Medicare changing rules regarding diabetic testing supplies


It’s no secret to anyone who follows this little column with any degree of regularity (and some of us would enthusiastically accept “any degree of regularity”) that I work in six different offices in four different counties — and yes, there is something to be said for being a “moving target.”

So, on the rare occasion that the phone rings in an office that I am actually in, I find it startling; nonetheless, I readily answered with my usual, chipper, “Hi! This is Mark.”

“Now what?” was what came back at me. The voice sounded … mature.

“Uh, now what, what?” I responded, with my usual immediate grasp of a situation.

“What is this I’m getting from Medicare now?”

“Uh, I don’t know? What does it say?”

The mature, female voice read as much of it as her exasperated, epithet-enabled condition would permit. I got it — to our mutual relief.

What she had was a letter from “Medicare” about, among other things, diabetic testing supplies, so let’s back up a bit:

Since the beginning of time (well, OK, for a very long time), Medicare has paid for “durable medical equipment” (think walker, or wheelchair or scooter) and prosthetics and orthotics and “supplies” (think, diabetic testing supplies) from more-or-less any supplier who got signed up with them and was willing to bill them — more or less, if a bit over-simplified.

Starting a few years ago, CMS (Centers for Medicare & Medicaid Services) launched the “Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program,” affectionately referred to with the catchy acronym, “DMEPOS.” The operative phrase here is, “… Competitive Bidding …”

The idea, of course, is that in a competitive bidding environment, Medicare is likely to get the best dollar-deals for DMEPOS; according to CMS, that is, in fact, proving to be the case. I have no reason not to believe that.

The “down side” of all this is that many smaller and/or local and/or “Mom & Pop” operations that many of us have dealt with happily for years can’t compete in that world, so they are (or will be) either (a) cut out of the Medicare game, or (b) fold-up altogether.

Remember, this is about money, right? So, DMEPOS has been (is being) phased in around the country over time, with the focus being on high-consuming, urban centers. In Washington state, that tends to be a lot of the I-5 corridor, which leaves most of us rural yokels out of the play, except for diabetic testing supplies. Why are diabetic testing supplies included? Why do you s’pose? Money.

So, Medicare has solicited and gotten competitive bids for mail-order diabetic testing supplies in our neck-of-the-woods (although the actual suppliers are all over the country) and is instituting a requirement that we get our supplies from one of those contractors, effective July 1.

Time out: Most of us would probably agree that Medicare getting more for its money (well, OK: our money) is a good thing; and, if you’ve already been getting your supplies from one of these contracted suppliers or are accustomed to the mail-order “thing,” then this is no big thing to you. If you haven’t been doing that, and have been getting your stuff locally, from people you know and trust, and have a comfortable little arrangement worked out, this is…CHANGE!

Another thing to have to figure out and worry about and hassle with.

Yes, it is. Welcome to the ever-changing face of healthcare and health insurance in America. Here’s the best advice that anyone is going to give you: Get used to it.

But more to the point and much more pressing: Figure out what you need to do to get your diabetic testing supplies when you need them, because the fact that health insurance is changing again has not made your diabetes go away!

Now, remember, this is about money — payment. If you want to keep purchasing your testing supplies from a local vendor that you know and trust, feel free to do so — just don’t expect Medicare to pay for them. If you want Medicare to pay for them, you’re going to have to play by their rules. Period.

You can learn a lot more about this and find a list of contract suppliers by going to www.medicare.gov/supplier/home.asp where you can search for particular manufacturers or brands; of course, if you need help figuring any of this out, call any of the numbers at the end of this column and decent people will help you, for free.

I certainly understand that while many of us support the idea of a more cost-effective Medicare (or more cost-effective healthcare/health insurance in general), the hassle on the personal level can be … exasperating. The “good ‘ole days” when healthcare and health insurance happened TO us (kind of “on the side…”) are gone, so just think of it as a new hobby that could replace stamp collecting, since the post office may go away, anyway.

And keep your epithets enabled.

Mark Harvey is the director of Information and Assistance for Olympic Area Agency on Aging. He can be reached at harvemb@dshs.wa.gov or 532-0520 in Aberdeen, (360) 942-2177 in Raymond or (360) 642-3634. FACEBOOK: Olympic Area Agency on Aging-Information & Assistance.