Among the least surprised by Dratch's predicament are the boutique owner's fellow merchants. Many who offer lingerie-oriented products and services for breast cancer survivors say the requirements begun in 2009 have drowned them in paperwork and fees that can reach into the thousands of dollars.
That, coupled with lagging reimbursement rates from insurance companies and a struggling economy, makes it very difficult for the boutiques that specialize in personalized service to stay in the business, shop owners say.
The number of mastectomy-bra suppliers reimbursed by Medicare decreased from 4,201 in 2008 to 3,599 in 2010, according to Medicare records. Some categories of prostheses suppliers also have decreased. Pennsylvania is one of five states that have the lowest bra reimbursement rates in the nation at $32.90, the records say.
Jack Lewis, president of Florida-based Classiques, a major manufacturer of post-breast cancer surgery clothing items, estimates 20 percent of the shops have closed or merged across the country.
In addition to the changes at Tulips, which will continue to sell conventional and custom-made lingerie, Shapes & Lace in Springfield, Delaware County, has closed, and several shops have stopped participating in insurance plans, now requiring customers to pay up front.
Catherine Carter, executive director of an agency that accredits boutiques and other suppliers of the bras and prostheses, says accreditation requirements are intended to ensure the highest quality of patient care.
"We feel strongly about our standards, and we have a lot of them," said Carter, of the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC). "But we do look for ways to assist the facility as they go through the process."
