Statistics, silver linings, no sense

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10/20/2017

I’ve had a few conversations now where the people I’m talking to try to find the silver lining in the statistic that the number of DME locations has dropped about 40% since 2013, when Medicare’s competitive bidding program began to really gain steam.

That’s a brutal statistic and one that, when shared with members of Congress, has to be impactful in the industry’s efforts to get some relief from the bid program.

But a few of the people I referred to above like to look at it as, 60% of locations are still standing and with the bid program now in effect nationwide, if they’re still standing now, they should remain standing.

“We believe we’re in a pinnacle moment in time here,” said one person I talked to. “Forty percent of dealers have closed their doors, but the people who are in business today, they have the opportunity to be in business going forward. We don’t expect additional cutbacks.”

Of course, there are a whole host of questions that come up when considering this logic. Mainly: Just because a company is still standing now, doesn’t mean it’s not still standing with two broken legs, limping along with crutches, am I right?

There are other questions: What are the types of businesses that can remain standing and in what areas? Are they larger companies in more urban areas? Are they full-line or specialty providers?

To move on to another statistic, I’ve also had a few conversations with people about the fact that DMEPOS appeals have made up about 49% of total appeals at the ALJ level so far in fiscal year 2017. AAHomecare reported this week that as of August 2017, 591,962 appeals were pending, a 300% increase since 2016, and as of October 2017, 291,047 appeals were for DMEPOS. It’s hard to find any silver lining at all in that.

The two big questions here: How much money are these appeals costing CMS to adjudicate, especially when the majority are overturned; and how is it fair that DMEPOS, which represents about 2.3% of the Medicare budget, represents nearly 50% of appeals?

Like a lot of things these days, none of this makes a whole lot of sense.