US Politics/Competitive Bidding

[John C. Ghormley]

[Charlie] Who watches the quality from the factory?
 
A discussion of Quality Control seems out of place here, but then
maybe it really isn't. Generally, quality control involves sampling a given
number of a product from each lot manufactured. The selection of the products to be
tested are generally picked a random. The units picked are subjected to
rigorous testing to insure they comply with the specifications for the
part being manufactured. Records are generally kept of the test results in
order to determine if the manufacturing processes need to be tweaked to stay
within compliance to the spec. If failures occur in the field and the 
manufacturer is notified, they will generally attempt to determine if
the failure related to manufacturing flaws. If so, the QA records for the
lot the failed part was produced in are examined to determine if there was any
indication of such a failure in the test results.
  
Competitive bidding of commodity products cannot happen unless the 
specifications are delivered to each bidding manufacturer. If a
manufacturer really wanted the job and lost, he'll be part of the policing of the
winning manufacturer since contracts are seldom awarded indefinitely. He'll use
any information he can located regarding failure rates and QA results
to help him acquire the bid next time. So the industry, in effect,
polices itself.
  
[Charlie] Are the proestists licensed or regerstered? 
  
It's my understanding that depends on the state. Some states require
no registration nor licenses, I believe.
  
Your other question has been answered already by Al, Charlie.
  
I think my first pass left me thinking the prosthetists would police
the quality of commodity components, assuming we were talking about the
prosthetics industry after the slippery slope caused the competitive
bidding process to bleed over into the prosthetics industry. However,
I don't see that happening, as it appears the manufacturers currently
split the cost of failure replacement with the prosthetists. My
experience is that there is a finger pointing exercise among the manufacturer,
the prosthetist and the client. Assuming blame for failure isn't something
manufacturers are wanting to do now. Certainly, prosthetists would 
rather not take responsibility for a failed device. So the client must
have misused the product. I don't see that triangle changing, regardless how
the manufacturer got the right to build the component. I do see the
price of commodity components going down. The same has happened in many
other industries.
  
Again, I don't understand AOPA's opposition to the measure.
  
John C. Ghormley
Bedford Texas RBK Feb '02
  
 
***  ********** REPLY SEPARATOR ***********
***  
***  On 10/4/2002 at 12:55 PM Charlie wrote:
***  
***  *** Who watches the quality from the factory? Are the proestists
***  *** licensed or 
***  *** regerstered? What qualification do they have to meet?
***  *** Can anyone start a Proestists Office without training? I agree
***  with 
***  *** Wayne, what is next?
***  *** 
***  *** John C. Ghormley wrote:
***  *** 
***  *** >I'm new to this community and know absolutely nothing about
***  orthodics.
***  *** >I also definitely subscribe to the slippery slope concept. That
***  said,
***  *** >however, I'm at a lost to understand the problem AOPA has with the
***  *** >competitive bidding process as is described here. Given the
***  exclusion
***  *** >of custom fabricated devices, aren't we talking about commodity
***  items
***  *** >here? The U.S. Federal government used competitive bidding with
***  *** >respect to hammers for the military. After all, if we are talking
***  *** about
***  *** >items that fit a specification that can be made by anyone,
***  shouldn't 
***  *** >the specification dictate the quality. During manufacture,
***  quality 
***  *** >control procedures can be demanded to insure compliance with the
***  *** >written specification. Why should the price of commodity items by
***  *** >artificially high as we see them now? Well, to be honest, I only 
***  *** >suspect they are artificially high now. Maybe I don't have all the
***  *** facts
***  *** >as the AOPA does, but to me their objection appears a result of
***  the
***  *** >industry fearing a loss of revenue.
***  *** >
***  *** >John C. Ghormley
***  *** >Texas Amputee Peer Connection
***  *** >Bedford, TX RBK Feb '02
***  *** >
***  *** >*********** REPLY SEPARATOR ***********
***  *** >
***  *** >On 10/3/2002 at 6:00 AM Wayne Renardson wrote:
***  *** >
***  *** >*** For those interested in such.....if orthotics is subject to
***  this,
***  *** >*** can prosthetics be 
***  *** >*** far behind? Guess it depends on how much you believe in the
***  *** slippery
***  *** >*** slope 
***  *** >*** theory. 
***  *** >*** 
***  *** >*** Wayne R
***  *** >*** ----------------------------------
***  *** >*** 
***  *** >*** AOPA Summary: Senate Competitive Bidding Proposal
***  *** >*** 
***  *** >*** The Senate Finance Committee unveiled October 1, 2002 a
***  *** bipartisan $43 
***  *** >*** billion Medicare reform package, the Beneficiary Access to
***  Care
***  *** and 
***  *** >*** Medicare Equity Act of 2002. The legislation includes an
***  onerous
***  *** >*** provision 
***  *** >*** that would permit competitive bidding for all orthotic
***  services
***  *** that
***  *** >*** are not 
***  *** >*** custom-fabricated. 
***  *** >*** 
***  *** >*** AOPA has raised strong objections to this provision and is
***  making
***  *** >*** every effort 
***  *** >*** to limit the scope of any proposal that would permit
***  competitive
***  *** >*** bidding for 
***  *** >*** orthotic devices. 
***  *** >*** 
***  *** >*** The Senate Medicare competitive bidding proposal would: 
***  *** >*** 
***  *** >*** --Allow Medicare to competitively bid all orthotic devices,
***  *** other than
***  *** >*** custom-
***  *** >*** fabricated orthotics as defined by the Secretary of the
***  *** Department of
***  *** >*** Health 
***  *** >*** and Human Services; 
***  *** >*** 
***  *** >*** --Allow for the continuation of the current Medicare
***  competitive
***  *** >*** bidding 
***  *** >*** demonstration projects now underway in Polk County, Florida
***  *** [where I
***  *** >*** left 
***  *** >*** my right leg-]and San Antonio, Texas; 
***  *** >*** 
***  *** >*** --Be phased in over a four-year period with at least ¼ of
***  *** competitive
***  *** >*** bidding 
***  *** >*** areas established in 2003, ½ in 2004 and ¾ in 2005; 
***  *** >*** 
***  *** >*** --Initially be applied only to Metropolitan Statistical Areas
***  *** (MSAs)
***  *** >*** with a 
***  *** >*** population in excess of 500,000 (about 1/3 of the nation);
***  *** however,
***  *** >*** the 
***  *** >*** Secretary may expand the program to additional areas if he
***  *** determines
***  *** >*** that 
***  *** >*** there is clear evidence that the program will result in
***  savings
***  *** and
***  *** >*** will not 
***  *** >*** reduce access, diversity, product selection or quality; 
***  *** >*** 
***  *** >*** --Require winning bidders to meet quality and financial
***  standards
***  *** >*** specified by 
***  *** >*** the Secretary or developed by accreditation entities or
***  *** organizations 
***  *** >*** recognized by the Secretary; 
***  *** >*** 
***  *** >*** --Require winning bidders to comply with all Federal and State
***  *** >*** Licensure and 
***  *** >*** regulatory requirements; 
***  *** >*** 
***  *** >*** --Exclude entities that have been suspended from the Medicare
***  *** program
***  *** >*** by 
***  *** >*** any DMERC anti-fraud unit for billing for items or services
***  not
***  *** >*** furnished 
***  *** >*** within the previous 12 months of submitting a bid; 
***  *** >*** 
***  *** >*** --Stipulate that bids must be lower than what Medicare would
***  have
***  *** >*** otherwise 
***  *** >*** paid including costs associated with the administration of the
***  *** >*** contract; 
***  *** >*** 
***  *** >*** --Allow small suppliers to join together to form networks for
***  *** bidding
***  *** >*** purposes, as long as the combined market share of such
***  suppliers
***  *** does
***  *** >*** not
***  *** >*** exceed 25 percent;
***  *** >*** 
***  *** >*** --Sanction various studies to analyze the impact of this
***  proposal
***  *** >*** including the 
***  *** >*** effect of competitive bidding on the development of new
***  *** technology and
***  *** >*** the 
***  *** >*** coding of such items; 
***  *** >*** 
***  *** >*** --Permit competitive bidding for all durable medical equipment
***  *** and
***  *** >*** inhalation drugs used in conjunction with durable medical
***  *** equipment
***  *** >*** (other
***  *** >*** than items used in infusion therapy); and
***  *** >*** 
***  *** >*** --Allow the Secretary to create competitive bidding
***  demonstration
***  *** >*** projects for 
***  *** >*** chiropractic, dentistry, physical therapy, occupational
***  therapy,
***  *** >*** optometric, 
***  *** >*** etc., services. Physicians were explicitly exempted from any
***  *** form of 
***  *** >*** competitive bidding. 
***  *** >*** 
***  *** >*** American Orthotic & Prosthetic Association (AOPA)
***  *** >*** www.aopanet.org
***  *** >*** 330 John Carlyle Street, Suite 200, Alexandria, VA 22314
***  *** >*** Ph: 571/431-0876 Fax: 571/431-0899
***  *** >*** Email: aopa at aopanet.org
***  *** >
***  *** >
***  *** >
***  *** >
***  *** > 
***  *** >