Providers appeal for help

‘They’ll miss us when we’re gone,’ says Karyn Estrella
Friday, May 20, 2016

PORTLAND, Maine – Providers from around New England took to the podium at a Small Business Administration hearing here last week, giving government officials and lawmakers an eye-opening look at what it’s like to be in the HME business right now.

“I am here today to tell you that CMS's implementation of competitive bidding, capped rentals on home oxygen therapy and ongoing unnecessary audits…is as bad, if not worse, than what is going on with the Veterans Administration,” said Michael McDonald of Clinical 1 Home Medical. “The time has come for Congress to launch an investigation into this program.”

McDonald was one of several HME providers who testified about the impact of competitive bidding and other issues on small businesses at the May 16 regulatory fairness hearing, one of several being held across the country.

McDonald discussed his company’s own experience with the bidding program—“a complete disaster,” he said—and also questioned the impact on patients of a program in which local providers are not awarded contracts.

“How in the world is a company in Florida going to provide same day delivery to Mass General Hospital on a Friday afternoon?” he said.

Providers also testified on burdensome documentation requirements and excessive audits. Provider Darryl Coplan typically appeals audits at great time and expense to his company, but he always comes out on top.

“We feel honored when we win, but it takes two-and-half years,” said Coplan, of Keene Medical. “How can companies survive when the government holds their money for that long?”

One of the board members asked how most auditors get paid. Upon hearing that they are paid a percentage of the money they recoup, a shockwave—and a few low whistles—rippled through the audience, which included staffers from several lawmakers’ offices, including Sens. Angus King, I-Maine, Susan Collins, R-Maine, and Jeanne Shaheen, D-N.H.

Perhaps some of the most powerful testimony of the afternoon came from Dr. Susan Bergman, a Massachusetts physician, who shared the stories of three patients who died either while waiting for necessary equipment or because Medicare coverage guidelines imposed limits. One of those patients: a 46-year-old triplegic who suffered two bouts of sepsis and ended up on life support.

“He needed to change his catheter every two weeks to avoid infections, but Medicare would allow only one per month,” she told the board. “His hospital expenses were well over $1 million.”

Board members asked how much a catheter costs and upon learning it was typically less than $2, one said,

“So for the cost of a few trips to Starbucks, (this could have all been avoided).”

At the hearing’s close, SBA Ombudsman Admiral Earl Gay referenced recent hearings in the Dakotas, as well as a roundtable in Cheyenne, Wyo.

“We need to continue to ask (lawmakers) to initiate legislative resolutions to these issues,” he said.

With more than 10,000 people turning 65 every day, there’s no time to waste, said Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England.

“If CMS thinks it is paying too much for home medical equipment now, wait until there is a shortage of providers,” she said. “They’ll miss us when we’re gone.”