You Be the Judge

How are things going with competitive bidding? It depends who you ask.

Round 1 of the Medicare program began Jan. 1 in nine cities across the country and, according to CMS, it’s working just fine.

“We are pleased to report that implementation of the program is going very smoothly,” CMS Administrator Donald Berwick said in an agency press release last month. “We continue to deploy a wide array of resources across all of the competitive bidding areas to address any concerns that may arise.”

But the American Association for Homecare has a very different view.

“Six weeks into Round 1 of the bidding program and AAHomecare has seen enough,” association President Tyler Wilson said in a mid-February letter to members. “Competitive bidding for home medical equipment must be abolished. The home care system should not be characterized and viewed merely in terms of the lowest cost and who can provide it most cheaply.”

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CMS’ program design is “faulty and its administration has been a lesson in poor planning, arrogance and clumsiness,” Wilson continued. For that, he said, the agency bears the blame.

But it’s Congress that authorized the program, and it’s Congress that must stop it, he said: “The philosophy behind bidding as a way for Medicare to manage, deliver and reimburse for home medical equipment is simply wrong-headed and misguided. For that, we can blame Congress. Lawmakers can be roundly criticized for mandating the program that is now causing such terrible financial hardship and economic dislocation.”

At presstime, a toll-free hotline sponsored by the association had recorded more than 300 complaints about the program, the majority from beneficiaries. (See “March-ing On” for a sample.)

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The “alarm bells are sounding” that Round 2 of competitive bidding will be implemented without considering the faults of Round 1, Wilson said. Scheduled to be bid this year, Round 2 will add 91 cities to the national bidding project.

“Looking ahead,” he added, “nothing about CMS’ handling of the program should give anyone comfort. The Medicare agency has been alarmingly dismissive toward a host of issues and completely unwilling to do any self-examination.”

CMS’ release said the agency had received “only a handful” of beneficiary complaints.

“CMS continues to monitor the implementation of the program very carefully,” Berwick said. “We urge all stakeholders to bring any issues to our attention in order for our caseworkers to resolve them as quickly as possible.”

But Wilson said “the only way to stop the problems is to stop the program. Congress must step in and enact legislation that ends bidding for home medical equipment.”

That needs to happen fast, he said, “while there is still a community of home care providers that can put the pieces of a robust home care system back together. If Congress fails to act, the economic fallout and the harm to the home care system and those that rely upon it will be irreversible.”

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