Competitive bidding: 'We'll wind up with a monopoly'

PITTSBURGH - CMS's national competitive bidding program could reduce the number of HME providers so significantly that it creates a monopoly, warned U.S. Rep. Glenn Thompson, R-Pa., during a media conference call last week.

Thompson pointed out that, in CMS's first crack at competitive bidding in 2008, it decreased the number of providers by about 90%, from 4,127 to 376 in 10 cities.

"I have a large concern that if the number of providers, especially small providers, declines, we'll wind up with a monopoly, and we'll see (Medicare) costs grow tremendously," he said. "Because when you create a monopoly, that's what happens."

The Pennsylvania Association of Medical Suppliers (PAMS) hosted the call to speak out against competitive bidding and drum up support for H.R. 3790, a bill that would eliminate the program. Competitive bidding is scheduled to go live again Jan. 1, 2011, in nine cities.

Thompson believes Medicare costs could grow because, with fewer providers, beneficiaries will have a harder time getting appropriate equipment and services. Without appropriate equipment and services, they're more likely to end up in hospitals.

"The outcomes are never good," he said.

Joining Thompson in criticizing competitive bidding was U.S. Rep. Jason Altmire, D-Pa., who, in 2008, helped the industry delay the program for 18 months. Altmire echoed Thompson's concerns about putting the health of beneficiaries in the hands of a few providers.

"When you have national providers come in and they're able to undercut local providers--that's clearly not good for the local provider, but, more importantly, it's not good for the patient," he said. "The patient has to have that personal relationship with the provider for follow-up care over the course of a lifetime."

Thompson and Altmire are both co-sponsors of H.R. 3790, which, at press time on Friday, had a total of 75 co-sponsors. Even though the bill didn't get attached to the House of Representatives' healthcare reform bill, Thompson believes it has a chance as a standalone bill. Altmire believes it has a chance as an attachment to another bill, possibly another Medicare bill or an appropriations bill.

Listeners to the call, which included reporters from the Pittsburgh Post-Gazette and Congressional Quarterly, also heard from Lucy Spruill, a consumer and director of public policy and community relations for United Cerebral Palsy of Pittsburgh. She says even without competitive bidding, there are access issues.

"There are often very long waits between ordering a wheelchair and getting it delivered, and long waits for getting repairs," she said. "If the number of providers is drastically reduced, that's just going to make a bad situation completely intolerable."