Competitive bidding: Questions and, maybe, some answers


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'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."

Liz Beaulieu