ATLANTA — Less than a week into competitive bidding, state and national home medical equipment associations are already fielding reports of fallout from providers and other stakeholders — and the complaints are on the rise.
"We are getting in the neighborhood of 10 to 15 complaints per day. Complaints are on the increase, not tapering off," said Michael Reinemer, vice president of the American Association for Homecare, which has set up a toll-free hotline to gather information on the program's implementation.
Reinemer said that so far, complaints include:
- Patient confusion or dissatisfaction about the need to switch HME providers;
- Delayed discharge from facilities;
- Admission to a hospital because of no access to HME;
- Problems coordinating delivery of items;
- Companies laying off employees; and
- Questions for the CBIC that go unanswered.
Other types of problems are also surfacing.
The Accredited Medical Equipment Providers of America cautioned its members that they should verify answers to questions about competitive bidding with others because the CBIC was, in some instances, giving conflicting answers. "Whatever you are told, check with others first to verify because the answer might not be accurate," AMEPA told members in its newsletter. "Many consultants believe that the CBIC is being stricter than the rules direct in order to make things run smoother or just to eliminate non bid-awardees quicker."
Members of the Midwest Association of Medical Equipment Services reported that some of their patients who do not live in a competitive bidding area had received letters from CMS implying that they had to get their HME from a certain company. Other patients got letters saying the first letter had been sent in error.
Providers are also running into problems with hospitals stemming partly from lack of awareness of or information about the bidding program.
AMEPA reported that at least one large Miami-area hospital had no idea there was a bidding program in place that affected Medicare patients. The hospital only learned of it when a case manager attempting to discharge a patient called an association member looking for a walker. (The provider had not won the bid for walkers and told the case manager the hospital would have to look elsewhere.)
"AMEPA called dozens of hospitals last week and found over a third were unaware of the program, and of those who knew, many had no list of winners and did not have a plan to deal with the changes," according to the association.
In an alert to its members, the Florida Alliance of Home Care Services said that Jackson Memorial Hospital in Miami-Dade County had contacted all non-contracted providers on its rotating list of accredited providers to tell them they would no longer be called to service any Medicare patients. FAHCS said hospital staff apparently believes it is too complicated to call multiple providers to fulfill various needs. The end result, according to Sean Schwinghamer, executive director of FAHCS, is that even smaller providers that won, say, only one product category will lose out because the hospital will seek a company that won all the categories needed to service the patient.
"CMS has said they have small business set-asides and are protecting small business, but that is simply untrue," Schwinghamer said. "What is happening now is what we knew would happen: The big guys will get all the business and the little guys will get the boot."
John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, said PAMS already has had to intervene in a situation with a hospital outside the Pittsburgh CBA. "One weird thing we had was that a hospital located 250 miles out of the CBA was being advised by CMS that they could not use their regular [providers inside the CBA]," Shirvinsky said. "We managed to get that straightened out."
But not all problems will be so easily resolved, and Shirvinsky is concerned that HME providers, in an attempt to make sure Medicare beneficiaries are taken care of, will try to solve those problems to their own detriment.
"As this week goes on, we're going to see more and more problems," Shirvinsky predicted. "It's a question of who is taking care of what. There is such a sense of honor and doing things right in this industry, people are going to start giving stuff away and trying to keep problems from occurring. But it's against the law to do that. That's by design, that's by government mandate."
Providers are going to have to let some of the problems happen, he said. "This system is destined for failure, and we have to allow it fail."
Concluded AAHomecare's Reinemer, "We hope that the complaints, added up as statistics and also compiled as individual stories, will underscore the problems with program, which we have all anticipated. The association and other stakeholders will be sharing the information with members of Congress and the media. We are sorting through the information to figure out the best way to do that."
Industry organizations are asking providers, consumers, caregivers, physicians and other discharge/referral sources to document any problems with the bidding system through online forms and toll-free hotline numbers. See the Competitive Bidding Begins Special Alert for information.
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