Told You So: HME Advocates Say Bid Problem Predictions Coming True

ATLANTA — Less than a week into competitive bidding, state and
national home medical equipment associations are already fielding
reports of fallout from providers and other stakeholders —
and the complaints are on the rise.

“We are getting in the neighborhood of 10 to 15 complaints per
day. Complaints are on the increase, not tapering off,” said
Michael Reinemer, vice president of the American Association for
Homecare, which has set up a toll-free hotline to gather
information on the program’s implementation.

Reinemer said that so far, complaints include:

• Patient confusion or dissatisfaction about the need to switch
  HME providers;
• Delayed discharge from facilities;
• Admission to a hospital because of no access to HME;
• Problems coordinating delivery of items;
• Companies laying off employees; and
• Questions for the CBIC that go unanswered.

Other types of problems are also surfacing.

The Accredited Medical Equipment Providers of America cautioned
its members that they should verify answers to questions about
competitive bidding with others because the CBIC was, in some
instances, giving conflicting answers. “Whatever you are told,
check with others first to verify because the answer might not be
accurate,” AMEPA told members in its newsletter. “Many consultants
believe that the CBIC is being stricter than the rules direct in
order to make things run smoother or just to eliminate non
bid-awardees quicker.”

Members of the Midwest Association of Medical Equipment Services
reported that some of their patients who do not live in a
competitive bidding area had received letters from CMS implying
that they had to get their HME from a certain company. Other
patients got letters saying the first letter had been sent in
error.

Providers are also running into problems with hospitals stemming
partly from lack of awareness of or information about the bidding
program.

AMEPA reported that at least one large Miami-area hospital had
no idea there was a bidding program in place that affected Medicare
patients. The hospital only learned of it when a case manager
attempting to discharge a patient called an association member
looking for a walker. (The provider had not won the bid for walkers
and told the case manager the hospital would have to look
elsewhere.)

“AMEPA called dozens of hospitals last week and found over a
third were unaware of the program, and of those who knew, many had
no list of winners and did not have a plan to deal with the
changes,” according to the association.

In an alert to its members, the Florida Alliance of Home Care
Services said that Jackson Memorial Hospital in Miami-Dade County
had contacted all non-contracted providers on its rotating list of
accredited providers to tell them they would no longer be called to
service any Medicare patients. FAHCS said hospital staff apparently
believes it is too complicated to call multiple providers to
fulfill various needs. The end result, according to Sean
Schwinghamer, executive director of FAHCS, is that even smaller
providers that won, say, only one product category will lose out
because the hospital will seek a company that won all the
categories needed to service the patient.

“CMS has said they have small business set-asides and are
protecting small business, but that is simply untrue,” Schwinghamer
said. “What is happening now is what we knew would happen: The big
guys will get all the business and the little guys will get the
boot.”

John Shirvinsky, executive director of the Pennsylvania
Association of Medical Suppliers, said PAMS already has had to
intervene in a situation with a hospital outside the Pittsburgh
CBA. “One weird thing we had was that a hospital located 250 miles
out of the CBA was being advised by CMS that they could not use
their regular [providers inside the CBA],” Shirvinsky said. “We
managed to get that straightened out.”

But not all problems will be so easily resolved, and Shirvinsky
is concerned that HME providers, in an attempt to make sure
Medicare beneficiaries are taken care of, will try to solve those
problems to their own detriment.

“As this week goes on, we’re going to see more and more
problems,” Shirvinsky predicted. “It’s a question of who is taking
care of what. There is such a sense of honor and doing things right
in this industry, people are going to start giving stuff away and
trying to keep problems from occurring. But it’s against the law to
do that. That’s by design, that’s by government mandate.”

Providers are going to have to let some of the problems happen,
he said. “This system is destined for failure, and we have to allow
it fail.”

Concluded AAHomecare’s Reinemer, “We hope that the complaints,
added up as statistics and also compiled as individual stories,
will underscore the problems with program, which we have all
anticipated. The association and other stakeholders will be sharing
the information with members of Congress and the media. We are
sorting through the information to figure out the best way to do
that.”

Industry organizations are asking providers, consumers,
caregivers, physicians and other discharge/referral sources to
document any problems with the bidding system through online forms
and toll-free hotline numbers. See the Competitive
Bidding Begins Special Alert for information.

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