What’s behind that spike in utilization, you ask?

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02/16/2018

Some eagle eyes on twitter (I’m looking at you Woody O’Neal) noticed that the August data for our Medicare Market Marker looked like it climbed Mount Everest.

For those uninitiated, the marker tracks the number of allowed Medicare beneficiaries for five of the most popular DME products: oxygen concentrator, semi-electric hospital bed, CPAP, standard wheelchair and power wheelchair.

For oxygen concentrator, for example, the trajectory of the number of bennies looked something like this for the three most recent reporting periods:

June: 218,411
July: 290,574
August: 321,652

O’Neal commented that his own business ramped up fairly dramatically in the same time period, too.

Grasping at straws, he suggested the spike was related to the DMERCs pulling back on audits related to advanced determination of coverage.

I emailed my sources at the PDAC (the Pricing, Data Analysis and Coding Contractor), where we get the data for the marker, as well as for our HME Databank, and they responded thusly:

“Excellence question, Liz. (That means excellent question, O'Neal). I’m not sure of all the factors that may have affected the counts, but one may be due to a large number of claims adjustments as a result of the 21st Century Cures Act.”

The Cures Act, as you’ll recall, required CMS to retroactively delay a second round of reimbursement cuts that went into effect in non-competitive bidding areas on July 1, 2016, until Jan. 1, 2017, allowing HME providers to essentially recoup six months worth of reimbursement.

“P.S.,” my sources continued, “you probably noticed that on the report for September the count of beneficiaries allowed decreased substantially.”

There you have it.