On July 1, 2013, the curtain opened on the second act of the DME competitive bidding program. The Center for Medicare and Medicaid Services (CMS) has billed the show as the cost-saving event of the decade.
The producers of this job-dwindling, access-denying performance are career bureaucrats with no medical or health care credentials. They are well known in the DME community because they have been selling tickets to the bidding show for years.
The only audience who truly loves competitive bidding is CMS. Economists and auction experts don’t like it—244 of them wrote to the president, emphasizing that it was so poorly designed that it was bound to fail.
Providers don’t like it—by the thousands they have told Congress and CMS that it will cause job losses and business failures.
Patients don’t like it—thousands have complained about delays in receiving the medical equipment and services they need to remain at home.
Even Congress doesn’t like it—more than 150 representatives have cosponsored a bill to repeal and replace it.
When the curtain rose on the CMS bidding show, it also fell on hundreds of providers across the country. The effects of the 45 percent fee reduction and loss of referrals continue to cause suffering—for patients and the way they obtain medical equipment and for the futures of the companies who are supplying it. It is heartbreaking to hear the personal stories of longtime businesses closing, and of their patients who are left stranded because those closures are compounded by bid winners who refuse to honor their contracts.
Competitive bidding is doing what the policy makers in Washington, D.C., want. Massive savings and fraud reduction may get top billing in the badly mismanaged bidding show, but it’s at the expense of an 80 to 90 percent reduction of DME providers. Coping with the needs of aging baby boomers in the coming years will dramatically increase the demand for home care, and that was never written into the script.
CMS has underestimated the resiliency and creativity of American small businesses in general, and the DME industry in particular. Even if CMS manages to change the industry so much that we no longer recognize it, they will not destroy it.
It may look and feel different—because of the amount of providers CMS has forced out of business—but the industry will find a way to continue to meet the demand for home medical equipment.
There will be an encore performance on the CMS stage, as the bidding program fails in the long-term and prices are driven higher by reduced competition. Some providers will exit the stage and others will enter when they see new opportunities. A new breed of provider will become the foundation of a completely new DME marketplace.
The DME industry will have its encore performance, because there will always be a need for the products and services it supplies, and there will always be companies willing to supply them. At some point in the future, the CMS bidding show will close.
The question that all providers must ask themselves is, “Will I quietly let CMS force me out of business, or will I fight for my business and my patients?” If you are a fighter, you have a role to play in the American Association for Homecare cast—and it is not a bit part!
Members and staff are pushing Representatives in Congress to cosponsor H.R. 1717, the Medicare DMEPOS Market Pricing Program Act of 2013. This is the bill that will repeal and replace CMS’s comedy of errors.
The Association and its members are also educating patients on how to effectively advocate to end the bidding program before it forces them into an emergency room or a nursing home.
Everyone’s calls, e-mails and meetings are making a difference, but the show is far from over. As the saying goes, “It isn’t over until the fat lady sings.” And she’s not even warming up yet.
