AUBURN, Mich. (Oct. 31, 2013)—A Medicare bidding program is jeopardizing the health of Michigan senior citizens and people living with disabilities who are unable to obtain critical home medical equipment prescribed by their physicians. More than 100 Michigan Medicare patients have sought assistance from a consumer hotline, despite claims from the Centers for Medicare & Medicaid Services (CMS) that there have been few problems.
Jacob Krzysiak, 36, from Auburn, Mich., is one of many Michigan Medicare patients suffering because of the bidding program. Like others, he told his story to People for Quality Care, who have collected more than 2,000 complaints from Medicare patients around the country, including in Michigan.
Krzysiak is struggling to survive without a wheelchair because he can’t find an equipment provider willing to repair his. Krzysiak, who has had his manual chair for seven years, says providers tell him that Medicare won’t pay for repairs. He’s trying to be qualified for a new chair, but that hasn’t happened thus far.
Diagnosed with a neurological muscular disorder, Krzysiak has been in a wheelchair since he was five. But the brakes don’t work on his chair, and the wheels keep falling off. Recently, 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, adding that he has called every provider in the area. At this point, he is completely disheartened. “I don’t like asking for help unless I need it; and I really need it. I cannot get around.”
While CMS will only acknowledge a few problems with the bidding program, people like Krzysiak are suffering throughout Michigan and across the country. CMS has badly mismanaged the bidding program for wheelchairs, oxygen therapy, hospital beds, diabetic testing supplies, and other home medical equipment known as durable medical equipment or DME. It has put hundreds of DME providers out of business, caused equipment shortages, and left beneficiaries without doctor-prescribed equipment.
Barry S. Cargill, executive director of the Michigan Association for Home Care, said the bidding program is causing problems for equipment providers as well as Medicare beneficiaries. For instance, he says some private insurers are seeking to use the Medicare reimbursement rates under the bidding program as guidelines for their payments. But the badly-flawed CMS program allows non-binding bids and low suicide bids, which are contributing to unrealistic prices being set in Michigan and other parts of the country.
“The result is that more suppliers will be hurting and more Medicare patients won’t have access to the home medical equipment that was prescribed by their physician,” Cargill says.
Stakeholders are disgusted that CMS won’t acknowledge the problems caused by the bidding program.
“CMS claims that everything is fine, but the reality is that Medicare beneficiaries in Michigan and across the country are suffering,” says Tom Ryan, president of the American Association for Homecare (AAHomecare). “This bidding program is bad public policy that Congress and the Administration need to fix or end. CMS must acknowledge the real problems that Medicare patients are facing and address them.”
Even the Government Accountability Office (GAO) has questioned CMS’s claims to have received few complaints from Medicare patients. A May 2012 GAO report said that CMS may be intentionally undercounting the number of problems. “CMS’s definition of inquiry and complaint may be an optimistic characterization of beneficiary calls,” the report states. “According to CMS, all calls are first classified as inquiries and are only classified as complaints when they remain unresolved by CSRs [customer service representatives].” However, CMS considers giving a caller a list of companies to research on their own sufficient. There is no assistance given and no follow-up done to ensure that beneficiaries get what they need.
Ralph Ainsworth, 66, of Goodells, Mich., is another example of a beneficiary whose health and quality of life was threatened by the bidding program.
Ainsworth woke up every night feeling like he was being strangled. The headgear for his continuous positive air pressure (CPAP) machine was so old that it wouldn’t stay on his face, which meant he didn’t get enough oxygen to breathe. He made constant calls to providers, but for two months couldn’t get the replacement he needed. A few weeks ago, he finally received the replacement headgear.
A retiree, Ainsworth suffers from severe sleep apnea and can’t sleep without a working CPAP machine. “My throat swelled up and I gasped for air,” he says. “You can’t imagine. It’s like someone is strangling you, and you don’t have any air going into your lungs; it’s pretty frightening.”
The mask fell off so often that he was getting only a handful of hours of sleep each night. In the morning, he was sleep deprived, exhausted, and woke up with splitting headaches. His health was becoming so poor, he says, that “I just laid around all day. I didn’t have energy. Normally I would have been active, been outdoors, walking with my wife, doing different things.”
The two-month ordeal had a negative impact on his wife as well, who worried constantly about him, trying repeatedly to find a supplier who would bring a new mask. “It worried me,” Ainsworth says. “We don’t have the freedom (because of the bidding program) to choose our equipment provider; we don’t even get a say in the matter. It was depressing.”
In Highland Park, Mich., Rose Hollis, 64, can’t get the mobility assistance that she needs. Rose had a stroke over a decade ago that left her paralyzed on the right side of her body, and her daughter, Theresa, 46, who is also disabled, has been taking care of her.
In July, Rose’s power wheelchair broke. In the past, they would have been able to get the chair repaired quickly and been given a loaner chair in the meantime. But now, due to the bidding program, they’re still waiting three months later. Rose has had to resort to using an old manual wheelchair that Theresa’s husband once received for a broken leg. The chair’s not much use to Rose, however, as she can only use the left side of her body to push it and barely fits in the seat.
Largely immobile, Rose stays in her apartment. She can’t go to church or to her stroke support groups, and she even had to drop out of “Steps,” the stroke rehabilitation and prevention program she’s been attending at the local university for years. With limited mobility, she can’t do anything unless someone can push the manual chair, something her daughter can no longer do.
“She’s depressed,” says Theresa. “We live next door to each other; I talk to her every day, and I can hear it in her voice. She doesn’t have the spark that she normally has.”
Theresa is becoming increasingly worried. She doesn’t know what will happen or how to get essential care for Rose. They don’t have the money to pay for wheelchair repairs out of pocket, let alone full-time nursing care.
“We don’t know from month to month if our benefits will be there,” Theresa says. “When she goes to the doctor, I’m afraid they might not see her because she might not have the money for her copay that day. That’s scary.” Visit aahomecare.org.
