HME Stakeholders: What Do We Do Now?

BALTIMORE–While HME advocates await action on H.R. 6331 to delay competitive bidding, the question on the lips of stakeholders throughout the industry has become: What are we supposed to do now?

In the weeks following competitive bidding’s July 1 implementation in 10 cities, CMS has held two teleconferences to field questions on the program. In both, agency officials were deluged with calls from providers, beneficiaries and referral agents who said they are witnessing the pitfalls of competitive bidding firsthand.

Numerous callers complained about lack of complete information, misinformation and ever-changing information resulting in a loss of business or the inability to service their clients. Flustered CMS officials have not had many answers.

On a call July 2–only one day after implementation–industry consultant Miriam Lieber said her clients were losing business because beneficiaries were being given incorrect information when placing calls to 1-800-MEDICARE.

After being told to submit her complaint in writing, Lieber responded, “But what you don’t understand is that now [my clients] have lost a lot of business, and you have no idea the number of complaints I am receiving.

“What it’s done is damage, and we need to undo the damage. You need to have damage control,” Lieber told CMS.

In addition, several callers expressed distress about the lack of providers for complex rehab, specifically in Dallas, where one caller said only one complex rehab provider–The Scooter Store, which, the caller pointed out, does not have a history of providing complex rehab–was included in CMS information mailed to beneficiaries.

An agency representative responded that the list of contract suppliers had recently been updated and more suppliers added–rendering the mailed list inaccurate.

During the second conference call held July 8, CMS told listeners that “additional contract suppliers may be added over the next few days, and, in fact, throughout the contract period.”

To keep up with the changes, officials recommended that providers and beneficiaries regularly visit the Medicare.gov Web site.

CMS also had no help to offer on questions concerning subcontracting. “We’ve noticed there have been a lot of questions concerning subcontracts,” an official said. “Unfortunately we are not prepared to answer all of those questions at the current time. We’re working on it.”

CMS did say it has come up with additional information on what constitutes “mail-order diabetic supplies.” That clarification is available on the CBIC Web site at www.dmecompetitivebid.com.

As in the first teleconference, the inaccuracy of the CMS mailers, the information provided by 1-800-MEDICARE and the changing contracted supplier list became a constant theme of complaints.

One caller from a major medical center voiced her frustration over the ever-changing list of providers and the strains that puts on hospital discharge planners. “We need something that’s stable, and that’s not changing every day because we’re calling a company that was on the list yesterday but is not on the list today,” the caller said.

A CMS representative answered, “I don’t think we’re ever going to have a list that is static and does not change … Unfortunately I do think there will be changes to this list over time.”

Another official suggested the caller should utilize the supplier locator tool on the Medicare.gov site to remedy her issue, despite the fact she had pointed out that discharge planners, often working at patient bedsides, do not have constant access to a computer. The official then advised she have her discharge patients or their families call 1-800-MEDICARE to locate contracted suppliers.

“You are asking for our challenges and our issues. And I am telling you that this is a challenge for us,” the caller said. She added that she represented “hundreds of discharge planners” working with “thousands of patients.”

“Well, I guess I would suggest that you print the list out in the morning and have it available on a daily basis,” the CMS rep replied.

Another caller, noting the “nightmarish” implications of competitive bidding for discharge planners, remarked that “there are so many things that were not thought out. So to go ahead and proceed with the ‘drop dead’ date is just hardly responsible … to not transition this, to not provide trials, to not allow a grace period–this clearly is an attempt to shift cost onto health care providers because we are going to end up getting stuck with a multitude of denied claims, and we’re never going to be able to get paid. This is just a travesty.”

CMS is not the only entity receiving provider feedback. The American Association for Homecare has set up a complaints page on its Web site at www.aahomecare.org. Thus far, according to the association, competitive bidding is “plagued with problems” and complaints are coming in from across the country.

Specifically, AAHomecare said providers have reported problems attesting to reduced access to care, service decreases, referral source concerns and beneficiary confusion.

AAHomecare cited a report from Oviedo, Fla., where “the daughter of an oxygen patient made multiple calls on July 2 to contracted suppliers in the Orlando bidding area to find a provider of liquid oxygen. She was upset because she was confused by inconsistent information she has received. The oxygen patient has yet to find a new contracted supplier as of July 8, 2008.”

In Dallas, the association said, “a beneficiary was informed by a contracted supplier that it would take seven to 10 days to service her equipment needs and she would need to contact three other suppliers for her other equipment because of the various product categories.”

And in Sunny Isle Beach, Fla., “an 82 year-old patient was needlessly sent to the hospital because her daughter was unable to find a contracted supplier who could properly provide enteral feeding services. According to the patient’s daughter, the home health nurse began having problems with the feeding tube while visiting her mother the week of July 1. The nurse called 911 because she didn’t know who else to call for assistance with the feeding system since it was obtained before July 1, but the problem came up after the bidding program was in place.”

AAHomecare said it also got a report from Los Angeles in which a provider expressed “concern after learning from a winning bidder that it has ‘never provided enteral and [is] not ready to do enteral.’”

Wayne Stanfield, president and CEO of the National Association of Independent Medical Equipment Suppliers, said such complaints and others will likely never see redress from CMS–even when H.R. 6331 becomes law.

Stanfield said when that happens, CMS will have “no choice but to send mail and email notices to the entire health care world stopping and reversing the [bid] process.

“Those letters will likely not be favorable to DME suppliers. I also expect to see a lot of editorial and opinion pieces that will blame the industry for fraud and abuse and higher cost for beneficiaries. They certainly will not admit that [national competitive bidding] was flawed, rather it was the savior of Medicare.”

Rob Brant, president and CEO of the Accredited Medical Equipment Providers of America, said he has “no idea” what steps CMS might take to rectify the damage done by competitive bidding.

”Some providers are upset about the time, effort and resources they have put into the competitive bidding process,” said Brant, general manager of City Medical Services in North Miami Beach, Fla.

“People are losing patients. I have lost patients. It’s going to take a lot of time to reeducate … It might take us months to get a meeting with a discharge planner. It’s not just so easy as to say ‘Let’s just make a phone call and we’ll be all right again.’ It’s going to take a long time [to get back on our feet].”

But there may be a silver lining to the struggles.

”The industry is finally starting to unify to speak up for our patients and speak up for HME,” Brant said.

For now, Stanfield said the industry should be focusing on competitive bidding’s repeal.

“If we don’t repeal it, the rebid in a matter of months will cost the government millions and will be a very unpleasant experience to suppliers. The question begging an answer is, what will be the rebid prices? Will suppliers be allowed to bid higher than this round? No clues about what CMS will do, but it won’t be pretty.”