A Medical Device Daily

The recent hearing in the House of Representatives on the bidding program for durable medical equipment highlighted Congress's discomfort with the program, but Congress may be chasing a train that already is moving quickly away from the station.

Some of Congress' concerns were that beneficiary access might be impeded, but Nydia Velazquez, (D-New York), the chairwoman of the House Small Business Committee, charged that "CMS has little regard for how its decisions are impacting small businesses."

Despite congressional concerns, the May 19 announcement by the Centers for Medicare & Medicaid Services (CMS) indicated that the agency has awarded contracts to 325 bidders for durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) in the 10 metropolitan areas that formed the first round of bidding areas. The CMS statement said that the winners will "provide certain medical equipment and supplies to beneficiaries in 10 communities across the U.S. at significantly lower prices than they are paying now."

CMS planned to keep small businesses in the program by setting a target rate of participation of 30%, but actually ended up awarding roughly half the contracts to small businesses, which were defined as those grossing $3.5 million or less a year. Other provisions of the program include that beneficiaries may, "in some situations, also be able to continue to receive certain items from a grandfathered supplier," defined as "non-contract suppliers that provide certain rented equipment under the terms of the program."

Acting CMS Administrator Kerry Weems said all the winning bidders "have met our stringent standards, so beneficiaries can be assured they receive their equipment and supplies from legitimate suppliers."

Weems said the agency "has the tools to ensure that the suppliers, as well as companies with which the suppliers subcontract, meet the needs of beneficiaries to guarantee continued beneficiary access to medical equipment and supplies" and that the agency reserves the right to "terminate contracts with suppliers that don't meet these requirements."

The suppliers will commence doing business July 1.

Hospital Compare ad campaign underway

The age of full transparency in healthcare is a step closer to reality with the report that the Department of Health and Human Services commenced with an ad campaign for its Hospital Compare web site, placing ads in the May 21 editions of almost 60 major daily newspapers across the country. CMS reported the launch of the web site earlier this year.

The ads provide the scores from hospitals located in the areas where the newspapers are located, but it was not clear how nationally distributed newspapers would handle editions distributed far from the publisher's location. The ads give the reader scores for two of the 26 quality and patient satisfaction measures, which HHS Secretary Mike Leavitt said "are intended to give consumers more information for making choices about their healthcare."

In the statement, Leavitt also said the move "brings us closer to meeting the goal of using new technologies to make the quality of health care services all across the nation more transparent to the public."

The statement noted that the site at www.hospitalcompare.gov lists almost 4,000 hospitals from across the U.S. and that the ads are "aimed at reaching areas covered by about 1,000 of these hospitals." The ads report the "percentage of patients at each hospital who always received help when they requested it, as reported by the patients themselves" and the "percentage of patients at each hospital who were given antibiotics one hour prior to surgery, as reported by hospitals." The ads also give the averages for each state on these measures.

The data found at the Hospital Compare site is based on information "collected through a new patient survey, the Hospital Consumer Assessment of Healthcare Providers and Systems survey," which HHS described as "the first national, standardized, publicly reported survey of patients' perspectives of care."

CMS eyes gastric bypass for diabetes

Gastric bypass is not commonly associated with having an impact on Type 2 diabetes, but the idea has been floating around for a couple of years, as a search of PubMed reveals. Given the impact of diabetes on the nation's health – not to mention the nation's healthcare tab – the Centers for Medicare & Medicaid Services has opened a national coverage analysis for the procedure as a solution to Type 2 diabetes.

The May 19 announcement is short on detail, noting little more than that the open comment period runs for only 30 days and that CMS is "especially interested as to the types of studies needed if the evidence is determined to be premature for coverage."

The request was filed internally at CMS, but the agency has two comments already. Michelina Juip, director of health status improvement initiatives at the Hurley Medical Center (Flint, Michigan) told the agency that of 560 patients with diabetes at Hurley, "249 were resolved at 3 months post operatively." While the tracking did not extend past three months, Juip said "a 44% rate in the reduction of diabetes with bariatric surgery is noteworthy and forceful in substantiating the need for Medicare to cover this surgery."

Arshag Mooradian, MD, a professor at the University of Florida College of Medicine (Jacksonville, Florida) wrote CMS to say that while "[t]he current literature on the benefits" of the procedure "is still limited ... the preliminary observations are very encouraging." He recommended the procedure be subjected to "carefully planned randomized controlled studies ... to look at the long term safety and efficacy."

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