ATLANTA--Despite CMS' claims that sending competitive bidding information to Medicare beneficiaries “on or about June 20” would provide sufficient notice of the impending changes July 1, HME providers in the field have been besieged by calls from confused patients.
“The information coming out of CMS and being sent to the beneficiaries is definitely creating confusion among those served in the round one CBAs,” said Heather Allan, executive director of the Florida Association of Medical Equipment Services.
Allan, who noted she had spent hours on the phone with FAMES members reporting beneficiary calls citing confusion and complaints about the competitive bidding program, said she had spoken with at least 20 round one providers.
“Just as the bidding and the implementation process has been mishandled, so, too, has been the informing of the people affected,” Allan said. “[CMS' rollout] does not leave beneficiaries time to clear up any confusion or make educated decisions,” she said.
Allan is not the only one fielding questions.
Barry Johnson, president of Texas Medical Inc. in Duncanville, Texas, said his office had been flooded since the CMS letter arrived.
“We are experiencing numerous phone calls plus on-site visits at our location from beneficiaries who believe they must change providers. They are unhappy about the short notice provided by CMS and do not understand why CMS waited so long to educate them about competitive bidding,” Johnson said.
“In addition to patients, physicians have been calling stating other competitive bid winners have remarked they are the 'only' Medicare provider selected in the [Dallas-Ft. Worth] MSA. We continue to assure the physicians and their staff there are several providers ... We have heard complaints from providers that some bid winners have been contacting their patients and asking them to switch providers but as of this writing, none have switched, preferring a wait-and-see position,” he said.
Johnson said Texas Medical is experiencing an unforeseen positive in the form of customer support.
“It is a tremendous feeling to have the patients say, 'I trust you,' and continue to wait before changing providers until Congress acts,” he said Wednesday.
Providers are also taking their questions to the government.
On Tuesday, during an “Ask the Contractor” teleconference held by NHIC, the Jurisdiction A DME MAC, one provider asked what CMS was doing to clarify its policies for beneficiaries. The provider, a winning bidder, said she had received numerous calls from HMO beneficiaries wondering how the competitive bidding program applied to them.
An official answered that competitive bidding does not apply to beneficiaries in HMOs. Those beneficiaries were notified about the program, she said, because CMS sent its information packets to every beneficiary in the 10 round one CBAs, regardless of whether the program would directly affect the individual.
In email messages last week, members of both The National Association of Independent Medical Equipment Suppliers (NAIMES) and the Accredited Medical Equipment Providers of America (AMEPA) reported receiving similar calls from beneficiaries in round one.
According to NAIMES President and CEO Wayne Stanfield, the CMS letter contains “vague” information and does not explain important concepts, including beneficiaries' ability to purchase non-contracted items.
“The letters, which began arriving at patients' homes [June 20], prompted over 50 calls to one supplier with questions about what the program was about and wanting to know why they had to switch suppliers. Many were confused by their current supplier not being on the list,” Stanfield said.
“The vague letter left beneficiaries with more questions than it answered,” Stanfield continued. “It also left patients feeling that they must get all of their equipment and supplies only from contracted suppliers, even if it was not included in the contract. Several suppliers indicated that the letter would push confused patients to competitors because of the failure to explain the program. Another supplier expressed that patients will switch or be influenced to switch because they will call suppliers on the bid list even though they are not included in either of the product areas or categories.”
On top of the confusing CMS notification, Stanfield said, some providers have resorted to illegal practices to net more business.
”There [have] been a lot of strange goings on in the CBAs and little of it good. Suppliers winning the bid are begging for help, they are opening branches and buying equipment like crazy. It's becoming a cutthroat marketplace and pitting local competitors against each other …
“NAIMES has received a copy of a letter being distributed by a bid-winning company offering to buy referrals from bid losers and other suppliers. Such actions are both illegal and unethical. Paying for referrals is a violation of the anti-kickback statutes. There are clear indications that serious problems are arising from the ill-conceived bidding process, and by the failure of CMS in managing the contractors given responsibility for the program as well as providing adequate guidance for the program.”
Further, Stanfield said NAIMES had learned that, as of last week, some companies included on the contract supplier list published by CMS still had not “received or signed the competitive bidding contract. This would seem contrary to the information released by CMS, and could further complicate the implementation of the bid program.”
Rob Brant, president of AMEPA, said his organization had also been fielding letter-driven questions. Brant said providers in his group were “inundated with calls” from “confused patients, caregivers, guardians, doctor's offices and other health care providers.”
According to Brant, the information provided by CMS included no background or details on grandfathering, so many beneficiaries were unaware that they might be able to stay with their non-contracted provider.
“The cover letter, which accompanied the list [of contracted suppliers], has no mention of the ability to be 'grandfathered' with the patient's current supplier. It only states that 'If your current supplier isn't listed, contact them for more information,'” Brant said.
For answers to questions on grandfathering, Brant directed inquiries to the Medicare Web site at www.medicare.gov, but he said the site provides no clarification and instead touts the money-saving prospects of the new program.
“As one guardian explained [to me], 'I wish the Web site would have less propaganda about how we are saving money and explain how I am supposed to get my mother her equipment under this crazy system,'” Brant said.
Brant said some providers were also facing additional, and previously unforeseen, challenges.
“We also received calls from bid winners that explained their own patients wanted to leave their company even though they are bid winners in the CBA. The patients thought that since the list of providers was divided by cities that they had to use a provider in that city.” In one example, Brant cited a call from a beneficiary who lives in Tamarac, Fla., a Ft. Lauderdale suburb, who thought he would have to use an oxygen provider in Tamarac.
Allan said she is not surprised by the turmoil coming out of the mad rush toward July 1.
“The whole process has been so terribly flawed that it's done horrible things to the industry,” she said, “and the beneficiaries will not be served by competitive bidding.”
Added Stanfield, ”CMS has set a monster in motion, and I hope we can stop it.” He noted the confusion may not be over for beneficiaries. If competitive bidding is delayed, he wondered, what will CMS do then?
”All contracts [would be] cancelled … so what does [CMS] do? Send out a 'nevermind' letter? It just points me to the blindness of CMS and its leadership,” he said.
