Providers Urge CMS to Pull Competitive Bidding IFR

WASHINGTON — In a race to stop the competitive bidding clock, more
than 600 HME stakeholders weighed in with comments on the project’s
interim final rule, with most calling for CMS to rescind the rule
before it takes effect April 18.

The rule initially had an effective date of Feb. 17–a month
before the comment period was set to end March 17. When CMS delayed
the effective date for 60 days to allow the new administration time
for review, it left the comment deadline intact.

Under the IFR, the agency would make another stab at
implementing competitive bidding on a national scale with a rebid
of Round One this year. Last July, Congress delayed the DMEPOS
program for at least 18 months so the many procedural and other
problems could be fixed. But home care advocates have said that
very few of the issues raised then have been addressed in the IFR
and, in their comments, many pleaded with CMS to withdraw the
rule.

Ellen S. Durrence, owner of an HME business in South Carolina,
pointed out that competitive bidding originated to save Medicare 12
percent in 2006. Since then, she said, Medicare has shaved payment
amounts by some 5 percent, and in January of this year, CMS
instituted another 9.5 percent cut on 10 product categories.

“This equals around 14.5 percent reduction! This is more
than 12 percent, so why destroy the industry and the access to
health care for the elderly by implementing the competitive bidding
program when the goal is more than met?” Durrence
questioned.

“Small DME companies like the one I run will close with
competitive bidding, competition will be no more with competitive
bidding, and competition is one of the original conditions for
participation of [the] Medicare program,” she added.
“This is America, and the ability to run a company and serve
your customers and make a difference will be gone! Please, rescind
the competitive bidding rule completely!!! Let Americans keep their
businesses and serve the patients that they have come to
know.”

Gloria Knutson, an Arizona provider, wrote: “The entire
competitive bidding program is and has been a disaster. It was not
well thought out, [it] eliminates patients’ ability to choose
their providers, and I believe [it] will lower quality of care and
products.

“CMS already controls costs; making all providers bid
against one another to provide a service is crazy. I don’t want to
lose my clients, many of whom I have been providing medical items
and equipment to for several years and have a relationship with, to
another provider just because he wins the bid. This plan and rule
[were] conceived by those who know nothing about the industry and
real world. Stop the implementation of competitive bidding totally.
There are other ways to control costs–the DME providers are not
the problem.”

In its comments, the American Association for Homecare also asked
CMS to withdraw the IFR and issue a proposed rule. “CMS
sidestepped all of the important procedural protections inherent in
rulemaking by publishing an IFR with an effective date
approximately one month before the deadline for submitting
comments,” AAHomecare asserted.

The organization also called on CMS to “convene the
[Program Advisory and Oversight Committee] as well as solicit
comments on its proposal to revise financial documentation
requirements and explain, in detail, its plans for implementing the
new oxygen rules under the program and provide an analysis of the
combined impact of a 9.5 percent payment reduction and competitive
bidding on small businesses.”

As well, the association said, CMS should review the
“factors that hampered an effective roll-out of Round One and
address how it proposes to prevent their recurrence.”

Some state associations also submitted comments on the IFR,
including the Ohio
Association of Medical Equipment Services, which said CMS
underestimated the magnitude of the program and its impact.

”As a state with two bidding areas in Round One, we have been
on the front lines of the roll-out of this program since its
inception and witnessed firsthand the lack of clear communication
and timely information throughout all stages, even up to the final
hours before launch,” OAMES said. “The program’s
real impact on seniors’ lives, the delivery of their health
care services and the small businesses and continuum of care
professionals providing these home care services are too important
to be hastened through a tight timetable with vague
direction.”