WASHINGTON (Jan. 27, 2014)—The Medicare bidding program for durable medical equipment (DME) is continuing to cause pain and suffering for the elderly and people living with disabilities, even as stakeholders urge Congress to adjust or replace the controversial procurement process for oxygen, wheelchairs, walkers, hospital beds, and other home medical equipment.
In December, the Senate Finance Committee approved a measure addressing one flaw: providers would be required to prove that they meet licensure requirements before submitting bids to supply DME to Medicare patients. This fix was needed after it was disclosed last year that in several states, including Maryland, Pennsylvania, and Tennessee, the Centers for Medicare and Medicaid Services (CMS) violated their own rules and granted contracts to bidders who had not obtained the proper state and local licenses.
This year, the American Association for Homecare (AAHomecare) and other stakeholders are pushing for additional fixes, such as requiring binding bids and that CMS set reimbursement amounts at the clearing prices. Critics of the program, including economists and auction experts, maintain that the current process is essentially price-setting by the government that allows arbitrary pricing.
AAHomecare is leading the push for a comprehensive, legislative resolution to the problems related to DME procurement. Their effort is gaining momentum: thus far, there are 166 House cosponsors on H.R. 1717, the Medicare DMEPOS Market Pricing Program Act of 2013. The legislation, known as MPP, would replace the current bidding program with one that is based on fair and open competition.
But while the policy debates unfold in Washington, Medicare patients, people like Norma Westbrook, 81, of Charleston, S.C., and Jacob Krysiak, 37, of Auburn, Mich., live with the consequences of a bad policy that has already been implemented. They and thousands of other Medicare patients in areas across the country covered by the procurement process are experiencing a lower quality of service and equipment, delays in obtaining the medical equipment prescribed by their physicians, or being denied services and equipment.
In the spring, Westbrook began trying to get a replacement for her power wheelchair because it wouldn’t hold a charge. Without the chair, it was difficult for her to complete simple tasks around her house. She had multiple medical examinations and filled out extensive forms. However, because of the procurement process, she could no longer obtain equipment from her old provider since the company hadn’t won a bid; she was forced to switch to a provider based in Georgia.
She called the company repeatedly. After weeks of prodding, the new provider shipped a wheelchair, but it was too small, so Westbrook had to return it. She questioned how the provider could have sent the wrong chair if they had read either her paperwork or her physician’s instructions. She was extremely discouraged and doubted that she would ever get the chair she needed through Medicare. She even began searching the local want ads on the off chance that a used one might become available.
The ordeal was quite traumatic for her. Westbrook is the caretaker for her husband, and she needed a working wheelchair to care for him and herself.
“To be able to stay in your own home with hospice is a blessing,” Westbrook said. “And it’s the cheapest thing that the government can do to take care of people in their older age. It’s scary to think that because you can’t replace a wheelchair, my husband being placed in an institution might have been inevitable. I didn’t want to get to the point where my husband had to go to a nursing home, and I had to have someone come in to care for me. And that’s exactly what would have happened. It just didn’t make any sense.”
But Westbrook refused to give up. She kept calling providers; she enlisted the assistance of advocates for seniors and the disabled. Finally, in November, after nearly seven months of agony, a provider delivered a power wheelchair she could use.
“I’m very grateful,” she said. “But I worry about people who couldn’t make all the calls that I did and can’t recruit all the help that I did. What happens to those people in this system?”
Meanwhile, up in Michigan, Krzysiak is still waiting for a working wheelchair.
Diagnosed with a neurological muscular disorder, Krzysiak has been in a wheelchair since he was five. But the brakes stopped working on his chair earlier this year, and the wheels kept falling off. During the summer, he tumbled off his deck. He is routinely forced to crawl around on the floor of his own home. “I have to crawl all over the place,” Krzysiak says, “I don’t like asking for help unless I need it; and I really need it. I cannot get around.”
Krzysiak has had his manual wheelchair for seven years, but after it broke he couldn’t find a provider willing to repair it. Krzysiak said providers tell him that Medicare won’t pay for repairs. He’s trying to be qualified for a new wheelchair, but that hasn’t happened thus far.
“My doctor and providers are working on it,” he said. “But I’m still waiting.”
Tom Ryan, president of AAHomecare, said that stakeholders are seeking changes in the bidding program to help both Medicare patients and providers.
“Medicare patients shouldn’t be put through the wringer just because they need home medical equipment,” Ryan said. “Prior to the bidding program, providers could quickly get them the equipment they needed. Now, it is becoming a struggle for many patients to receive the equipment prescribed by their doctors. Hopefully, Congress and CMS will take notice and we can work with them to make this a better process for Medicare patients as well as providers. Visit aahomecare.org.
