While all eyes are on competitive bidding, it's not the only microcosm in town


I called a provider in Mississippi the other day after my editor, heretofore known as...Liz... asked me to. Seems this person knew of over a dozen local providers that had closed their doors. Liz' theory: It must have to do with competitive bidding.

"Mississippi could be a microcosm of what's happening around the country," said Liz.

In five years of working with her, that's the first time I have heard Liz utter the word "microcosm."

Actually, what the Mississippians are currently battling is audits. You remember those, the RACs, ZPICs, OIG's etc that have have ramped up in frequency and intensity over the past year or so. It seems that Mississippi is the latest state caught in the prepay audit bullseye. Providers simply can't keep their doors open when their cashflow is halted.

I also talked to Michael Hamilton in Alabama, and asked if he had heard of providers closing in his state. He estimates that ADMEA has lost about 15 members a year over the last three years.

His take: the oxygen cap.

"They tried to sell the business and then gone back and just tried to give away the patients," said Hamilton. "They were unable to do that if they were mostly oxygen. The patients were all capped and nobody wanted to assume liability for unknown equipment."

Hamilton also cited shrinking reimbursement as another reason.

Competitive bidding. Audits. Oxygen cap. Declining reimbursement. The higher cost of doing business. The economy, stupid. Yes, there's plenty of issues, with corresponding microcosms, to choose from out there.

It's a wonder folks have time to take care of patients.

Theresa Flaherty