A new spin on bidding
I talked to a wheelchair provider in Texas last week who told me they have to participate in some kind of bidding system to provide wheelchairs to Medicaid recipients in a certain part of the state. The system works like this: When Evercare, the HMO that administers the Medicaid program for the Houston area, receives a bid from a provider, it turns around and solicits a second bid from another provider. Nine times out of 10, whichever provider has the lowest bid wins the patient.
Here's an example of how the system plays out, according to the provider:
Say a patient goes to a hospital or a clinic and the therapist there selects a chin drive and some other high-end stuff. We submit it to Evercare and they send it to another provider who sends their own therapist out and they downgrade the equipment. In one case, the tech asked a patient to get out of bed—she was a para—to try a Captain's seat when she needed a head array. So then the case manager at Evercare asks us why we speced out such a fancy chair and we say, "We didn't; the hospital did with their PT and our ATP; this is what the patient needs." But they're making decisions solely on cost.
You can probably see where this is going. Providers complain that other providers are undercutting their bids and, to do so, putting patients in inappropriate wheelchairs.
The provider also gave me an audio clip of one of his employees discussing the system with one of Evercare's employees. Getting a straight answer out of Evercare seems as difficult as getting a straight answer out of CMS.