Big Sky Business Journal

Providers of home medical equipment and services across Montana are proposing a fiscally responsible alternative to the mislabeled “competitive” bidding scheme currently under way in Medicare that will actually discourage competition, reduce access to care for many of Montana’s 160,000 Medicare beneficiaries, and put dozens of Montana homecare providers out of business.  

“Even though Montana is not in Round One or Two, the effects of competitive bidding will be devastating to Montana suppliers,” explained Mike Calcaterra, branch manager of Norco Inc. and state legislative chair for the Big Sky Association of Medical Equipment Suppliers.  “The price achieved will be applied to Montana by law in 2016. Before that, both Medicaid and Blue Cross Blue Shield of Montana will adopt the fees set by competitive bidding. This will force some Montana suppliers to eliminate services to Montanans, and others will simply get out of the business.”

 The Medicare bidding program encourages “suicide bidding,” using economic coercion by forcing providers to submit unsustainable bids necessary to win a contract. Although Congress delayed the implementation of the selective contracting program in 2008 to allow for needed changes, the Centers for Medicare and Medicaid Services (CMS) ignored congressional intent and did not address the flaws that precipitated the delay.  

The bidding process for durable medical equipment and services is now underway in nine metropolitan statistical areas in the U.S. with an additional 91 areas scheduled to be affected next year.  

This bidding program will trigger a race to the bottom in terms of quality for home medical equipment and services. With a loss of providers, expedient deliveries of items and services will suffer and Medicare costs will increase.  

Big Sky Association of Medical Equipment Services supports H.R. 3790, a bipartisan bill that would preserve access to homecare and provide a cost-effective alternative to a misguided Medicare “competitive” bidding program for durable medical equipment. H.R. 3790 replaces the Medicare bidding program with other types of cost-savings that will reduce reimbursements to home medical equipment providers but preserve patient access to medically required equipment and services in the home.

So far, the bill has 247 cosponsors in the U.S. House of Representatives with broad bipartisan support. More than half of both the Democratic and Republican delegations in the House support the bill, including Montana Representative Denny Rehberg (R).

Patient and consumer groups that support the elimination of Medicare’s “competitive” bidding program for durable medical equipment include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, and Post-Polio Health International, among others.

Proponents of the Medicare bidding program for durable medical equipment have perpetuated several myths about the program. However, the reality is quite different.

MYTH:  The bidding program will be good for Medicare beneficiaries.

REALITY: It will, in fact, reduce access to medically required equipment and services.

MYTH:  The program will eliminate Medicare fraud in the durable medical equipment sector.

REALITY: The solution to fraud is better screening of providers, real-time claims audits, stiffer penalties, and better enforcement mechanisms for Medicare – steps that the home medical providers support.

MYTH: The bidding program helps businesses by creating a more competitive environment.

REALITY:  The program coerces providers to bid at unsustainable Medicare reimbursement rates and will force thousand of businesses to close, reducing competition in the long term.

MYTH: Providers will be competing on quality and price.

REALITY: The bidding program will ration care. Home medical equipment providers already compete on the basis of quality and help move people smoothly from hospitals to cost-effective care at home.

MYTH:  The bidding program will make healthcare more cost-effective.

REALITY: The home is already the most cost-effective setting for post-acute care. As more people receive good equipment and services at home, the U.S. will spend less on longer hospital says, emergency room visits, and nursing home admissions.  

Big Sky Association of Home Medical Equipment Suppliers (Big Sky AMES) is dedicated to promoting ethical and professional home medical services to the patients of Idaho and Montana. Members adhere to strict professional practices to provide the highest quality services available.  Big Sky AMES’ members provide home medical equipment and services including oxygen therapy, wheelchairs, hospital beds, inhalation therapy, and other medically required supplies and services for people with conditions such as chronic obstructive pulmonary disease (COPD), multiple sclerosis, Lou Gehrig’s disease, spinal cord injuries, congestive heart failure, and diabetes.