An industry ‘dehumanized’: Providers say CMS ignored feedback, favors large companies

YARMOUTH, Maine – Home medical equipment (HME) providers say the Centers for Medicare & Medicaid Services (CMS) is ignoring what’s best for Medicare beneficiaries by finalizing its competitive bidding program (CBP) without taking into consideration thousands of submitted comments. 

CMS in July proposed new CBP policies, followed by a public comment period ending Aug. 29. The agency released its final rule on Nov. 28, largely sticking to its original plan.  

“It’s hard when CMS has not engaged with us to best serve their patients – our patients – and it goes contrary to the notion of patient-centered care,” said Bryce Schaffner, executive vice president, business development, for Bellevue Healthcare, which has nearly two dozen locations in the Pacific Northwest. “We are about humans and providing great customer service to individuals, and it feels like the industry has been dehumanized.” 

In their comments, stakeholders had lobbied for changes like excluding ostomy, urological and tracheostomy supplies; retaining the bid ceiling at the unadjusted 2015 fee schedule; and preserving the current methodology for calculating the single payment amount (SPA) using the clearing price.  

An unlevel playing field 

The biggest concern for many providers: being shut out of Medicare if they can’t compete against national providers. CMS has said that the number of contracts will equal 125% of providers that filled at least 3% of total utilization of the lead item in the category and competitive bidding area (CBA) during the most recent calendar year prior to bidding – a change that some stakeholders estimate will reduce contracts by 30% to 50%. 

Pamela Jones lost hundreds of Medicare patients “almost overnight,” when the original competitive bidding program was implemented, and nearly went out of business. 

“Since then, we have worked intentionally to build a stable, compliant business,” said Jones, president of Colorado-based Home Medical Supplies. “We invested heavily in urology and other complex care areas, believing we were creating long-term stability in a category we understood to be safe from competitive bidding. We focused on strong clinical partnerships, integrity and local service. Now, as another competitive bidding round approaches, many small suppliers like myself are once again facing deep uncertainty.” 

A small win – sort of? 

On Dec. 9, CMS announced that the next round of the CBP will not include legacy product categories like CPAP devices and oxygen concentrators. Instead, it will be limited to the items already announced as part of the remote item delivery (RID) CBP, including continuous glucose monitors (CGMs) and insulin pumps, ostomy and urological supplies, hydrophilic catheters, and off-the-shelf braces. 

“Maybe that’s a win, but I’m not sure it’s fully a win unless they address some of the reimbursement issues that still remain,” said Joel Gallion, president, Bellevue Healthcare. “Despite that, like most suppliers, we’re still in a wait-and-see mode, given the scope of what we believe is going to be laid out in the next 18 months.” 

Fewer contracts, greater risk to system 

As a respiratory-focused provider, Casey Toomajian does not have any products that will be affected, but he says what’s bad for some providers is, ultimately, bad for all providers. 

“This is signaling a trend for them to continue to eliminate providers,” said Toomajian, CEO, New York-based Hometown Healthcare. “If they keep going down that track, it’s going to create a massive vulnerability. There’s no backup if these national suppliers win the bids. It’s a crisis – a single point of failure.”