PFQC’s Philadelphia Town Hall Teleconference

People For Quality Care BadgeLast week I mentioned that I had participated in a town hall teleconference call sponsored by People For Quality Care (PFQC).

Yesterday I saw on the PFQC’s Facebook page that HME News, the Business Newspaper for Home Medical Equipment Providers, published an article about that town hall. During the call, participants were invited to answer poll questions. One of those questions asked if they knew about competitive bidding. 100% of the people responding to the poll question did not know about it. Philadelphia is in the next round of areas to be added to competitive bidding. I think that it is really sad that people were not aware of what is going to happen.

You can read the full HME News article here, but I wanted to share part of what I stated during that teleconference:

Booth, who lives outside Pittsburgh, a Round 1 bid area, said she’s heard that beneficiaries in that area are having trouble getting quality test strips and are having to wait to receive supplies.

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Medicare, Test Strips and Competitive Bidding

If you have read my blog in the past, you are aware that on January 1st, Medicare put into effect a competitive bidding rule for certain areas of the country.  Part of that rule changes how and where you can get test strips.  I have also posted that I am an advocate for People for Quality Care.  PFQC has a Facebook group that you can follow the activity and problems related to competitive bidding.

This week, I heard about a guy named Lowell having problems getting test strips.  Besides the problems in finding a new supplier, he also was told that he would have to switch brands of test strips.  If you read my first post on this issue Medicare 2011 DME Changes),  you know that I am concerned about suppliers substituting cheaper strips because they are now getting paid one low price no matter what brand of test strips that they send you.

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Reporting Medicare Competitive Bidding Problems

When I did the More Information on the Medicare Bidding Program post, I mentioned that the American Association for Homecare had a place on their website to submit problems with the competitive bidding program. Michael Reinemer, American Association for Homecare, left a comment on that post with another website and phone number. I copied his comment here:

Also, providers, consumers, clinicians and others can report concerns or complaints about the competitive bidding system by visiting or by calling a toll-free number, 1-888-990-0499.

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More Information on the Medicare Competitive Bidding Program

After I posted the Medicare 2011 DME Changes, I found out a few more things that I wanted to share.

I know a lot of you are thinking that because you are not on Medicare, this stuff does not affect you.  Well, it does.  A lot of insurance companies follow Medicare guidelines so other insurance companies can start doing this same thing.  My friend Mary’s husband works for a very large corporation and his company switched insurance policies the first of the year.  Mary’s daughter has an intellectual disability and uses the Omni Pod pump and the Dexcom CGMS.  The Omni Pod is one of the easiest pumps to use and she is able to use it without having to make complicated decisions on what she should bolus.  Although Mary makes the important management decisions for her daughter, her daughter having a pump that she is able to use and give herself meal boluses with ease is something that is very important to both of them.  A CGMS is a very important part of her control and Mary does not have to worry 24/7 about her daughter having severe lows.  They were informed that their new insurance follows Medicare guidelines and they will not cover the Omni Pod or the Dexcom.  Now Mary has to start her year off fighting to try and keep the Omni Pod and Dexcom for her daughter.

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Medicare 2011 DME Changes

In case you are not aware, beginning January 1st, Medicare begins its Competitive Bidding Program. This program will take effect in 9 areas of the country and puts forth new rules about getting durable medical equipment, prosthetics, orthotics and certain supplies (which includes test strips). If you don’t live in one of the 9 areas but travel to one of those areas, you will need to follow the rules in order to get your supplies covered while you are away from home.

The areas included are North Carolina, South Carolina, Ohio, Kentucky, Indiana, Texas, Missouri, Kansas, Florida, Pennsylvania and California. Now I know that I listed 11 states and said 9 areas – that is government math for you! They have Cincinnati, Oh grouped with areas in Kentucky and Indiana so those three are considered one area, but the Cleveland area is listed as a separate group. It is not necessarily the whole state that will be affected. They have Pittsburgh listed but not Philadelphia. I live a couple hours from Pittsburgh and will not be in the changes for this year. The best thing to do is click on the link below if you are in one of the states I listed and enter your zip code to see if you are part of the 2011 change.

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