By Andrew Morris
Background
When Congress passed the Medicare Modernization Act of 2003, one of the ways it paid for the new prescription drug program was to require a competitive bidding program for wheelchairs and other durable medical equipment (DME) that Medicare pays for. United Spinal Association, along with other disability groups, has voiced concerns to Congress that the looming competitive bidding program is likely to harm Medicare recipients.
What is competitive bidding and where will it happen?
The Centers for Medicare and Medicaid Services (CMS) will roll out the new competitive bidding program in 10 metropolitan statistical areas on July 1. CMS put out a call for providers in these areas to bid on the costs of providing wheelchairs and other DME that Medicare will pay for. Companies submitted bids based on the lowest cost for which they thought they 
could provide services and supplies. Some of the winning bids were from companies that have never provided wheel chairs or other DME, and they may be unaware of the ancillary services that are needed. Once CMS announces the providers in the affected areas, it is only through these CMS selected providers that people can use Medicare to obtain wheelchairs and other DME. Even if you do not live in a listed area and are visiting and need an emergency fix, you will have to know ahead of time who is authorized to provide service and go to that provider.
Metropolitan areas affected by the July 1 start date are:
- Charlotte-Gastonia-Concord, N.C.-S.C.
- Cincinnati-Middletown, Ohio-Ky.-Ind.
- Cleveland-Elyria-Mentor, Ohio
- Dallas-Fort Worth-Arlington, Texas
- Kansas City, Mo.-Kan.
- Miami-Fort Lauderdale-Miami Beach, Fla.
- Riverside-San Bernardino-Ontario, Calif.
- Orlando-Kissimmee, Fla.
- Pittsburgh, Pa.
- All of Puerto Rico
The second round of competitive bidding is slated to take affect in January 2009 in an additional 70 metropolitan areas.
What kind of durable medical equipment and supplies are affected?
Under the new program, Medicare beneficiaries who need DME and related services must use only those vendors selected by CMS through the bidding process. No longer will people have a choice about where they go for supplies.
Equipment that falls under the new program includes:
- Power wheel chairs
- Oxygen
- Complex rehab wheel chairs
- Mail order diabetic supplies
- Enteral nutrients, equipment, and supplies
- Hospital beds and related accessories
- Respiratory assistance devices and continuous positive air pressure devices.
What are the concerns with competitive bidding?
United Spinal Association and other disability groups have five primary concerns with the new program:
- Decreased quality of devices, products, and technologies. The new reimbursement rates will be a disincentive to suppliers to offer the highest quality of services and products. Medicare has said that it expects to lower reimbursement rates by 26 percent. A lower reimbursement rate will almost surely mean lower quality equipment. The wrong wheelchair can easily lead to secondary conditions.
- Decreased service. Suppliers who bid and win contracts may not fully understand the time that goes into equipment being fitted or programmed for use for each individual’s needs. Since Medicare will be paying less to suppliers, the suppliers may reduce the number of hours they are available, may have less qualified staff to help, or may simply cease providing needed related services such as repairs.
- Decreased accessibility to suppliers. CMS was expected to award 9,000 service contracts in the first 10 metropolitan areas but only awarded 1,300. This large difference means that there will be fewer suppliers available to people who need services. People will be forced to travel further to get needed services – which can be a serious burden to someone with a functional limitation. In some cases, this burden could ultimately jeopardize someone’s ability to live in their community.
- Diminished relationships with suppliers. People often develop an on-going relationship with their suppliers over the years. Many people have used the same supplier for a number of years. Unless their supplier is one of the chosen contractors people will be forced to give up the relationship and trust and go to a stranger who does know their condition, history, or related needs.
- Decreased access to brands of equipment. People may find that they no longer have access to brands of equipment that they need. Since CMS will be paying less money, suppliers will not be able to afford the same equipment as in the past. People could be forced to use equipment that does not fit their personal needs and could ultimately impact their health.
What can be done?
Now is the time to act. Next Tuesday May 6, 2008 the House Ways and Means Subcommittee on Health will hold a hearing on this important matter. Contact your members of Congress and ask them to put a halt on this new CMS competitive bidding program. This program is simply not ready to start. Assurances are needed that people on Medicare will have access to the equipment and services they need. To find your members of Congress go to www.house.gov and www.senate.gov.
This post is late since it’s now May 16th; however, if CMS and Congress really want to reduce unnecessary costs, they would purchase all DME from manufacturers. Bidding is routine to become a government sub-contractor, and any business will go out for bids–government or not. That’s why we spent nearly 15% on medical care in the U.S. yet the other top healthcare nations are under 7% but provide care for everyone, no opting out, not “Socialize Medicine,” and also cover glasses, alt. medicine, spas, stress reduction, etc. (see http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/talk/index3.html).
The key is getting the consumer involved, and each of us taking responsiblity to know the actual function of each member of our healthcare teams…but most importantly what constitutes professional conduct–our lives depend on this.
Work is being done now between Congress and CMS’s Weems, and DHHS’s Leggett – it should. Congress was not given all the information by CMS to make a wise decision in their voting…but we must speak up, too. Unless we share “where” we are, and what we need to be optimally healthy, no one really will know–and frankly,most physicians are the last to know, much less communicate our status or needs to anyone, or the referrals they make (and are responsible for) would be followed up on and save us all a lot of grief.
We will help one another as much as possible, and have people with neuromuscular conditons, TBIs, breathing disorders, on vents, wheelchair users, etc. Helping one another identify breathing disorders is prime, and supporting those with NM conditions–especially Polio survivors. At the same time, we all need to become more astute healthcare consumer and realize who is really serving us and their qualifications, responsibilites to us, and their primary functions.
At the same time, we must demand that CMS act more responsibly at all levels, and judicious purchasing is one area that must involve the consumer; there’s far too little transparency with medical vendors services, billing, acquisitions, equipment, encentive programs, bonding of in-home workers, and responding to physicians orders – we are the consumer.