Commentary: No Calm Before the Storm

Commentary by Rob Brant, president, AMEPA

Editor’s Note: HME provider Rob Brant of
City Medical
Services, North Miami Beach, Fla., is president of the Accredited Medical Equipment
Providers of America, formed in 2008 to stop competitive bidding. Still
working hard in support of H.R. 3790 to repeal the bidding program,
the following are Brant’s thoughts as CMS prepares to reveal
payments (expected June 25) resulting from the Round 1
rebid.

“It will all work out.”

That is what I remember telling my office staff and my wife at
home, in March 2008, as we waited for the release of the DMEPOS bid
results. I explained options to a loyal staff, unsure if they would
have a job in a few months, and a concerned spouse who wondered how
the family was going to cope financially as losers or winners.

But I was naively optimistic. For some crazy reason I had this
strong feeling of confidence that I was going to win the bid. I
based that on the knowledge that no one else in the Miami MSA put
as much time and effort on their bid package. Surely the
Competitive Bidding Implementation Contractor should have taken a
moment to recognize the genius in my method of calculating prices
for items with large weights and high utilization, versus those
with small weights and low utilization.

Counting down the days before the bid release, I felt as if the
DME gods owed me a bid contract based on the amount of time I
analyzed my bid and for the effort alone. In the highly unlikely
scenario that I lost the bid, my fallback plan was to subcontract
with friends in the industry that I knew from my years on the board
of the [Florida] state association and at VGM educational
conferences. The oxygen cap was nine months away, and surely
Medicare was going to pay providers a fair reimbursement for
ongoing maintenance and service after month 36.

I figured that by early 2009 if things didn’t work out, I could
always downsize. Plan C was to sell my house while the housing
market continued to skyrocket in South Florida. After all, home
prices always go up. I could go into another business. I was
college-educated, unemployment levels were low and the economy was
booming.

Us Vs. Them

Fortunately, I was disqualified from the bid, and as reality set
in, it was clear that the industry needed to work together to
repeal the program. It should have been a call to unite the entire
industry, but unfortunately companies that were rumored to have won
the bid, who called me for advice during the bid process, were not
returning my calls. The fantasy about having a monopoly or selling
their business and bid contract were stronger than years of
friendship.

Besides a handful of logical business owners, most bid winners
had a mentality of “us” vs. “them” in the battle to keep bid
winning contracts against those who were trying to delay the
program. It was nice to see that once the program was officially
delayed in [July 2008], most of the former bid winners, who were
not previously involved, joined AMEPA and the national effort to
repeal the flawed program.

Out of Options

This time around we hopefully know better. The cost of doing
business and ability to maintain cash flow has certainly changed
since March 2008. There have been additional operating expenses and
losses in revenue:

• 36-month oxygen cap
• 9.5 percent cut in reimbursement
• CPAP compliance requirements
• Upcoming removal of the purchase option in power mobility
• Prepayment reviews for oxygen, CPAPs, APMs and enteral feed
  supplies
• DME MAC, Recovery and ZPIC audits
• Surety bonds
• Loss of other insurance contracts

[This] week, as bidders learn their fate, I certainly hope that
those offered contracts take the time to evaluate how their
businesses will continue to operate under the additional
reimbursement cuts and realize that they were not winners after
all. This time I hope they will return my calls and work together
with the industry.

Since it is clear that there will be no “winners,” if all those
“offered” and “not offered” contracts work together, we can finally
put an end to the threat of DMEPOS bidding and focus on resolving
other issues that threaten our ability to service our patients and
the health care community.

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stories.