Blues Terminate Florida HME Contracts; FAHCS Offers Alternative

DORAL, Fla.—Working against a ticking time bomb, the
Florida Alliance of Home Care Services is striving to get Blue
Cross/Blue Shield of Florida to reconsider its decision to
terminate vast numbers of HME provider contracts, according to a
FAHCS spokesman.

“We are less than 60 days away from the last day most Blue
Cross/Blue Shield providers will be able to [serve the Blues
patients],” said Sean Schwinghamer, executive director of
FAHCS. “We have been trying to schedule a meeting with Blue
Cross/Blue Shield to discuss this. We hope to meet with them to
offer our alternative.”

Officials at BCBS of Florida could not be reached for
comment.

Beginning in the spring and culminating July 27, hundreds of
Blue Cross/Blue Shield providers across Florida were notified that
their contracts were being terminated at the end of 90 days. The
notices were an especially hard blow since Florida providers are
also grappling with the threat of Medicare competitive
bidding—two of the Round 1 CBAs are in Miami and
Orlando—and issues with Florida Medicaid, both of which would
also push providers out of payer programs, Schwinghamer pointed
out.

No explanation for the terminations was given, and providers
from across the state were unable to gain any information from
BCBS, they told FAHCS. However, published reports indicate that
BCBS invited some large regional providers to participate in a
competitive bidding process in an effort to shave administrative
costs.

According to TCPalm, an online newspaper that covers
Florida’s Treasure Coat and Palm Beaches, the results of that
process mean only three HME providers will be allowed, as of Nov.
1, to serve BCBS patients in the populous Treasure Coast
area.

“Liberty Medical Supply and Physician’s Choice
Respiratory Services, Inc., both in Port St. Lucie, and Rotech
Oxygen & Medical Equipment in Stuart remain as the lone
Treasure Coast suppliers after the bidding,” Jonathan Mattise
wrote in TCPalm. That information, he reported, came from a BCBS
list sent to Oxygen Plus in Vero Beach.

According to the list, the news report said, the BCBS bid
limited provider offices in the state to 100 and comprises 41
companies.

Schwinghamer, who said he has been taking calls from providers
from throughout Florida, said hundreds of them would be severely
affected by the BCBS move. Of the scores of providers FAHCS has
been in contact with, he said, “most are over 65 percent Blue
Cross Blue Shield.” Some have more than 1,000 BCBS patients,
and one has been a BCBS supplier for 24 years, Schwinghamer
said.

After learning of the terminations, FAHCS President Roger Ribas
sent a letter to BCBS asking that they be reconsidered. “We
request that you reconsider your mass termination due to the many
negative effects it will have on our state and its patients,”
Ribas wrote. “These terminations will force lay-offs, the
firing of gainfully employed people state wide and it will also
force the closure of many businesses during already extremely
difficult economic times.”

Ribas proposed a possible alternative that would help BCBS shave
costs and still allow providers to remain in business. Under the
proposal, terminated providers would “come under the umbrella
of VGM Homelink,” the Waterloo, Iowa-based service
group’s nationwide HME services coordinator.

“Under this plan, BCBS will have one source with which to
bill and coordinate new patients, existing patients can retain the
same quality level of service from the same qualified providers
with whom they have been working and your cost savings can be
replicated without having to negotiate with numerous providers
statewide,” Ribas wrote.

Schwinghamer said BCBS has acknowledged receiving the letter.
“Things are moving forward the best they can at this
time,” he said. “We are hoping something can come from
this. We are using every means available to us to help providers
stay in business.”