CMS vs. My Mom
The reality of Round Two’s ridiculousness sinks in as contract holders are unveiled.
- By David Kopf
- May 01, 2013
Chances are, you’re aware that CMS has
debuted the contracted providers for
Round Two of its national competitive
bidding program. If you haven’t, turn to “News,
Trends & Analysis,” on page 8, to get the details.
The figures should astonish you: CMS awarded a
total of 13,126 contracts to just 799 providers to
serve all of the categories for Round Two’s 91 CBAs.
We in the industry find this jaw dropping, but
I wonder what it will be like when the average
Medicare beneficiaries and their families discover
what they’re in for with this program. Well, I’d
like to share my personal story: I’m the youngest
of three siblings, and my surviving parent, my
mother, is in her 80s (she’d ground me if I shared
her actual age) and lives in a nearby. She’s doing
great. We have her over multiple times a week; she
loves visiting with her grand kids; and when she’s
not running circles around us, she’s out and about
doing all sorts of activities with her friends.
However, like a lot of seniors, she depends on
DME to live this independent lifestyle. Specifically,
she needs a walker. She is not stable to walk on her
own, and uses it nearly every moment of every day
to get around. That walker is a part of her.
Well, that walker is getting a little long in the
tooth at the moment. I do a lot of work in the
garage, and the other day I gave it a much-needed
overhaul. The bolts and bushings on the wheels
were falling apart; multiple fasteners were loose;
and I had to extract a broken bolt from a threaded
star nut insert in one of the tubes and replaced it
with a good one. A thorough cleaning and liberal
lubrication finished the job.
I probably breathed another year or two of life
back into that old piece of “bent metal” that she
dearly depends on, but I told her that we had to
hit up her local provider soon to get a replacement.
That’s really not a big deal, as there are multiple
providers in her area, and a really good one about
a mile and a half away. She could take her bus
service, or I could drive her over at some point.
Well not under competitive bidding Round Two.
I used the handy online Supplier Search that CMS
provides (again, turn to “News, Trends & Analysis”
to read where to find the tool and how to use it) to
check out where her providers will be. That’s when
things got plain, old fashioned ridiculous.
The search yielded 18 providers. The first
provider was roughly four miles away. That’s
not too bad. The next was 16.5. Then the mileages
started getting higher — 22 miles, 28 miles,
35 miles, 45 miles. Look, we live in Southern
California. If you’re not familiar with it, there are
roughly 8 million people living in the Los Angeles
and Orange County basin and getting around is
hard. Traveling 22 miles is a bona fide pain in
the neck for me to drive at rush hour, but if my
mom were alone and had to use the bus? It would
take her the better part of the day. And traveling
45 miles up to L.A.? She might as well get a hotel
room, because the busses will stop running before
she can get enough transfers to get home.
But what really threw me was the out-of-state
bidders. Contract holders hundreds and thousands
of miles away in Texas, Kentucky, Alabama, North
Carolina, and Florida are somehow supposed to
start serving my mom by Round Two implementation.
There is virtually no way they are going to be
able to site locate and fund commercial real estate
in Southern California of all places by July — or
even December — let alone set-up shop, staff
and start serving patients. (One wonders if they
accepted the contract simply to sell it.) How did
CMS deem their viability as potential providers?
And my mother’s dilemma is for a simple walker.
What about an oxygen patient? Trust me, the
results are just as surreal. This is the ridiculousness
of competitive bidding on parade for everyone to
see. The question is, when is the public going to see
it? Hopefully in time to build enough support to
stop this program before implementation.
This article originally appeared in the May 2013 issue of HME Business.
David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.