Round two competitive bidding for oxygen: 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 Health Services Accessibility Insurance, Health, Reimbursement Medicare -- economics Oxygen Inhalation Therapy -- 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 two populations of beneficiaries for whom Medicare paid claims for oxygen equipment and contents before Round 2 of the Competitive Bidding Program started in 2013. The first population included those with paid claims for oxygen equipment; the second, those with paid claims for oxygen contents. Using discontinued payments after Round 2 began as a proxy for disrupted access within each population, we compared the rates of discontinued payments in Round 2 CBAs and non-CBAs. We also analyzed Medicare claims data from 2012 to determine how often Medicare payments stopped for beneficiaries who were receiving oxygen equipment or oxygen contents in the last full year prior to Round 2 of the program. In addition, we drew samples of beneficiaries for whom Medicare payments for oxygen equipment and contents stopped after Round 2 began. We then sent surveys to the physicians who had ordered oxygen for these beneficiaries and to some of the beneficiaries to learn about their experience after Round 2 began. What OIG Found. The vast majority of beneficiaries who in 2013 started using oxygen equipment--including compressed gas systems, liquid oxygen systems, and oxygen concentrators--appeared to have continued access to this equipment after Round 2 of the Competitive Bidding Program began in July 2013. After Round 2 began, Medicare payments for equipment continued for 86 percent of beneficiaries in Round 2 competitive bidding areas (CBAs) and 89 percent of beneficiaries in areas that were not CBAs (which we refer to as non-CBAs). These rates are consistent with the 88 percent of beneficiaries for whom Medicare payments for oxygen equipment continued over the same timeframe in 2012, 1 year prior to Round 2 of competitive bidding. Our surveys of physicians and beneficiaries provided some anecdotal context for a sample of beneficiaries for whom payments for oxygen equipment and/or oxygen contents--compressed and liquid oxygen refills for oxygen equipment--stopped. For example, physicians told us that most beneficiaries still needed the equipment, and 5 of the 11 responding beneficiaries reported continued use of equipment. For oxygen contents, we found that the vast majority of beneficiaries appeared to have continued access to them after Round 2 began in July 2013. Medicare payments for contents continued for 86 percent of beneficiaries in Round 2 CBAs and for 88 percent in non-CBAs. These rates are almost identical to the 87 percent of beneficiaries for whom Medicare payments for contents continued over the same timeframe in 2012. As they did with regard to oxygen equipment, our physician and beneficiary surveys provided some potential insights for a sample of beneficiaries without continued payments for contents. In our physician and beneficiary surveys, the majority of physicians in both Round 2 CBAs and non-CBAs told us that the beneficiaries still needed contents after Round 2 began, and responding beneficiaries reported getting contents when they needed them. What OIG Concludes. The Competitive Bidding Program aims to combat fraud, waste, and abuse; improve the methods for setting payments for durable medical equipment (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 oxygen equipment and contents after Round 2 began. However, we did find that the percentage of beneficiaries for whom Medicare payments for oxygen equipment and contents 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 oxygen equipment and contents. For example, this difference may indicate that the program reduced the provision of unnecessary oxygen equipment and contents, 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 (29 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101737992 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101737992