HUNTINGTON, W.V. – Why are many HME advocates urging Congress to delay round 2021 of the competitive bidding program? There are many reasons, but quality and availability of care are still major concerns. With a pandemic raging, the time may be right for lawmakers to hear the message, particularly if presented with convincing evidence.
“Moving forward with the competitive bidding program will impede patient access given the current economic and care delivery landscape caused by the COVID-19 public health emergency,” wrote Cara C. Bachenheimer, JD, chair of the Government Affairs Practice Group at Brown & Fortunato, in a recent Medtrade Monday editorial. “There are compelling reasons for Congress to delay the Round 2021 competitive bidding program. First, beneficiary access issues will occur because, by design, the program reduces the number of DME suppliers who can serve beneficiaries in bid areas.”
Bachenheimer’s contention has plenty of backup among clinicians who have experienced the real consequences of competitive bidding over the course of several years. Medtrade Monday sat down with one of those health care providers to get a ground-level view of what it’s really like to work under competitive bidding restraints.
Jodi H. Biller, MSN, APRN, FNP-BC, CCRN, has worked in the pulmonary department at Huntington Internal Medicine Group, Huntington, W.V., since 2013. She prescribes HME (CPAP, BiPAP, Home Trilogy Machines, oxygen, and nebulizers) for patients with chronic obstructive pulmonary disease, obstructive sleep apnea, and other chronic lung diseases.
Greg Thompson, editor, Medtrade Monday: How would you characterize your experience working within the constraints of competitive bidding?
Biller: Taking care of patients in my area under the competitive bidding program was one of the worst and most frustrating experiences I have ever experienced as an APRN [Advanced Practice Registered Nurse].
Thompson: How has competitive bidding affected access to DME for the patients you serve?
Biller: When we were practicing under the competitive bidding program, patients had no choice in the type of care they could receive from a DME company, because every DME practices differently. Making that choice is a 5-year commitment, specifically for severe COPD patients on non-invasive ventilation. Some DME companies offer better care than others, and patients should be able to choose.
Thompson: What happens when patients are assigned companies that are known for poor service/care?
Biller: When patients are assigned companies that deliver poor care, they cannot change that. They don’t have any say in where their care comes from, because it’s automatically assigned through competitive bidding. Sometimes patients are assigned to DME companies that are farther away from their home. Patients would actually bypass another DME company and have to go to another, because that was the one in their bid according to the zip code.
Thompson: What have the reduced reimbursements for DMEs led to in your experience?
Biller: Due to decreased reimbursement—especially for CPAP, bi-PAP, the trilogy, and home oxygen—DME companies provide a limited delivery service for home oxygen. Those patients who are in more rural areas of West Virginia are on a limited delivery of oxygen tanks. They become trapped in their homes because that DME they’ve been assigned to only delivers on certain days of the week or even month, so they have to stay home on their home concentrator.
Thompson: How well do legislators understand the challenges of competitive bidding?
Biller: I do not feel legislators create these laws intentionally to harm people, but the secondary effects are negative to patients, providers, and small businesses. When a patient does not want to use a company, and I don’t want to use the company but we have to because of the comp bid process, it ultimately impacts patient care and patient outcomes. Getting the equipment to patients is a small portion of the process.
Thompson: What happens after the equipment is received?
Biller: The rest of the time is spent trying to keep the patients well. We look at patient activation by engaging patients in their care and teaching them self-management techniques and promoting wellness—these improve outcomes. If I can partner with a respiratory therapist in a home and build a relationship with patients, their care improves and they are in their best health.
Thompson: What should advocates make sure that legislators understand?
Biller: The negative effects that legislators should recognize is when you give all the business only to a few places in our area, and assign those by zip code, you’re forcing smaller DME companies owned by local people to close their businesses and give up what is sometimes their life’s work.
Thompson: What attitude do you sometimes find among DME providers who have won the bid?
Biller: DME companies don’t have to provide great care when they have the bid. They know the providers have to give them the business because we can only use equipment and services from that specific company under competitive bidding.
Thompson: What changes would you make to competitive bidding?
Biller: I would completely eliminate comp bidding because when that happens DME companies provide the best service. They become innovative, they engage with patients, and they compete for business and patients. Ultimately patients have better service and outcomes because DME companies are more attentive. In the past when we have operated under comp bid, it was hard to get DME companies to engage with us because they knew we still had to send them business because they had the bid. We had no other choice…and now competitive bidding is supposed to start back up in 2021 unless it is delayed.
