From: Ocala Star-Banner

By Jim Ross, City editor

BELLEVIEW — One day last week, Brenda Counsell sat at a small desk inside her store, Comfort Care Medical Equipment and Uniforms, which is in the Kmart plaza off U.S. 441. Surrounding her were walkers, countless boxes of health supplies and racks of brightly colored medical uniforms.

Pretty soon, much of the inventory will be reduced or stored off site. To get a lower rent, Counsell will downsize from two shop suites to one. And she already has reduced work hours for one of the store’s five employees.

Why all the cutbacks?

The federal government. Medicare, to be exact.

Like many mom-and-pop suppliers of “durable medical equipment” such as wheelchairs and standard walkers, Counsell’s business has been slammed by a new Medicare rule that kicked in locally on July 1.

Simply put, Medicare solicited bids from outfits that want to be suppliers of certain medical supplies, like standard walkers. It’s important to note that not all items are affected, just those on the specific bid list.

At the winning stores, Medicare coverage is accepted for items on the bid list.

At every other store? Medicare patients can buy items on the list, but the Medicare coverage doesn’t apply.

On Friday, when explaining all this to a journalist, Counsell overheard a customer who had come into her store. Sure enough, when hearing the news, the customer left — no doubt to find a winning bidder where her Medicare coverage will greatly reduce her cost for the item she sought.

The bidding program is simple enough in design. The goal is to reduce Medicare expenditures through competition while still ensuring that patients have access to needed equipment and supplies.

So far, the government says, the strategy is working and has achieved hundreds of millions in savings.

But Counsell isn’t a fan. She didn’t even enter the bidding process, knowing that big national companies, which benefit from economies of scale, would be unbeatable.

“They can buy truckloads. We are a small operation,” Counsell said. “I could have bid. We just felt it was in vain.”

Pramila Mitra had a different experience. The owner of Pramila Mitra Respiratory Services in Ocala won all four bids she sought, including the walker category. She said she is proof that small operators can succeed under the new system.

“I can still make it happen,” she said.

Mitra has been in business 11 years, keeps her staff numbers and overhead costs low and considers her business a calling more than anything.

“Obviously we picked up lots of business” with the new bidding system, she said. “I’m very much honored to serve the patients.”

Medicare has a website,, that allows users to type in a ZIP code and find the nearest suppliers for particular bid-list items.

On Monday, a search of “34471” and “walkers and related accessories” turned up 12 providers. Walmart and two Ocala stores — Mitra’s and Repiratory Support Services, Inc. — were the only ones with Marion County addresses.

The others were in Leesburg, Tavares, Altamonte Springs, Largo, Fort Lauderdale, Hollywood, Hialeah and Fort Walton Beach.

There’s a bit more to the geographic part of the story. North Florida Medical Sales & Rentals, Inc.’s Ocala office, for example, says it can provide most bid-list items because it is a subcontractor for a winning bidder: Colonial Medical Supplies in Orlando.

This is the kind of confusion that worries many local operators. Counsell is concerned that patients now have fewer local options and might have to travel to get what they want.

These patients have been shopping at stores like Comfort Care for years and are accustomed to the staffers who know their needs and medical situations.

“We go out of the way. The patient comes first,” Counsell said.

Bitting’s Pharmacy also worries about the patients. In the past, they could get all their needs, including prescriptions, at the store. Now they have to go to two or three places.

“The problem is the inconvenience to the patient,” said Pam Hammar, co-owner of Bitting’s.

“I don’t think they (government officials) realize it,” she said, wishing that the people who design and implement these kinds of programs actually work a day in the field to get the true story.

As for store owners like her: “I guess we all have to adapt.”

Some haven’t been able to do so. In Rochester, N.H., Carney Medical Supply was in business for more than 46 years but had to close its doors last month in the wake of the new program, according to an account in the Rochester Times.

For Counsell, the short-term solution is making cuts and playing up what used to be a secondary part of her business: medical uniforms.

“It’s probably going to be our saving grace in the end,” she said.

A written defense of the bidding program was provided last week by Jonathan Blum, acting principal deputy administrator and director for the Center for Medicare at the Centers for Medicare & Medicaid Services.

Blum wrote that the program has already saved more than $400 million during its first two years in the nine pilot areas.

On July 1, when the program expanded to the additional 91 areas — including Marion County — the result was an average savings of 45 percent on competitive bid items.

The national mail-order program for diabetic testing supplies resulted in average savings of 72 percent, he wrote.

“CMS has awarded contracts to experienced national and local suppliers across the country. Each supplier is carefully screened to ensure that it is accredited under applicable Medicare quality standards and meets rigid financial standards, specific Medicare supplier enrollment requirements, and state licensing standards,” Blum wrote.

But according to the American Association for Homecare, a trade group representing smaller sellers of durable medical equipment, the government presents an overly rosy picture.

For example, the group worries that the program is not holding bidders accountable for providing the equipment, explaining how it works, and repairing it when necessary.

The association also worries that bidders are being properly vetted to make sure they are qualified to provide the products they promised to provide.

The association has plenty of help in its battle — which so far has been unsuccessful — to stop the program in its tracks.

In May, members of Florida’s congressional delegation called on the feds to delay the bidding program’s expansion into the 91 new areas.

Signers included all three of Marion County’s voices in Congress: Democrat Corrine Brown and Republicans Ted Yoho and Rich Nugent.

The delegation said the public should be allowed to independently verify CMS’ calculations, evaluate the financial health of providers, determine if the provider can serve the market, and conclude whether the bids are based on market forces.

Blum, the federal official, said his agency is conducting real-time claims monitoring and so far has found no problems.

“In addition, we have heard very few complaints about the program. We continue to carefully monitor the program to ensure that there are no negative consequences for Medicare beneficiaries while savings are achieved,” he wrote.

Still, longtime Comfort Care customers like Jane Blue are worried about how this bidding system has worked out.

Her husband, a doctor, requires personal medical supplies because of spinal cord damage suffered during a vehicle wreck. They understand the medical system and will be OK.

But Mrs. Blue said the government made “a big mistake” by not making more room for the local stores, who are dedicated to helping the customers who need help navigating the system.