State insurer follows Medicare's lead

Wednesday, April 30, 2008

NASHVILLE, Tenn. - When it comes to national competitive bidding, the state's home medical equipment providers may have escaped the wrath of CMS but not Blue Cross Blue Shield of Tennessee (BCBST).
BCBST plans to award three-year competitive bid contracts in May for HME and medical supplies for its commercial and Medicaid (TennCare) plans. Providers like Steve Kent, director of Baptist Home Medical Equipment in Knoxville, Tenn., feel like they've gotten the wind knocked out of them.
"It has been difficult," said Kent, who relies on BCBST for about 20% of his business. "We looked at contracts we do well on and contracts we don't do so well on, and we went with something in between. We didn't have a long time to look at it."
Providers had about 30 days from BCBST's Jan. 10 announcement to submit bids.
BCBST has not indicated the number of contracts it will award. On its Web site, the insurer indicated that it's moving toward competitive bidding because "the current volume of participating providers who offer DME and medical supplies is unmanageable."
"Our best solution is to enable all providers for whom we have paid claims to participate in the bidding process and describe to us how they provide the highest quality, most cost effective care," BCBST states.
Providers like Don Hite, president of Aeroflow in Johnson City, Tenn., think the industry should get used to competitive bidding. Aeroflow may even benefit from competitive bidding. Because the Asheville, N.C.-based provider is a relative newcomer to Tennessee, a contract could be a big break.
"People tend to panic about it, but it's just one of those things that you're going to see more and more of," Hite said. "We look at it as a challenge we need to overcome."
Ultimately, providers like Thomas Henley, owner of Henley Medical in Chattanooga, Tenn., blame the state, not BCBS, for the predicament providers are in.
"The bottom line is that the state has no money for Medicaid, and therefore, it's not paying insurers enough," he said. "Blue Cross has no choice but to ask providers to work for nothing." HME