Questions and answers

Tuesday, November 23, 2010

What's life like without Medicare?

The remnants of Hurricane Tomas brushed the coast of Maine the night of Nov. 7, dumping heavy rain and blowing strong winds. I had some water in my basement, but I didn't lose power, so I didn't think much of it. But when I arrived at our offices the next day, I learned that the Internet was down. That meant no writing or responding to e-mail, no posting fresh stories or blogs to our website and no tweeting.

After about a day and a half of this, I must say I started to feel lost. I mean, I had to call, rather than e-mail, our cartoonist with the concept for this month's cartoon, and he had to fax, rather than e-mail, me a rough draft.

The whole experience got me to thinking: This is how non-contract suppliers  will feel Jan. 1, 2011, when the competitive bidding program starts. The Internet has become ubiquitous to my job, and Medicare has become ubiquitous to theirs. So what will life be like without Medicare?

Well, if it's anything like life without the Internet, it won't be business as usual, but it'll still be business. But just as I had to forgo e-mail and websites for phones and fax machines, non-contract suppliers will have to forgo Medicare for other payers, and, in some cases, reimbursement for cash.

The truth is, without the Internet, I got more work done. Maybe without Medicare and all of its trials and tribulations, providers will generate more business.

What are they supposed to do?

Shortly after CMS released the names of the contract suppliers, the previously tight-lipped  Scooter Store announced it had accepted contracts in each of the nine CBAs for standard and complex power wheelchairs, and hospital beds. It also accepted contracts in four CBAs for oxygen equipment and supplies.

When it came time to address whether competitive bidding is good or bad for the industry, The Scooter Store walked a tightrope. The company stated that it's pleased it won contracts and it expects them to result in "accelerated growth" for the company. But it also stated that it shares the industry's concerns and those expressed by bidding experts.

I'm sure this will piss off a lot of our readers. But given the circumstances, what else is The Scooter Store supposed to do? On the one hand, they need to act like competitive bidding is the new normal, and on the other hand, they have to fight like hell.

What's the rest of the story?

I groaned in November, when CMS officials stated that 92% of the suppliers who were offered contracts accepted them, giving officials "great confidence" in the program. That number may be statistically correct, but it doesn't tell the rest of the story.

The rest of the story is that many of the contract suppliers accepted contracts because they felt they had no choice. One said: "It was either don't accept the contract and get a bullet to the head or accept the contract and have terminal cancer."

The rest of the story, according to economist Peter Cramton, is that the high acceptance rate could be a sign that a good number of the contract suppliers are: a. small suppliers who used unsophisticated methods to develop unrealistic bids, b. desperate suppliers or c. fraudulent suppliers.

That CMS officials are so black and white on this topic shocks me. These are the same officials who, when asked for the date when they'll start denying HME claims with the names of physicians who aren't enrolled in PECOS, said:

"It's not likely that (the denials) would be before July. I did not say that it will not be before July. I don't think it will be before July, but you can never tell." hme