WASHINGTON — In a race to stop the competitive bidding clock, more than 600 HME stakeholders weighed in with comments on the project's interim final rule, with most calling for CMS to rescind the rule before it takes effect April 18.
The rule initially had an effective date of Feb. 17--a month before the comment period was set to end March 17. When CMS delayed the effective date for 60 days to allow the new administration time for review, it left the comment deadline intact.
Under the IFR, the agency would make another stab at implementing competitive bidding on a national scale with a rebid of Round One this year. Last July, Congress delayed the DMEPOS program for at least 18 months so the many procedural and other problems could be fixed. But home care advocates have said that very few of the issues raised then have been addressed in the IFR and, in their comments, many pleaded with CMS to withdraw the rule.
Ellen S. Durrence, owner of an HME business in South Carolina, pointed out that competitive bidding originated to save Medicare 12 percent in 2006. Since then, she said, Medicare has shaved payment amounts by some 5 percent, and in January of this year, CMS instituted another 9.5 percent cut on 10 product categories.
“This equals around 14.5 percent reduction! This is more than 12 percent, so why destroy the industry and the access to health care for the elderly by implementing the competitive bidding program when the goal is more than met?” Durrence questioned.
“Small DME companies like the one I run will close with competitive bidding, competition will be no more with competitive bidding, and competition is one of the original conditions for participation of [the] Medicare program,” she added. “This is America, and the ability to run a company and serve your customers and make a difference will be gone! Please, rescind the competitive bidding rule completely!!! Let Americans keep their businesses and serve the patients that they have come to know.”
Gloria Knutson, an Arizona provider, wrote: “The entire competitive bidding program is and has been a disaster. It was not well thought out, [it] eliminates patients’ ability to choose their providers, and I believe [it] will lower quality of care and products.
“CMS already controls costs; making all providers bid against one another to provide a service is crazy. I don't want to lose my clients, many of whom I have been providing medical items and equipment to for several years and have a relationship with, to another provider just because he wins the bid. This plan and rule [were] conceived by those who know nothing about the industry and real world. Stop the implementation of competitive bidding totally. There are other ways to control costs--the DME providers are not the problem.”
In its comments, the American Association for Homecare also asked CMS to withdraw the IFR and issue a proposed rule. “CMS sidestepped all of the important procedural protections inherent in rulemaking by publishing an IFR with an effective date approximately one month before the deadline for submitting comments,” AAHomecare asserted.
The organization also called on CMS to “convene the [Program Advisory and Oversight Committee] as well as solicit comments on its proposal to revise financial documentation requirements and explain, in detail, its plans for implementing the new oxygen rules under the program and provide an analysis of the combined impact of a 9.5 percent payment reduction and competitive bidding on small businesses.”
As well, the association said, CMS should review the “factors that hampered an effective roll-out of Round One and address how it proposes to prevent their recurrence.”
Some state associations also submitted comments on the IFR, including the Ohio Association of Medical Equipment Services, which said CMS underestimated the magnitude of the program and its impact.
”As a state with two bidding areas in Round One, we have been on the front lines of the roll-out of this program since its inception and witnessed firsthand the lack of clear communication and timely information throughout all stages, even up to the final hours before launch,” OAMES said. “The program’s real impact on seniors’ lives, the delivery of their health care services and the small businesses and continuum of care professionals providing these home care services are too important to be hastened through a tight timetable with vague direction.”