Did You Bid? CSI:HME Wants to Know

HALIFAX, Va. — Are you a provider in one of the Round 1
competitive bidding areas? If so, CSI:HME wants you.

Or, more correctly, it wants your information. The Committee to
Save Independent HME Suppliers, with the help of the National
Association of Independent Medical Equipment Suppliers, is
attempting to compile data via an online survey to help put the brakes on the
bidding program.

Industry advocates say competitive bidding spells
disaster for HME providers and patients alike, warning that
recently announced Round 1 rebid rates — averaging 32 percent
less than current Medicare allowables — are unsustainable and
mean serious access issues for beneficiaries. Stakeholders have
since been seeking ammunition to fight the program, scheduled to go
live on Jan. 1, 2011.

So far, no cohesive battle plan has emerged. CSI:HME and NAIMES
are hoping that information garnered through their survey will aid
in deciding on the best strategy.

“The goal of the survey is to try and gather some information
about the bidding,” said Wayne Stanfield, president and CEO of
NAIMES, which is hosting the survey on its website. “We are going
to share the responses we get with other organizations so we can
put together all the intelligence we can find in order to make some
good decisions going forward. We have to have a plan.”

The survey asks providers in the competitive bidding areas some
basic information, such as whether they bid or not, and whether
they were offered a contract and accepted or rejected it. No
identifying information is requested and no bid amounts are asked
for, Stanfield stressed.

“We know that there were 1,000-plus companies that bid, and 364
were offered contracts. We want to hear from all of those 364
companies,” he said. Across the nine CBAs, 1,287 contracts were
offered overall.

Armed with information from the survey, Stanfield said, the
industry can then approach Congress with some real data and also
with what he calls the bid program’s “anomalies,” among them:

• A supplier could bid below cost in a geographic area thousands
  of miles away with no obligation to ever actually supply the
  products it bid to provide, yet its bid will set the price others
  will have to live with.

• A bidder could bid to supply up to 20 percent of the market with
  no verification that it could actually meet the demand, and could
  choose never to honor the bid, yet the prices it offered will set
  the prices other bidders will receive.

• Bid prices were set based on a process where bidders will never
  know how the calculations were used to set the fees.

• A bidding supplier could be offered a contract where payments it
  receives would be 20 percent or more lower than its bid.

• A supplier who signs a contract can only exit the executed
  contract by filing bankruptcy.

“We have identified the anomalies and the issues,” Stanfield
said. “Our objective now is to try and set a strategy that will
allow us to take these anomalies, the problems we know are there,
to Congress.”

Part of that strategy will be to determine how — and if
— the industry can pay to stop the program. CMS has estimated
it would save $17 billion over 10 years through DMEPOS bidding, a
figure the industry would have to match.

“Right now, in order for us to end it, the industry is going to
have to pay for it,” Stanfield said. “We’re not sure how much more
we can pay, if anything. That has not been decided … We have
been labeled the low-hanging fruit. All the low-hanging fruit has
been picked. The fruit is gone. There is nothing else left. We
can’t afford to pay more to fund a program that is fundamentally
flawed.”

On the other hand, he said, “If it goes forward in January and
in three months it fails, Congress could write it off the books
with the stroke of a pen and that would be the end of it.”

While support has been building steadily for H.R. 3790 to
eliminate competitive bidding — as of July 23, the bill had
254 cosponsors — “the problem is the Senate,” Stanfield said.
“We have more than a majority in the House to pass this if we could
get this on the floor, but it would go to the Senate floor and
promptly die.”

Key Senate leaders favor competitive bidding, he pointed out,
and it will take some doing, including a lot of data, to change
their minds. And the industry must act fast, he added. There are
only about 10 legislative days until Congress goes on summer recess
in August, returning following Labor Day. After that, there are
only 15 legislative days before Congress adjourns for the November
elections.

“We need to use the August recess to educate Congress,”
Stanfield said. “We’ve got to convince a whole bunch of people to
do something as soon as they come back.”

NAIMES is advocating a series of town hall meetings in
legislators’ home districts in the CBAs put on by the state
associations. Stanfield also said the group wants to make sure
referral sources understand the problems in the CBAs. “We have to
stop [competitive bidding] before patients get harmed,” he
said.

The impact the bidding program will have on hospital discharge
planners, physicians, hospice coordinators and others is going to
be “profound,” Stanfield said. Conceivably, a referral source could
call all over their local community trying to get, say, a hospital
bed for a patient set to be released from the hospital and not meet
with any success because the provider for the area is three states
away and can’t get the bed there in one day.

The answer, said Stanfield, “is to send the discharge planner to
their congressman and say, “I can’t find anyone to serve my patient
and he’s been in the hospital for three extra days. You wanted this
program; tell me what I am supposed to do.”

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