Nat'l competitive bidding: 'Someone is going to lose'

BALTIMORE - Panelists representing key segments of DME - rehab, respiratory services, O&P, diabetic and enteral supplies - made passionate pleas to CMS officials in late September, arguing that their specialties are clinically complex and should be exempt from national competitive bidding. "The panels were patient focused and explained how home care is a safety net between the physician and patient and that they provide services like no other," said AAHomecare CEO Kay Cox. "If it isn't provided, there will be a downfall in the infrastructure of seniors and disabled that we service today." The panels presented their cases Sept. 26-27 during a meeting of the Program Advisory Oversight Committee (PAOC), a group assembled to advise CMS on how to craft a competitive bidding program for DME. The common theme of each panels' argument: Their specialty involves a complex mix of product/technology, service and care that makes it inappropriate for competitive bidding. By including these specialties in a competitive bidding program, reimbursement could be cut to a level that forces providers to reduce services. That, in turn, could reduce patient compliance and outcomes, and result in more emergency room and hospital visits. "You can't just drop off a portable concentrator or liquid system with a pulse dosing component or a cylinder with a conserver and make the assumption that that patient is going to be well managed and oxygenated appropriately," said Joe Lewarski, who represented the American Association of Respiratory Care (AARC) and spoke on behalf of the respiratory panel. The respiratory panel advocated that clinically complex respiratory services - oxygen, sleep therapy, ventilation and potentially aerosol therapy - should be excluded from competitive bidding. Rehab panelists said it's impossible to bid high-end custom wheelchairs, where each unit is configured to meet the unique needs of a single patient. Bidding diabetic test strips could result in less face-to-face contact between patient and pharmacist, reduced disease management and consequently increased foot problems and other complications, said members of that panel. "The panels were saying the same thing: Implementation of competitive bidding at this point is extremely dangerous to the patient, and no one sees it working," Cox said. While that may be true, the message comes too late in the process, said one provider who attended the meeting. "They should have pointed that out last fall," he said. "It's too late. Someone is going to lose." Indeed, as the various HME specialties jockey for a carve out, the result could be that everyone's message becomes diluted and less effective, the provider said. "As we try to carve out, we carve each other up," added John Gallagher, vice president of government relations for VGM. "At VGM, we sink or swim together."