Providers Say CMS Letter Confuses Round One Benes

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.