ARLINGTON, VA – The Centers for Medicare and Medicaid Services’ competitive bidding program for durable medical equipment has “created concern and chaos for beneficiaries, physicians, hospital discharge officials and home medical equipment providers” since it was implemented in 10 metropolitan areas on July 1, according to the American Association for Homecare.
Widespread disruptions have been alleged in service to beneficiaries who require oxygen therapy, power wheelchairs, CPAPs, diabetic supplies and other items and services. Critics of the DME program say this could potentially eliminate thousands of qualified providers from Medicare and reduce services and access to care for Medicare beneficiaries.
The AAH was denied a preliminary injunction in a federal lawsuit in June, filed against Health and Human Services Secretary Michael Leavitt and CMS Acting Administrator Kerry Weems, seeking to halt the “faulty implementation” of the DME bidding program. Since then, the Medicare Improvements for Patients and Providers Act of 2008 (HR 6331) has passed both the House and Senate and survived a presidential veto on July 15.
By approving the legislation, Congress agreed to delay competitive bidding in order to allow some critical process reforms, quality improvements, and other reforms to HME policy and the bidding program. The homecare industry will pay for the delay through a nationwide 9.5 percent payment cut on homecare items and services subject to bidding.
“We (were) facing a potentially dangerous situation in which some of the most vulnerable people in our society are having difficulty getting the medical equipment that they need,” said Tyler J. Wilson, president and CEO of the AAH. “Those who are in hospitals are being forced into longer stays in those expensive institutions because equipment can't be obtained in a timely manner to sustain them in their homes.”
The program is scheduled to expand to 70 additional areas in 2009.
AAH officials say they have received many complaints, including delays in patient discharges from hospitals because proper equipment can’t be found for home use; Medicare beneficiaries calling previous providers because they can’t find new providers; and providers who had won DME bids but are unwilling or unable to service their patients’ needs.
The AAH has argued that the bidding program has caused numerous violations of the Medicare Prescription Drug, Improvement and Modernization Action of 2003, the Small Business Act and the Administrative Procedures Act.
The law requiring bidding is five years old, but the implementation rules were not announced until last year. After taking more than six months to review bids, the AAH said CMS rushed the implementation, providing incomplete and inconsistent information to beneficiaries.
“I am supportive of competitive bidding as a means of reducing cost, but that cannot be accomplished at the expense of low quality and inconsistent care,” said Senate Finance Committee Chairman Max Baucus (D-Mont.).
“These improvements also will help prevent many small home medical equipment suppliers from going out of business,” said Senator Charles Grassley (R-Iowa).