BIRMINGHAM, AL – The bidding program, studied for many years before CMS created the current nightmare of a misdesigned program, was developed with the express intent of wiping out a large portion of the industry. The current very good (but inadequate) adjustments just invited more dishonest entrepreneurs into the game. Previous bids included thousands from providers who never had any intent of providing services, and many others who thought they could steal enough to make up for below-cost pricing. The concurrent loss of services greatly weakened the benefit, and we may never recover from that. At the least, it has made it much more difficult to make the case for services outside of product delivery, and even that is difficult, given changes bid winners had to make to survive.
I have believed for many years that a very high percentage of all the issues we have experienced were caused by simple greed. Before Medicare, most people in the industry now known as HME were either clinicians with a high regard for good patient care or honest business people intent on providing good service at a reasonable cost to make a well-earned profit. Medicare, with its awful mismanagement in the early years, created an opportunity to make a lot of money taking advantage of the public’s lack of knowledge concerning most health issues.
A few examples:
Well before the efficacy came into question, IPPB (intermittent positive-pressure breathing) therapy was abused, in some part by unethical early practitioners of respiratory care. Acting with typical bureaucratic inefficiency, the Medicare program attempted to address the issue by making it more difficult to provide coverage to those who could really benefit.
Queen City pioneered the mass sale of seat-lift chairs, forcing the program to make drastic changes to avoid buying new furniture for almost every beneficiary. Others followed with other products that have nearly universal demand— such as back braces—sold via cable TV ads, apparently with the approval of the OIG! The first company that tried to sell me on getting association members involved led with a letter from the OIG “approving” the process as legal. I told them it might be legal—which I doubted—but it was certainly unethical and I didn’t want any part of it.
The Scooter Store first wrecked the scooter market, then moved on to seriously damage and complicate the entire power wheelchair benefit. And so on…
AAHomecare, VGM, and the others who have helped and supported their effort, including all the local associations, have provided extremely abundant, well-designed, and easy-to-use education and valuable resources to allow honest providers to prepare bids that are rational and will allow the benefit to survive, even if the industry remains considerably smaller. I sincerely hope it works as intended and the resulting bids allow efficient providers to service and still provide sufficient patient/caregiver education and service levels that make the benefit useful. Since most all third-party payers base rates on Medicare in some manner, that is the only hope for maintaining survival-level pricing, and I believe it will happen.
Recent increasing emphasis on addressing the Medicare Advantage rate reductions is very welcome and could produce excellent results, but I am at a loss to understand how we let them abuse the program for so very long. Intended as a method for saving money, they are, I believe, still being subsidized; and much news I have seen lately reports on the abysmal record of CMS’ near-total lack of response to audit issues that should have recovered zillions in overpayments. Now, it isn’t really late, but I need to catch my breath and treat the nosebleed before bedtime, so it’s time for me to climb down from my soapbox and take it easy for a bit.
Most of what I’m hearing, which is less than I expected, is cautious optimism. There seems to be a consensus that the improvements are very worthwhile and should produce reasonable rates if most bidders actually understand the application of lead-item bidding. The free education provided certainly appears to be sufficient, but it remains impossible to predict the effect of the “greater fool” theory. I won’t presume to offer advice. It’s been too long since I stopped filing claims for me to have any delusions that I could do it right. (I can write reading and read writing, but I can’t count.)
Although I have always been and remain an optimist, I am getting a little more pragmatic with age. That said, I really believe this will work to at least the extent required for survivability. The need for what the industry provides will always exist and there will always be some who can afford to pay what it takes to get it, even if the market may shrink and it won’t be as rewarded as it was for so long.
My greatest fear is that it will take long enough to finish a correction that we will lose many more very good providers before recovery is complete. The steps taken to improve bidder qualifications, followed by the changes that should increase the number of bids accepted, are at the top of my list of improvements for the current round.
Michael Hamilton is executive director of the Alabama Durable Medical Equipment Association, Birmingham, Alabama.