The Rest of the Story

On Jan. 8, Dave McCausland got mad. “I was listening to the CMS teleconference announcing the expansion of competitive bidding. When I heard [CMS Acting Administrator] Kerry Weems say that competitive bidding would reduce fraud and abuse and improve access to quality products, it just seemed to me that somebody had to balance the record. They are using sound-bite mentality to fuel the justification for what they are doing, and it just doesn't add up.”

Before that Jan. 8 call, in fact, CMS sent out an announcement that included the following statement:

“The Centers for Medicare and Medicaid Services and the Office of the Inspector General will hold a news briefing to announce the expansion of a competitive bidding program designed to help lower Medicare beneficiaries' out-of-pocket costs and reduce fraud and abuse while improving access to high quality durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).”

“That seems to sum up the anticipated benefits associated with competitive bidding,” McCausland says. “Clearly, any program that could reduce beneficiaries' costs, reduce fraud and abuse, improve access to goods and improve the quality of those goods is a program worth pursuing. Yet,” he continues, “will the competitive bidding of DMEPOS really produce all of these benefits? Is the DME industry really as bad as it is made out to be? Is there another side to this story that's missing?”

According to McCausland, senior vice president of planning and government affairs for The ROHO Group, Belleville, Ill., those questions were worth pursuing. So he looked back at CMS data, researched congressional hearings on competitive bidding and sat down and did the math to get the answers.

In the following discussion of competitive bidding's “alleged benefits,” as he labels them, McCausland pulls out all the stops for an in-depth look at the likely outcome of the program — an exercise that becomes more important following the recent announcement of round one pricing and contracts.

“Sadly,” McCausland says, “looking at some of the bid prices just reinforces that beneficiaries are not going to have access to the highest-quality products in some categories. They can't. The money's not there.

“Some of these numbers are frightening,” he says, “and they leave us with more questions than we had before.”