Medicare Bidding Program Puts Patients Last

Doctors don’t provide the medical equipment their patients use at home. Doctors and patients alike rely on home medical equipment companies to not only provide the right equipment, but also to provide numerous essential, required services and to teach patients how to use the equipment properly.

Now imagine a scenario in which equipment companies are paid the lowest possible price for the equipment and nothing at all for the teaching and the service. What happens to patients in such a scenario?

Actually, you don’t have to imagine it because that is the precise situation that doctors and patients in nine metropolitan areas across the country were forced into by Medicare last year through its bidding program. Another 91 areas will soon face the same troubling circumstances.

Dr. Dennis Rosen laid out the simple arithmetic and its complex consequences in a May 16 New York Times op-ed. He wrote, “This extra care takes time, and time costs money. But sicker patients and unnecessary hospital visits cost far more. And competitive bidding doesn’t take these subsequent costs into account. If competitive bidding is predicated on supplying equipment at the lowest possible price, something has to give. And more likely than not, that something will be patient care.”

“Using CPAP [continuous positive airway pressure], or any medical device, is complicated, and the machines work only if you know how to use them properly. If the CPAP mask doesn’t fit snugly, it can be uncomfortable and cause skin abrasion or even scarring…. If used incorrectly, CPAP will not do what it is supposed to. The obstructive sleep apnea will remain untreated...”

Rosen, a pulmonologist, concludes: “On the face of it, competitive bidding sounds like a very good idea… But as a doctor working with patients on the ground, I have doubts about that quality-of-care measure, and I worry that those savings obscure a potentially serious problem.”

Is this truly what we as a society want for our neighbors, or for ourselves? There is no denying that the need to control healthcare spending is forcing hard decisions upon us, but let’s consider just two questions for now: 1) Is an hour of service time to teach a patient how to use equipment more or less expensive than even one night in a hospital, and 2) Are we willing to let the most vulnerable among us suffer because we can’t do the math in 1)?