Spring comes and goes without payment amounts

Friday, July 26, 2013

WASHINGTON – The word on the street is that CMS won’t release the single payment amounts for the Round 1 re-compete until this fall, leaving more than one HME provider on standby.

CMS had planned to announce the amounts in the spring.

“It’s not fair,” said Chris Rice, CEO of Diamond Respiratory Care in Riverside, Calif., which submitted bids. “But nothing with this program is going to surprise me.”

CMS also plans to release the names of the contract suppliers in the fall and kick off the Round 1 re-compete on Jan. 1, 2014.

Providers like Frank Trammell say they can’t begin any new major initiatives until they know where they stand with the program.

“We’re blindfolded and handcuffed—it’s crazy,” said Trammell, president of Carolinas Home Medical Equipment in Matthews, N.C., which submitted bids. “I was expecting to hear something the last day in June.”

Speculation on the reason for the delay is rampant: Was the recent roll out of the program in 91 cities as part of Round 2 a much bigger job than CMS expected? Has all of the recent push back against the program given the agency pause?

“I’m sure they’ve gotten so much flack on Round 2 that they’re taking a break until the bullets stop flying,” said Mark Ehlers, owner of Ehlers Health Supply in Stockton, Calif., a Round 2 bid area. “The thinking, here, is that we’re not even hitting the iceberg in terms of the problems.”

While providers suspect CMS likely doesn’t think the delay is a big deal—it’s the second go-around in these nine cities, after all—they beg to differ.

“If a provider is not an existing contract supplier, then I would expect they’d need more ramp up time than they’re going to get,” said Bob Lichtenstein, president of Hollywood Medical Supply in Hollywood, Fla., which submitted bids.

Providers also point out that the nine areas may be the same for the Round 1 re-compete, but the product categories are vastly different. CMS has added new products like home infusion pumps, and lumped together products like oxygen concentrators and CPAP devices.

“If I’m going to do low-air mattresses as I have been, I also have to do beds, which I haven’t been,” Trammell said. “The last thing I want to do is deliver beds and lose money, but I have to in order to do low-air loss mattresses. That’s probably one of the most intelligent things that Medicare has done for itself.”

The delay adds fuel to the industry’s argument that CMS hasn’t been transparent enough throughout this process, says John Shirvinsky, who heads up the state HME association for Pennsylvania. Pittsburgh was one of the bid areas in the Round 1 re-compete.

“The problem we’ve always had is one of transparency,” he said. “That turns on a couple of different things, but one of those things is we don’t know who the winners are until they release the amounts, and usually there’s a two-month lag in between those two things. They’re going to have to turn things around pretty quickly.”

CMS officials would not comment on the record for this story.