retirement savings
to pay health care costs, and about 18 percent said medical bills
make it more difficult to pay for necessities like food and
housing.
Consumer-directed health options, instead of rigid long-term
care programs, should be made available to more people with
disabilities, according to a report from the National Council on
Disabilities. Consumer-Directed Health Care: How Well Does
It Work? stated that the government should move “from
oversight of tightly defined program options to a broader
responsibility … to assess consumer needs on an ongoing basis
across disability groups and age categories.” These needs
include more emphasis on the government's “money follows the
person” initiative, ensuring that funding follows the person
wherever caregiving occurs, from institutional care to home
care.
The fact that the MMA prohibits competitive bidding rates to
be subject to administrative and judicial review could create
problems for the DME industry as it prepares for competitive
bidding in 2007, a health care attorney said. According to the
Bureau of National Affairs, Alan K. Parver of the law firm Powell
Goldstein, Washington, D.C., told attendees at the Medicare Part B
Conference on Nov. 9, sponsored by the National Association of
Chain Drug Stores Foundation, that waiving standard review
processes gives CMS the authority to apply an area's competitively
bid rate to other areas without provider appeal, giving the
government an “enormous grant of power.” He added that
the issue may be re-examined on Capitol Hill next year.
HHS Secretary Tommy Thompson and CMS Administrator Mark
McClellan said Congress will not likely cut Medicare spending to
reduce the federal budget deficit in 2005. “I doubt very
much [Congress is] going to touch anything that's going to
adversely impact on the drug benefit,” Thompson told
reporters on Nov. 9, referencing the MMA's prescription drug
benefit that will take effect in 2006. To reduce spending, however,
Congress has historically put Medicare on the chopping block,
particularly provider payments — something that's a
possibility in 2005, according to industry observers.
Amazon.com is wading into the HME business. Recently the
online giant began selling Andover, Mass.-based Philips Medical
Systems' HeartStart Home Defribrillator, now available
over-the-counter to consumers.
