Advocacy in Action

Diana Guth is not the first HME provider to call national competitive bidding a “train wreck.” However, her approach in getting patients — and friends — involved in grassroots lobbying against the program was definitely distinct.

“There is no way possible that this could have a positive outcome,” she says of competitive bidding. Guth is the owner of Los Angeles-based Home Respiratory Care, which focuses exclusively on sleep-disordered breathing and non-invasive ventilation.

Guth, a respiratory therapist, knows how vital service and education are for her patients, many of whom have ALS. That is why she decided to give them details about competitive bidding along with talking points and action items to use to contact legislators and ask them to stop the competitive bidding program.

“I have sent out thousands of letters to all of my patients, referral sources, friends and family and I have gotten hundreds of responses,” she says.

Sent to 3,200 patients and others, Guth’s letter used bold but simple points to show how the program will adversely affect patient care, including this opening statement: “How would you feel if you received a letter from me that read as follows? With a heavy heart I must inform you that I can no longer stay in business because of a federally mandated Medicare program called Competitive Bidding for Durable Medical Equipment.”

Another portion of the letter stated: “In order for Home Respiratory Care to remain being a Medicare provider, I and many other small HME companies will have to bid against other companies. If I’m not a ‘winning bidder’ or if the bid offering is so low that it is no longer profitable, I will not be able to financially survive.”

The letter detailed how national competitive bidding will affect patients by pointing out that access to HME providers will be very limited; smaller, service-oriented companies will most likely be put out of business; quality will be seriously compromised as the products offered will be the least expensive, bottom-of-the-line devices; and innovation in home medical equipment technology will be suppressed because manufacturers will be forced to focus their efforts on producing cheap — not better — equipment.

Guth ended the letter by telling the recipient what he or she could do. She also included a sign-on letter that she urged recipients to return to her office for delivery to the appropriate senator and representative. She got 600 signed responses, and hand-delivered those letters in June to the office of California Rep. Henry Waxman.

Guth says it was tough to carve out the time she spent on her letter-writing campaign against competitive bidding. Yet, she also believes it is crucial to keep service as a vital aspect of patient care.

“Right now, it’s difficult enough, especially for seriously disabled people, to get what they want from whom they want, and [under competitive bidding] they’re going to be limited by who they go to. There are just so many unknowns,” she says.