Viewpoint: Medicare Part B: To stay or go?

July 23, 2007

Community pharmacies should seek accreditation so they can continue to serve patients under the Medicare Part B DMEPOS program.

Since shortly after the passage of the MMA, whenever I spoke to a group of pharmacists about accreditation, it was apparent right from the start that of all the different types of DMEPOS providers I have come across in my travels around the United States, pharmacists have been, by far, the most vocal when showing their frustration with Medicare. Many pharmacists/owners I have met are rightfully concerned about their future. Who can blame them? My worry is that community pharmacies will decide to sit out this next phase of the MMA's implementation and elect to not continue their participation in Medicare Part B.

Let's face it, few among us like being told how to run our businesses. As a fellow entrepreneur, I also share some of the same concerns that owner/operators have about counterproductive laws and rulings.

For the second time in less than 18 months, community pharmacy owners and managers need to think long and hard about their participation in Medicare. Only this time, it is Part B. One thing is certain, if a pharmacy has a Medicare Part B billing number, whether it accepts assign ment or not, CMS says that it must become accredited.

Sure, some patients will pay out of pocket and wait for their reimbursement check from Medicare. Eventually, though, in spite of their old loyalties and friendships, many will have little option but to find a DMEPOS provider that is accredited and has maintained its Medicare Part B eligibility.

Although we won't know until next spring what effect competitively bid contracts for DMEPOS products and services will have, we do know that mandatory accreditation is here and now. Denial and frustration are no longer workable options if the industry is to hold on to its position as the preeminent local resource for healthcare products and information.

Despite the fact that sales of diabetes supplies and other DMEPOS items in many neighborhood pharmacies don't add up to much in the ledger books, it is likely that this seemingly insignificant patient population may have a lot more to do with whether a pharmacy stays profitable or not. That's because most every time these patients or their loved ones go to their local pharmacy to pick up DMEPOS supplies, they invariably make additional purchases that don't show up on any Medicare-related billing tally. That alone should be reason enough for community pharmacies around the country to take a second look at what the impact will be if these core customers are left with few good options but to move their Part B business to Medicare-eligible competitors.

Community R.Ph.s who opt out of the Medi care program by not becoming accredited will not only inconvenience Medicare beneficiaries and send them scrambling to competitors who are accredited, but they will also likely suffer losses that will go well beyond what at first glance may seem to be only "small potatoes" Part B billings.

The good news is that it is not too late for most pharmacy DMEPOS providers in the country to pursue accreditation. Sure, there are costs in volved in doing so. But by not seeking accreditation, community pharmacies will not only run the risk of permanently losing valued customers, they will also jeopardize their role as the bedrock of our nation's healthcare delivery system. And that would be a very dear price to pay indeed.

THE AUTHOR is president of The Compliance Team Inc., one of about a dozen organizations approved by CMS to provide DMEPOS accreditation.