Round 1 Train Wreck Continues

While the Centers for Medicare & Medicaid Services (CMS) pushes ahead in 91 new areas of the country with Round 2 of its badly designed Competitive Bidding Program, we must keep Round 1 problems front and center. 

More members of Congress—especially those in Round 2 areas who have not yet encountered the structural flaws in the bidding system and the detrimental fallout—need to understand the problems occurring in the nine areas already subjected to Round 1. Only then can we hope to stop the current bidding program and replace it with a more reasonable alternative, the Market Pricing Program (MPP).

The American Association for Homecare urges beneficiaries, providers, case workers, physicians, caregivers, family members and referral sources to provide feedback about the bidding program at www.biddingfeedback.com.

During 2011, AAHomecare documented more than 600 complaints in the first nine bidding areas: Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside, Calif. For every complaint we logged from Medicare beneficiaries, providers and case workers, we can reasonably assume many more have gone undocumented. The problems brought to our attention include:

• Difficulty finding a local HME provider
• Delays in obtaining medically required equipment and services
• Longer hospital stays due to trouble discharging patients to home-based care
• Significantly fewer choices for patients when selecting equipment or providers
• Reduced access to services
• Confusing or incorrect information provided by Medicare

“I’ve called a lot of the numbers on the Medicare website, and none of them have what I need,” lamented a Medicare beneficiary from Leesburg, Fla.

“We had four providers in the city, and two have been driven out of business already by this competitive bidding,” reported a Decatur, Texas, beneficiary.

We also learned that hospital discharge planners in many cases are only sending patients to HME providers who won contracts for multiple product categories under the bidding system, effectively excluding those companies that only won contracts for one or two categories. This further shrinks the pool of providers available to serve Medicare beneficiaries who require contract items such as oxygen, CPAP devices, diabetic supplies, wheelchairs and hospital beds.

Even though AAHomecare shared these problems with CMS during the past year, Medicare officials continue to insist that the bidding system has gone forward without a hitch.

Government data from Round 1 show the sharp reduction in the number of providers allowed to supply products and services to Medicare patients. This, in turn, contributes to the reduced access to and use of cost-effective home medical equipment and care for seniors and people with disabilities.

In the Riverside, Calif., metropolitan area, for instance, the number of providers eligible to provide standard power wheelchairs to new patients in Medicare dropped from 375 in 2010 to just 37 in 2011. In Pittsburgh, the decline was from 125 to 18, according to government data.

Karen Miner, a California advocate for people living with disabilities, said, “We are very concerned about the impact of the bidding procurement program on some of the most vulnerable people in our society.” Miner, who is quadriplegic and a co-founder of two advocacy organizations, Research for Cure and Californians for Cures, noted that, “If providers go out of business or no longer serve Medicare patients, seniors and others with limited mobility must wait longer for the medical equipment prescribed by their physicians. For someone with limited mobility, a power wheelchair can mean the difference between living independently at home or being confined to a care facility or nursing home.”

Economists and auction experts developed the Market Pricing Program as an alternative to the CMS bidding program. The MPP is designed to establish market-based prices around the country without jeopardizing access to care and decimating the HME sector. MPP would help preserve the economic viability of home-based care and ensure that millions of seniors and people with disabilities retain the option of remaining safe and independent at home.

Please make sure your members of Congress understand the problems with the Medicare bidding program for durable medical equipment. Visit www.aahomecare.org to learn how to contact your lawmakers.