Miami Hustle

I love Miami. My husband’s family is from that special city so we spend a lot of time there, and I’ve come to enjoy its sizzle. The food, the beaches, the palms — wow.

I’ve also spent some time over the past several years in Brevard, N.C., a small mountain town nestled in the Appalachian foothills. With few restaurants and temperatures after sundown that can dip to freezing in the middle of the summer, the city is about as far away from Miami in atmosphere as you can get.

And for Medicare beneficiaries, the differences between the two will soon become even more pronounced.

We have an elderly aunt who lives in Miami. Beginning in July when competitive bidding is implemented, should Aunt Dot need medical equipment, she will be able to get it only from a provider the government has chosen for her. That’s 44 out of an estimated 450 that currently provide oxygen, 25 if she needs a walker and only five should she need complex rehab equipment.

If Aunt Dot needs the equipment in a hurry, she may be out of luck considering Miami’s traffic, which is one thing I don’t like about the city. Considering the expanse of that MSA with its drawbridges, toll roads and rush hour that lasts all day, it could take hours for an HME company to respond if its location is not close by.

What’s more, based on the round one payment rates CMS has announced for Miami, I’m doubtful Aunt Dot would get the quality equipment I would prefer her to have, much less the service I would want to come with it.

We also have an elderly aunt living in Brevard. You may remember my Aunt Helen. I wrote about her years ago when she danced in her wheelchair at a family wedding. I’m happy to report that, at 89, Helen is still a party girl despite severe medical problems. (She even survived emergency brain surgery last year following a fall.)

Like many of those her age, Aunt Helen needs help with daily activities, and she is now on oxygen. You can imagine that to remain at home where she wants to be, she relies on several items of medical equipment to make that possible. In July, however, when competitive bidding takes effect, Aunt Helen will continue to receive her equipment from a local provider she knows and trusts, and she’ll continue to get the service with it she deserves.

I’m sure by now you have studied the payment rates CMS has set based on the round one bid results. They are substantially lower than the industry’s worst predictions. The number of contracts offered in the 10 first-round bid areas, including Miami, is also low, as expected, and at press time, CMS had not released the exact number of providers that would be involved.

Competitive bidding has already begun to reshape this industry.

I hope that, if you are a provider in round one, you have built sources of revenue other than Medicare. I hope that, as a provider in round two — or in Brevard, N.C., or any other area — you have begun to do the same thing.

I only wish that your Medicare patients, including my Aunt Dot in Miami, could choose as you can to prosper outside of the program.