Are you playing the game?

Thursday, March 24, 2011

I'm beginning to think home medical equipment providers are damned if they do, damned if they don't.

We had a story on the front page of our March issue about industry leaders who are worried providers are helping to "prop up" the competitive bidding program by, among other things, providing services for free to Medicare beneficiaries who can't locate a contract supplier.

It's a valid concern. If providers continue to soften the blow of competitive bidding, how will anyone, especially CMS and Congress, take the negative impact of the program seriously?

No sooner did the March issue hit mailboxes than I got an e-mail from Tom Dorsey of Certified Medical in Ocala, Fla., who described what happened when he refused to play this game.

Dorsey has been getting more and more referrals for wheelchair repairs ever since documentation requirements became more stringent a few years ago and competitive bidding went into affect this year. Recently, he got a referral to fix "a charging system that went bad." The problem: The documentation from the provider who supplied the wheelchair and who stopped doing business with Medicare Jan. 1 was "lousy."

If Dorsey had agreed to play the game, he would have done the repair and written it off, keeping the beneficiary happy but oblivious to what's really going on with Medicare.

Instead, he suggested another wheelchair evaluation, and when the beneficiary bristled at that, he told the beneficiary he couldn't do the repair and bill Medicare. The beneficiary went "crazy."

Can you guess what happened next? Let me give you a hint: It doesn't involve the beneficiary complaining to CMS or Congress.

"The client, being frustrated because we would not accept assignment for the repair, filed a complaint with the Better Business Bureau," Dorsey said. "Now Medicare policy has affected my standing and rating with the BBB. I am following guidelines set forth by the federal government and now I have to justify my actions."

Play the game? Don't play the game? Neither option is attractive, but I can see now why some providers choose the former as the lesser of two evils.

But no one said it was easy to do the right thing, especially when the right thing means turning away business and the people who need your help.

"I expect more of this," Dorsey said. "I have the parts, the staff and the clients. But I can't move forward."