Washington Three counties in the San Antonio, Texas, area will be the site of the second competitive bidding demonstration, according to Nancy-Ann DeParle, administrator of the Health Care Financing Administration. The project scheduled to begin Jan. 1, 2001, includes the counties of Bexar, Comal and Guadalupe.

In addition to announcing the site during a Senate hearing of the Labor, Health and Human Services and Educational Appropriations subcommittee, DeParle supported the competitive bidding initiative, saying that the first demonstration in Polk County, Fla., achieved Medicare savings without compromising patient access to quality care.

"Competition helps Medicare beneficiaries receive quality medical supplies at fair market prices," DeParle said in a prepared statement. "Old laws have forced Medicare to spend more for equipment than market prices or common sense should allow."

Although the site itself didn't come as a surprise to industry officials, the fact that HCFA is moving forward with the second demonstration so soon after implementing the first, did.

"The fact that they're proceeding with the demonstration without having adequate information and data from the Polk County demonstration is very problematic," said Asela Cuervo, vice president of government relations for the American Association for Homecare, Alexandria, Va.

Cuervo added that it is too early to determine the demonstration's impact on San Antonio area providers, but said it will be detrimental to some. "The biggest impact is going to be that most of those providers aren't going to be doing business with Medicare beneficiaries in January of next year," Cuervo said. "This is not a wise program. It is not wise to remove beneficiaries' freedom of choice. The fact that you have freedom of choice protects beneficiaries because it guarantees quality. And when you take that away, then you have to make very sure that you've in fact protected the beneficiaries, and we don't think that that is occurring."

HCFA said it selected the San Antonio area because of its number of suppliers and Medicare beneficiaries. Nearly 112,000 senior citizens and disabled individuals in the area receive Medicare benefits; according to HCFA, between 15 and 48 suppliers provide at least $10,000 in services to the region's beneficiaries in each of the five product categories-oxygen supplies, hospital beds, manual wheelchairs, noncustomized orthotic devices and nebulizer drugs-included in the new demonstration.