ATLANTA — Proponents continue to track the progress of H.R. 3790, which would repeal DMEPOS competitive bidding. Introduced Oct. 13 by Rep. Kendrick Meek, D-Fla., the bill had picked up 75 cosponsors as of Friday.
Last week, representatives from the Accredited Medical Equipment Providers of America, the American Association for Homecare, VGM and state associations in Florida, Texas, California, Kentucky, Georgia, Indiana and Missouri met with staff from 52 congressional offices about bill.
"In general we were well received," AMEPA officials reported in a Friday afternoon update. While there were questions, the group said, "we made clear that Congress mandated CMS attempt to fix the program, but the fundamental elements of the program which make it flawed — no accountability in bidding, no physical location in an MSA required, no guaranteed times for service, the ability to flip and walk away from Medicare contracts, the elimination of patient service as a priority — all remained in the system.
"We emphasized that fixing [the program] would take time that first-round providers, especially, do not have."
The new Round 1 bidding window closes Dec. 21; Saturday (Nov. 21) was the cutoff for bidders to gain a review of financial documents from CMS. According to the agency's current timeline, the program will go live in January 2011.
On Nov. 16, the Pennsylvania Association of Medical Suppliers held a press conference in support of the Meek proposal, noting it already has "strong bipartisan support" from House members and national disability groups. Cuts in the bill, together with a 9.5 percent cut on bid items that took effect this year, would represent a 19.5 percent savings to Medicare.
PAMS Executive Director John Shirvinsky told reporters there were 4,127 DME providers in the first nine bidding areas in 2008. But only 376 — a 90 percent reduction — won contracts in the original Round 1. "Eliminating such an overwhelming percentage of providers from the program will impact patient choice and access to cost-effective medical care and threaten the economic survival of the companies involved," Shirvinsky said.
He also noted that in the Pittsburgh bidding area, 40 percent of the winners were from out of state.
"There are many examples where competitive bidding makes sense, but durable medical equipment is not one of them," added Rep. Jason Altmire, D-Pa., who spoke in support of H.R. 3790. He pointed out that CMS also should consider the quality of care provided, the personal relationship between providers and patients and the bidding program's impact on jobs.
"When national providers come in and they're able to undercut local providers, that's clearly not good for the local provider, but more importantly, it's not good for the patient," Altmire said. "The patient has to have that personal relationship with the provider for follow-up care over the course of a lifetime."
"Competitive bidding, as CMS has framed it, is anything but competitive," said Rep. Glenn Thompson, R-Pa., who joined Altmire on the call. "Looking at savings solely on a balance sheet is not a smart government solution. If the number of smaller home providers of durable medical equipment declines, I'm concerned that more home care patients will need to be hospitalized, particularly in rural areas because of their distance from one of the massive contract holders.
"CMS should be working to keep homebound Medicare recipients in their homes — the quality of life is better for the patient and will involve an overall cost savings to Medicare."
Thompson, who worked for 18 years in rehab services, said HME companies "were lifesavers to the thousands of patients that I interacted with." He is concerned, he said, "that if the number of providers, especially small providers, declines, we'll wind up with a monopoly and we'll see costs grow tremendously, because when you create a monopoly, that's what happens."
Reporters also got an earful from Lucy Spruill, director of public policy and community relations for United Cerebral Palsy of Pittsburgh, who said she, too, is concerned with both access to providers and their expertise under the bidding program.
According to Spruill, a power wheelchair user herself, last year's implementation of the bid (delayed by Congress July 15 after a two-week run), "would have shunted all of the work currently being done by eight or 10 small- to medium-sized companies in [Pittsburgh] to two companies, and the business already exceeds the capability of all those companies. There are often very long waits between ordering a wheelchair and getting it delivered and for getting repairs. If the number of providers is drastically reduced, that's just going to make a bad situation just completely intolerable."
She pointed out that under the bid program, dealing with several different companies that win bids for different items or out-of-town companies to get basic medical needs met could also be difficult for patients. "Let me tell you that is so difficult for an older person or a person with disabilities who is living alone with a complex medical condition," Spruill said.
She also voiced concern that "if we again end up with inexpert bidders, that we're going to consistently get equipment that's not right for us. We know when that happens, one of the results is secondary conditions like bed sores, pneumonia and other infections, depression from staying in the house and placement in institutions, which is very expensive."
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To contact your representative in support of H.R. 3790 to repeal competitive bidding, call the U.S. Capitol switchboard at 202/224-3121. The operator will connect you directly to your congressman's office using your ZIP code.
Read background and talking points for H.R. 3790.
View the full text of H.R. 3790.
