The Hill reporter Jeffrey Young posted an extraordinarily misleading account of the disastrous Medicare competitive bidding program on the Atlantic Monthly blog (see “Pay Up or Grandma Gets It” at http://business.theatlantic.com/author/jeffrey_young/). Young very accurately parrots the arguments set forth by the Bush Administration for a rush-to-the-bottom approach to home medical care in Medicare, which the bidding program would trigger. Congress wisely reformed and postponed the competitive bidding program.
The bidding program was designed to get the majority of home medical equipment providers (mostly small practices) out of Medicare regardless of what reimbursement rates they agree to. In other words, the program is designed to drastically reduce the number of competitors – who currently compete on the basis of quality, since Medicare sets prices (which have been cut or frozen repeatedly over the past 10 years).
Medicare beneficiaries already trying to cope with cancer, stroke, Lou Gehrig’s disease, COPD, and other serious conditions, will face more challenges under this flawed competitive bidding program: a large decrease in their choice of providers, longer waiting periods to receive equipment or services, and in many cases, a forced change to a provider who may have no prior experience in a given therapy such as enteral nutrition (tube feeding) or oxygen therapy.
Young writes, “Of course, in grand lobbying fashion, [the HME sector] also griped about the bidding process … said the prices would end up so low they would go out of business, and issued dire warnings about grandmas choking for breath while their oxygen tanks went unfilled.” What’s breath-taking is to see Young use COPD patients as a punch line. The more than one million Medicare beneficiaries who depend on medical oxygen therapy in order to breathe surely don't think the quality of their oxygen service and equipment is a joke.
Young fails to mention that durable medical equipment is growing at an incredibly slow rate -- 0.75 percent per year, according to the National Health Expenditure data just published by CMS (2007 data). This compares to more than 6 percent growth for Medicare overall. Nor does Young mention that providing medical oxygen therapy including the required services to beneficiaries in their homes costs less than $7 dollars per day, which includes 24-7 on call service.
Nowhere does Young mention the many consumer and patient organizations, such as Muscular Dystrophy Association and Paralyzed Veterans of America, that adamantly opposed the bidding program.
The deep reimbursement cut that took affect on January 1 is was much more significant than what Young describes as “a tribute of sorts.” That nationwide cut is equal to or greater than the amount of money the bidding program was projected to save. Moreover, the bidding program did not die “on the vine” by a long shot. In fact, the Bush Administration issued a rule to implement the bidding this year in a regulation that was published literally in the last hours of Bush’s term.
Medicare reform will indeed fail if it is pursued with the same incompetence that the Bush Administration applied to the home medical equipment and service sector.