Providers 'scratching their heads'

Blown away by CMS's decision to include complex rehab in the first round of national competitive bidding, providers in April scrambled to prepare bids. Providers and industry groups like NCART and NRRTS also put muscle behind a last-ditch effort to exempt the product category from the program (See story right). "It was a surprise," said Jerry Keiderling, vice president of The VGM Group's U.S. Rehab. "We were pretty much told that (CMS) understood our concerns, and complex rehab wouldn't be included. We thought we got through to them." The rehab industry has argued that complex rehab products meet unique needs, making them inappropriate for competitive bidding. Because bids must come in below the current fee schedule amount, providers of complex rehab, like providers of other selected product categories, were closely examining their costs and service models. Many reported "scratching their heads." "With complex rehab, often you need a session with a therapist, you loan out equipment, or you conduct sub-fittings," said Georgie Blackburn, the compliance officer at Blackburn's in Tarentum, Pa., which is 20 miles northwest of Pittsburgh. "But that's not in every case. How do you factor those costs in and come up with an appropriate bid?" Providers gritted their teeth at having to reduce services to make their bids more competitive. Unlike providers of other selected product categories, CMS has already cut reimbursement for all power mobility devices, on average, by 27%. Rehab providers are trying to make end's meet, as it is, they say. "Can I afford another cut--no," said Dan Craig, the rehab manager for Miller's Rental and Sales, which has a branch in Cleveland. "But it's not going away. So we've been talking a lot about what we can afford to bid. Do we create an expense model and come at a bid, or do we come at a bid and determine what services we can provide? Either way, changing our service model is probably going to happen." Few providers discussed at what percentage below the fee schedule they would submit bids, fearing collusion and providers besting each other with what Keiderling called "a downward spiral" of bids. Before submitting bids, Sharon Hildebrandt, executive director of NCART, advised providers not to bid without realizing the "full costs and the real complexity" of supplying high-end wheelchairs. "That's my biggest fear," she said. "This really has the potential to create problems with access and getting appropriate products."