Data energizes industry's bid fight

Thursday, January 19, 2012

WASHINGTON - Industry stakeholders greeted lawmakers who returned to Congress last week with new data in the fight against competitive bidding.

Claims for home medical equipment in Round 1 bid areas plunged by as much as 82% in 2011 compared to 2010, according to data obtained and analyzed by Prof. Peter Cramton, a vocal critic of competitive bidding as it's currently designed. That points to access problems for beneficiaries in those areas, stated AAHomecare, which released the data in a bulletin to members last week, and other stakeholders.

"There are serious, serious problems," said Wayne Stanfield, president and CEO of NAIMES. "You can't have claims volume go down by that much. This is potentially a smoking gun."

Cramton found that claims subject to bidding fell by the following percentages: complex rehab, 82.1%; CPAP devices, 63.7%; diabetes supplies, 74.1%; enteral nutrition, 65%; hospital beds, 63.7%; oxygen, 61.7%; standard power, 81.5%; support surfaces, 73.8%; and walkers, 71.5%.

Stanfield theorized several possible reasons for the decline in claims, most notably that beneficiaries can't find contract suppliers. That means they are: obtaining needed equipment from non-contract suppliers who can't bill for it; obtaining it from charity organizations; paying for it out-of-pocket; or doing without.

The new data should energize efforts to gain support for the industry's alternative to competitive bidding: a market pricing program or MPP. Stakeholders would like to see MPP incorporated into a final bill on the tax cut and "doc fix" due in February.

While provider Bernie Zimmer was readying himself to submit a bid for Round 2, he also did his part to lobby against the program.

"We are absolutely talking to our lawmakers," said Zimmer, officer at California Home Medical Equipment in Foster City, Calif. "I haven't really had much feedback other than 'We understand the message and we are working on it.'"



At a minimum, CMS should delay the round 2 bidding process until everyone can process this information. If even some of this is true then we need to ask ourselves how we can learn from it and do better by the beneficiaries in round 2.

Fat Chance. They have the results that they wanted. Overhaul the payment methodology and then claim to have saved the program millions by getting rid of all the fraud and abuse. Just think, all the new beneficiaries that just entered the program won't know any difference. They will just accept the system how it is.

John, I am as cynical as the next guy when it comes to this sort of thing but I think you underestimate the polical side of the equation. This sort of wholesale denial of access will cause political ripples. Not to mention the additional cost burden it puts upon the system as people more directly to more expensive alternatives such as hospitalization, therapy and nursing homes admittances.