The Ohio Association of Medical Equipment Services and the American Association for Homecare praised a bipartisan bill in Congress, H.R. 3790, to eliminate the misguided, flawed "competitive" bidding program for durable medical equipment and services in Medicare. The bidding process in this controversial program began October 21 in Cincinnati, Cleveland, and seven other cities across the U.S. So far, the bill has six cosponsors from Ohio.
Durable, or home medical equipment, such as oxygen, wheelchairs, diabetic supplies, and hospital beds, enables seniors and people with disabilities to receive quality care at home. Home-based care represents a cost-effective alternative to institutional care, and seniors prefer to receive care at home rather than in an institution.
To ensure that seniors and taxpayers receive the savings projected for the bid program, the bill would reduce Medicare reimbursements to home medical equipment providers in 2010, 2011, 2012, 2014, and 2015. At the same time, the bill will allow thousands of home medical providers to keep their doors open to serve the millions of Americans who require home-based care and will allow patients to continue to receive services from the providers of their choice.
So far, H.R. 3790 has been cosponsored by six members of Congress from Ohio: Democrats John Boccieri (D-Ohio), Marcia Fudge (D-Ohio), and Tim Ryan (D-Ohio), and Republicans Steve Austria (R-Ohio), Patrick Tiberi (R-Ohio), and Michael Turner (R-Ohio).
The introduction of the legislation comes just days before the start-up of the bidding process for the bid program for home medical equipment. The Medicare bidding process began on October 21 in nine metropolitan statistical areas (MSAs) across the U.S. including Cincinnati and Cleveland. The bid prices and bid winners would be selected in 2010 and new prices would become effective January 1, 2011. Another round of bidding would begin after that in 100 MSAs across the U.S.
The initial roll-out of the bidding program in 2008 produced disastrous results for home medical equipment patients and for providers (mostly small businesses) who were excluded from Medicare as a result of the first round of bidding.
"I have serious doubts that the re-bidding will be any more legitimate than the initial roll-out given CMS provided no transparency or public collaboration to assure us otherwise," said Kamela Yuricich, executive director of the Ohio Association of Medical Equipment Services. "Furthermore, the home medical equipment community nationwide is reeling from cuts and increased regulations that are coming at an unbearable pace which have already achieved the goals of what 'competitive bidding' intended. It's absurd that Medicare is rolling out a program again that guarantees job loss and disruption in care for the four million seniors affected under round one of this bid program."
Categories subject to the bid program include medical oxygen, which is a highly regulated prescription drug, complex rehabilitative power wheelchairs, enteral nutrients (used in tube feeding), and hospital beds, among other categories.
During the 2008 implementation, serious problems were encountered, such as:
- Disruption to patient services - Patients were forced to go to multiple, unfamiliar providers for different items and services. Informal surveys showed that some winning providers were unable to provide care to beneficiaries.
- Greater costs to Medicare due to longer hospital stays - Confusion about the restricted list of contracted home medical providers delayed hospital discharges and triggered unnecessary emergency room visits.
- Non-local providers - Providers with no history of servicing a geographic area or no operations in a bidding area were awarded contracts.
- Inexperienced/unlicensed providers - Companies were awarded Medicare contracts to provide equipment and services for which they were not licensed in their states and for which they had no previous experience providing.
- Desperation bidding - Structural flaws in the bidding program caused providers to submit artificially low bids because they were faced with the threat of losing their businesses if not awarded a contract. Winning contracts also were viewed as commodities that could be sold once a bid was won.