Monday, April 7, 2008

Errors Plague Medicare “Competitive Bidding” Program

A new Medicare bidding program for durable medical equipment (DME) scheduled to be implemented in 10 metropolitan areas starting on July 1, 2008 will put many DME providers out of business and will disrupt services for many of the three million seniors and people with disabilities living in those areas. Executive directors from "the state associations affected by Round One of competitive bidding have provided the following thoughts.

Cincinnati and Cleveland, Ohio
"Whether you accept or reject that a blind auction is a sound method for establishing health care reimbursement, one has to strongly question how this actual concept is currently being rolled out through the DME bidding program. In my two decades of involvement in the home medical equipment industry, this is the most severe and life-threatening issue this small, but vital segment of our nation's health care delivery system has faced. It's disheartening on a personal level as a taxpayer and consumer, shocking as a business professional witnessing chaotic and arbitrary processes by the government, and distressing as a free-enterprise advocate observing the unraveling of respectable organizations that have provided years, sometimes generations, of service to their communities."

"At the core of this problem is the public's inability to understand, thereby trust, the internal method for how "winners" were selected because the program rules provide no transparency. Even more alarming, since losing these bids can be the death of your business, the rules do not allow for any formal appeal mechanism. Many of Ohio 's Congressional delegation have been strong allies helping home medical equipment providers in Cincinnati and Cleveland work through the chaotic phases of the bidding program -- from bid submissions last summer, to bid announcements of winners and losers today. Their efforts to protect the recipients and providers of important homecare services are commendable and realistically, the last line of defense for these small businesses who are facing serious harm to, or possibly elimination of, their livelihoods."

-Kam Yuricich, Executive Director, Ohio Association of Medical Equipment Services

Charlotte, North Carolina
“Our story in North Carolina is no different than those all across the country in the first 10 CBAs. I am hearing story after story of providers who were unfairly disqualified for not providing financials (as one example) when in fact they did provide the information they were required to; and in their follow-up conversations with the proper authorities, they seem to get no help. Providers that have received contracts are skeptical about not only the pricing but the language used in those contracts. CMS’s response to the 120 Members of Congress did nothing to reassure them or the patients they serve; in fact, I believe it did the opposite by infuriating them even further. They are coming to NCAMES for help and we are telling them as much information as we can but until we can TEAM UP TOGETHER across the country, we will have a hard time offering them a solution other than the fact that NCAMES will continue to work hard for our members. CMS has to hear from our industry loud and clear that we will NOT accept this Competitive Bidding Program as it is and providers across the country should be able to “play the NCB game” without the rules being changed. NCAMES has to count on AAHomecare to lead the way by using all the most powerful resources it can throughout the country to come to bat for providers and beneficiaries who count on US!”

-Beth Bowen, Executive Director, North Carolina Association of Medical Equipment Services

Kansas City, Missouri
“For the providers who have received contracts, it has to be difficult for them to determine what the impact to their business is because they do not know how many other providers received contracts. For planning purposes, how are they going to know what the impact to their business will be and whether or not they should be ramping up to prepare for the July 1 start. There will be many issues with patient access. Contracted providers may not be able to handle the sudden increase of service. Example, for those providers who are not contracted, there is just no way to know if they plan on holding onto those patients who can be serviced under grandfathering, or chose to no longer service them and will send them to contracted providers. The real losers in this program will be the Medicare beneficiaries.”

-Rose Schafhauser, Executive Director, Midwest Association for Medical Equipment Services

Miami and Orlando, Florida
“Now that the initial shock has worn off and we're getting more and more information from our members in the two Round One Florida competitive bidding CBAs, we're deeply concerned and very alarmed at the volume of the mistakes made in the CBIC's provider-selection process. I've known many of the Florida bidders for several years, and have absolutely no doubt that their bids were thorough and complete when they were sent in. A process this obviously flawed needs to be stopped, analyzed, and corrected if it can't be done away with altogether; if it's not, I think the ramifications for beneficiaries and small businesses alike will be much worse than we anticipate.”

- Heather Allan, Executive Director, Florida Association of Medical Equipment Services

Pittsburgh, Pennsylvania
“Some of the most seriously ill and disabled Medicare patients in Southwestern Pennsylvania will be profoundly affected by this ill-considered program. Competitive bidding will directly impact the manner in which most will receive in-home medical equipment, supplies and related services. It will greatly reduce the number of providers who can serve Medicare beneficiaries and will eliminate community-based suppliers for many. In other words, Medicare beneficiaries will lose their ability to choose the provider who best meets their needs. The ability to choose a provider safeguards quality and continuity of care because it allows Medicare patients to establish long-standing relationships with providers who are most responsive to their individual needs.

Additionally, many patients may have to contend with the likelihood of several different services being offered by several different suppliers—suppliers who may be located far outside of their own community. The result is a process that is both confusing to patients and largely inconvenient when compared with the current single-supplier system.”

-John Shirvinsky, Executive Director, Pennsylvania Association of Medical Suppliers

"Round One of Competitive Bidding is proving to be every bit the nightmare the industry feared. MESA has only one MSA in this round, but we've heard from so many providers who had bids rejected because of allegedly missing documents -- documents they can prove they'd submitted! Extrapolate our numbers across all 10 of the Round One MSAs and the scope and impact of the faulty process boggles the mind. Well run, competitive bidding will be harmful to the industry; as it is now, it can only be disastrous. Far too many companies will be driven out of business while we wait for CMS and the CBIC to first admit, then clean up, the mess they've made."

-Liz Moran, Executive Director,Medical Equipment Suppliers Association

1 comment:

Anonymous said...

The CMS competitive bidding teleconference call held today on July 8th for questions from non-contract suppliers and referral agents was a BIG JOKE. It's one and half hour into the question and answer session, and there is lots of questions but no answers. It seems to me that the gentleman from CMS who was on the line knew nothing and acted like a small child with his defensive attitude. Does CMS understand that they dealing with human beings not black and white rules written on paper? I hope some of our lawmakers was listening in on this would surely open their eyes to this CMS disaster. My suggestion is to tell the Medicare Beneficiaries to call their lawmakers for answers...since CMS doesn't know the answers and cannot provide providers with the answers. If the lawmakers voted to continue competitive bidding on July 1st then they must be the people with the answers!