Losing providers 'prop up' competitive bidding program

Sunday, January 23, 2011

YARMOUTH, Maine - When it comes to letting the competitive bidding program fail, HME providers are beginning to look like their own worst enemies.

Losing providers are, in some instances, artificially propping it up, say industry watchers.

By subcontracting at unprofitable rates, or providing services for free to beneficiaries who can't locate a winning provider, losing providers are sparing beneficiaries pain and suffering. Without that pain and suffering, beneficiaries won't complain to CMS, lawmakers and referral sources.

That's not good, say industry watchers.

"We're enablers," said John Gallagher, vice president of government affairs for The VGM Group. "If providers keep patients happy and comfortable, the program will likely roll on."

It's easy to see why some providers may play this losing game. Many probably expect the program to fail. As such, they want to stay on good terms with patients and referral sources. Others are just plain compassionate, said Wayne Stanfield, executive director of NAIMES.

"Nobody is suggesting throwing patients under the bus," he said. "But a provider who says, 'I can't say no to these patients because if this thing goes away I need to have my good name in the community,' needs to rethink his business model. It's not going to do you any good if you are broke."

Walt Gorski, AAHomecare's vice president of government affairs, said he's heard anecdotally that some providers who did not win contracts are still taking care of patients. That's "concerning," he said.

"The advice of the association is to follow the rules of the program," he said. "It makes no sense to prop up the program artificially."

Rather than take care of patients for free or at an unsustainable rate, give them three phone numbers, Gallagher said.

"You can say, "Call your congressman and raise holy hell; call your local media and raise holy hell; if you are bored, call 1-800-Medicare,'" he said. "Lastly, say, 'Here is the address and telephone number for the emergency room. Sorry, you are on your own. I hate to do this to you, but this is the government.'"