SBA Appeal a Lost Cause, Provider Says

MIAMI–A Miami HME provider who appealed to the Small Business
Administration for help in fighting competitive bidding said last
week he is giving up on getting any support from that agency.

Rob Brant of City Medical Services in North Miami Beach said
that he and other providers involved in the effort are now striving
to generate support for H.R. 1845, the Tanner-Hobson bill, which
would allow qualified providers who do not win a bid to continue to
do Medicare business under the new competitive bidding rates.

“There is no place to go with the SBA,” said Brant, who earlier
this year mustered the support of more than 70 other small Florida
providers and filed a formal complaint with the SBA ombudsman
against the implementation of competitive bidding. The complaint
charged that “CMS improperly interpreted the congressional mandate
and did not provide the appropriate protection of small suppliers.”
(See
HomeCare Monday, May 22.)

The agency has responded with form letters, including one from
CMS, Brant said. “They say the complaint is unfounded, that it’s
fair for everyone,” he said.

So Brant and his peers are taking another tack.

“We’ve been very focused on visiting congressmen and women about
Tanner-Hobson and getting the word out to our patients about [the
bill] and giving patients the toll-free switchboard line to
Congress to say we are not happy about what is happening,” Brant
said.

“In every state where there is competitive bidding, I think
every congressperson should sign on to Tanner-Hobson,” he added.
The bill has picked up 130 cosponsors, but needs more to move
forward.

Like other HME providers in the first 10 cities where the
bidding program is being implemented, Brant, who did bid, is in a
holding pattern until the winners are chosen and the new allowables
are revealed by CMS. Bid winners will be announced in March or
April of 2008, the agency said at a recent meeting of the Program
Advisory and Oversight Committee. The resulting reimbursements are
set to take effect in July.

“We are just waiting to see what the allowables will be compared
to other areas,” Brant said. “Right now, we are trying to do as
much business as we can while we still can.”

Already, though, he is seeing an impact from competitive
bidding. Some smaller providers have closed down, Brant said, and
whether his company wins a bid or not, he anticipates big
reimbursement cuts. So he is looking everywhere for business
economies, even at service. “We used to visit patients every week.
We can’t do it anymore. We’ve told about three patients a month
that we can’t service them the way they are used to being
serviced,” he said.

Brant recognizes, he said, that the providers in the first round
of MSAs are essentially guinea pigs. “The next 70 MSAs will benefit
so much from the knowledge of what happens to us,” he said. “They
are having time to get accredited, trim the fat, gobble up the
customers from businesses that are closing.”

Still, he is hopeful that Tanner-Hobson will eventually pass and
competitive bidding’s impact can at least be blunted.

“We’re going to keep plugging away and do what we can,” Brant
said. “We have eight months left ’til the end of the world.”