The waiting game
WASHINGTON - It's no surprise that providers who expect to participate in the second round of national competitive bidding are watching the first round of the program closely. What's less clear: How much should they be doing right now to prepare for the program?
In 2009, CMS plans to extend competitive bidding to 80 more cities. The agency hasn't named the cities yet, but providers across the country have a good hunch based on population statistics.
Providers like Wendell Matas, president of Wheelchairs Northwest in Bellevue, Wash., are "watching what's going on and talking to peers," but they're hesitant to invest too much time until a specific implementation date nears.
"There's so much effort that goes into preparing for something like this, and often, the minute you're ready, (CMS) makes changes," said Matas, who suspects CMS will select Seattle-Bellevue for the second round. "I'm trying to understand what the pieces are and what my options are, and I'll make decisions when it's on the horizon."
Other providers like Marcia Togami, the billing manager for Albuquerque, N.M.-based A&R Medical Supply, have made preparing for competitive bidding a regular exercise. She's part of a committee at the company that addresses competitive bidding monthly.
"We don't want to be caught with our pants down," said Togami, who suspects CMS will select Albuquerque for the second round. "When I went to Medtrade Spring this year, I was astonished at the number of providers in the first round who are totally unprepared. In one seminar, a woman in the Riverside competitive bidding area said she was looking for subcontractors. I thought, 'It's a little too late for that. You should have been talking about that two years ago.'"
A&R Medical's competitive bidding committee discuses everything from increasing non-Medicare related businesses, such as retail and managed care; to assessing its credit reports and ratings; to working with manufacturers to reduce prices; to cutting costs, such as trimming the number of oxygen deliveries to one per month.
"We go through our expenses line-item by line-item," Togami said. "Nothing can be left untouched, not gas bills, not cell phone bills--nothing."
Like Togami, Jackie Bolt, owner of Carolina Homecare in Greenville, S.C., has already taken steps to make do with decreased reimbursement, a likely outcome of competitive bidding. She recently implemented new technology (everything from GPS tracking devices to document imaging systems to portable oxygen concentrators) and started reorganizing and restructuring the company.
"We're trying to downsize management staff and employees gradually," said Bolt, who expects CMS to select Greenville for the second round. "We don't want such a shock to our daily operations or to our patients."
Providers like Doug Crana, however, will feel more comfortable making decisions once they see the results of the first round. Crana, president of Consolidated Medical in Newburgh, N.Y., expects CMS will select several areas in New York for the second round.
"That's going to be so important--that's really going to tell us how to prepare," he said.