Discussion Forum

Medicare continues to not factor the true costs of oxygen therapy and the cost of the regulations that Medicare imposes on providers.

For a provider to deliver oxygen the cost are concentrator $575.00, oxygen tanks( avg 6 per week, but higher liter flows may use up to 20) $35.95 ea.,tank fills 3.95 ea tank, nasal cannulas 4 per month2 $1.00 ea, tubing 2 per month at $1.00 ea, connector $1.25 per month, delivery drivers time and paperwork for setup 1hr at 13.00 to 15.00 per hr, 15 pages of perwork for setup to meet criteria and regulations, gas,mileage and wear/tear on … Continue Reading

Since the 36 month cap has been implemented, our company has had to turn away several patients wanting to switch providers. Their provider isn’t willing to provide the latest technology in portable oxygen, but we do offer that to our patients. The patient is the one who loses, because this becomes a quality of life issue for many oxygen patients who would be able to get out more if they had the technology that allowed them this freedom.

The congress people need to realize that the services and equipment that DMEs provide are life sustaining equipment; with the continuous cuts in reimbursement and now competitive bidding, lives will be at stake. Many DMEs are closing doors which means national chains are more prominent. This also means unemployment. Utilizing national chains are vary dangerous, they lack customer service, don’t respond to emergency call outs, and so much more. If the congress is looking at saving dollars, maybe we need to keep the non-U.S. citizens out of our country whom are spending our hard worked money. The congress needs to … Continue Reading

Patients attempting to move to a new location are finding it to be
next to impossible to find a new supplier. Patients approaching their
cap, and some with as many as 18 rental months remaining are finding
that suppliers are unwilling to take them on as new patients.

CMS has no clue the impact of Competitive Bidding will do to the healthcare in our country. They were mandated to implement a program and that is what they intend to complete. With little or no understanding the program they have proposed has been stopped once already and will crash and burn if they implement it again. Who looses? The Medicare Beneficiaries but no one is being honest enough to tell them what is going to happen. As I refer to it the “unintended victim”

If CMS had any desire to be a credible agency they would stand up and tell … Continue Reading

Medical equipment suppliers loose again. The 1st round of the CMS competitive bidding program was a disaster as once again the lowest bidding contractor who was responsible for the bid on CMS’ behalf did not do a fair nor complete job. The same faulty program (with no recourse for those that have to complete bids) is about to go to round #2. In the So. Florida area the 1st bid reduced the number of oxygen providers allowed to deliver these services to about 11% of the existing providers at that time. It would have increased the patient load on these … Continue Reading

I am a registered respiratory therapist and have been in the field since 1979. For the past 8 years I have co-owned a Durable Medical Equipment (DME)company. We never anticipated to become wealthy but wanted to at least make a salary comparable to what we earned working on staff at the local hospital. Since the changes made by Medicare that went into effect 1-1-2009 especially on oxygen payment it has become very difficult for the small independent provider to remain open for business. The patient is the one who ultimately suffers the most. The 36 month cap on oxygen and … Continue Reading

Our DME company was recently contacted by a patient who had moved into our service area from Florida in order to be closer to his cheildren. We were asked to take over his stationary and portable oxygen needs. Unfortunately, his provider in Florida had been paid for 35 months of O2 rental. We had to turn down his request, because after receiving 1 month of reimbursement we would have been responsible for the next 24 months of service for practically no money. There is now a patient using a concentrator that he brought with him from Florida, with no portable … Continue Reading

I have worked in the HME industry providing home oxygen for over two decades. The one driving force that insured that the patient received quality and timely service has been that the patient was always free to choose another oxygen provider. Under the new reimbursement system for oxygen, the longer the patient uses the oxygen, the more limited their choices become. In fact, beyond 18 months of service, they will be hard pressed to find any other provider who would be willing to accept them. As they get nearer and nearer the 36 month cap, they simply have no options. … Continue Reading

Patients wanting to change from their current oxygen supplier for no or poor service. I ask them how long have you been on oxygen and if it is near 36 months or over. That I can not help them because you have cap out on your oxygen. I also give them the names in congress, the phone numbers and ask them to call.

Charles H. Wadick.

Has CMS already forgotten that DME took a 9.5% reduction in fees for the 10 categories that were up for bid in Round One of the competitive bid project last summer? And has CMS forgottent that the cut was taken simply to allow a DELAY in the program? The simple fact that our industry was willing to take a nearly 10% cut to delay a program does not indicate that we as an industry are overpaid…it indicates that we as an industry were trying to buy time to figure out how to survive.
I know that our small company in west … Continue Reading

“Competitive Bidding” What we are really doing is auctioning off health care services to the lowest bidder. Is this really what we want health care services to become in the USA? Competitive bidding might work in other industries where the variables of the service elements can be tied to a cost, in home medical equipment this can’t be done because of the uniqueness of our business, we care for people, we do not just deliver supplies or commodities, those of us who have been successful realize the service side of our business is important. Unfortunately Competitive bidding will force most … Continue Reading

“Competitive Bidding” this is not bidding at all, this is “competitive discounting” at best. The laws read, the bid must be LOWER than the current amount paid. How can this be a bid? If the cost is higher, if process changes, if costs increase how can prices drop. Not long ago gas was $4.50 or more in many areas, could a DME adjust for costs? Of course not, but it was demanded that they drop fee’s charged by 9.5%. Oxygen was CAPPED, with an additional 24 months of responsibility and liability added on to the DME in the 34th month … Continue Reading

Congress needs to clean house at CMS and hire competent administrators. The competitive bidding for DME as it stands will force numerous legitimate providers out of business, increase unemployment, increase bankrupties and possibly home foreclosures. Limiting providers will only decrease accessability, service and quality to Medicare patients. DME is actually a part of the solution to reduce health care costs by keeping patient’s out of hospitals and SNF’s. DME is approx. 2% of the whole health care budget. Nobody can get good, high quality healthcare for free!

Competitive bidding without the “any willing provider” component is just an avenue to grant access to the unethical providers. “AWP” will help keep the ethical companies in the game. But the real issue is that Competitive Bidding (the way it is structured) is a waste of the tax payers money. It is all ridiculous when CMS sets the price anyway. So just set the price and let the chips fall where they may. This whole thing is a waste of time, money and definitely energy.

This company has been in the DME business for twenty five years. Over the last fifteen years ,the industry has been on a self distruction track. The addition of unethical suppliers to the mix has only increased the need for increased GAO unenounced inspections. With the mandated order of accreditation and bonding, you would think that the process would weedout the bad apples. The competative process that is in place right now will probably put this company out of business

Competitive bidding will do nothing to save Medicare money. The companies that are the unethical companies that are over marketing the benefits are the same ones that will win the contracts and all the bidding process will do is take away the ethical competition that gives Medicare clients an option. CMS already sets the allowable and by taking away number of providers, they offer less CHOICE for elderly and much worse service. The Scooter Store already bills about 1/3 of Medicare powerchairs, won I beleive 6 of first 10 areas and they won’t make that mistake again, they will win … Continue Reading

I am part owner of a small HME near Pittsburgh, so we are in Round 1a. Competitive bidding is a jobs killer and a service killer and will do nothing to reduce fraud as has been suggested. We have already agreed to the 13 point fraud reduction program, Surety bonds, and are subject to RAC audits. What else can be expected of our industry? Competitive bidding is designed to eliminate 70-80% of the DME companies which will reduce competition and reduce quality of product and service provided to keep the costs low.
The Medicare population is expected to … Continue Reading

The Competitive bidding program addresses the wrong problem. Total Medicare expenditures will not decrease if Medicare contracts only with the provider who gives the least services (lowest labor cost)and only the cheapest hardware.

Where significant service is required, and outcomes are clearly defined, Medicare should switch to paying only for successful treatment of a disease, not just for delivery of a gizmo.

1. Home health care is the low cost alertnative to institutional care. We are the solution, not the problem. The whole DME industry developed in response to a need to shorten the lenght of hospital stays. I hope the Obama administration researches the comparative effectiveness of home medical equipment and supplies versus institutional care. Maybe then the administration would protect the industry from CMS’s and the Republicans’ constant attacks.
2. Medicare policy is so complex and mercurial that it takes constant monitoring of the changing policies, rules, billing and documentation requirements in order to be a COMPLIANT … Continue Reading

I have been medical biller for two DME Medical providers for the last 20 years in Michigan. I have seen alot of changes; however, Competitive Bidding does not make any sense to this business. I have always been very proud to be a part a business that helps people. That has always been our main objective-to help people and provide quality equipment/service. Service is a large component of what a DME business does. The original allowables were created by “averaging” what suppliers billed in certain regions; which resulted in inflated billings in order to keep reimbursement rates reasonable–which I never … Continue Reading

I don’t understand why Medicare can’t set reimbursement prices then let DME’s decide if they can or want to provide services for Medicare recipients. It is now required that you must be accredited and bonded in order to become a DME in the Medicare program. I’m asking this to determine why we must bid to set the prices when Medicare already sets them.

The attached document was the second of two attachments provided to the IPD along with the letter beginning, “Having been in the Home Medical Equipment business for the best part of 40 years….”

Lincare sole survivor-From HME Business.doc (27 KB)

The attached document was one of two attachments provided to the IPD along with the letter beginning, “Having been in the Home Medical Equipment business for the best part of 40 years….”

Flaws in Bid Implementation July 2008 2-page summary 070808.doc (113 KB)

[The complete text of the following letter with proper formating of the table is posted in the attachment “IPD Letter.doc”   The next two posts contain the two attachments to the letter that were provided by the letter’s author, “Flaws in Bid Implementation July 2008 2-page summary 070808.doc” and “Lincare sole survivor-From HME Business.doc” — CRE]

Having been in the Home Medical Equipment business for the best part of 40 years, I have seen many changes in the industry, some good, and some bad. None of which would have the negative effect on the quality of care that the National Competitive Bidding … Continue Reading

Just like what was stated above so eloquently by Shannon whom I couldn’t agree with more. You lawmakers seem to have no knowledge of what it’s like to run a small business much less a DME business. Sorry if that seems harsh but reality is far from you policy. In your attempt to cut Medicare costs you are only pushing for increased Part A costs by limiting the suppliers payment for services on Oxygen. You are also really wasting taxpayer money by spending so much time on this competitive bidding issue. It seems that it would be more productive to … Continue Reading

If you think it is bad now, just give it a little time and you will see how bad it can really get. Congress passed a law and handed it down to CMS to enforce and they have made it clear that there are no exceptions to the law. I fully understand the intent but I also think I might have a clearer picture of what is coming than you do in regards to this specific legislation.

On January 1, 2009 Medicare stopped paying the monthly rental fee for every Oxygen patient that has been on service since on or … Continue Reading

Competitive Bidding is the wrong term for the program that CMS has and still is proposing. It is more of an auction for the lowest bidder, who may not be a qualified provider of the equipment they are bidding on. This does not save money, nor does it give the patient the freedom of choice that Medicare has always demanded. CMS has not proven that they have eliminated the issues that Congress demanded and are going ahead with a program that that is inadequate.

I was involved in a focus study group a number of years ago which was a … Continue Reading

I am a sole proprietor and have been in the DME business and a Medicare Provider for over
24 years. I am a small business owner (8 employees) in the Sierra Nevada mountain range in California. Yosemite National Park is part of my service area. I have Medicare Customers scattered all through these mountains. It’s normal for my drivers to put 200 to 300 miles a day of mountain driving to service Medicare Patients with their medical equipment needs. Like the Post Office we deliver / service thru “rain, hail, sleet and snow,” but ours is 24 hours a day 7 … Continue Reading

It appears to me that we should save the money of going through the bidding process. If you are in this business you already know if you are not a National company you are already out of business, so save the money of the process.

July 17th, 2009 at 11:27

Competative Bidding & Medicare Advantage plans are a dis-advantage to beneficiaries needing DME equipment. My company just this mornign told a sweet couple looking for a wheelchair that our company was not a provider for the Medicare Advantage Plan they had. Truly a SAD situation because I do not know how this couple is going to get what the wife is needing. They just pulled out of our parking lot more lost than when they came in.

Now how is Competative Bidding going to fix this? No way it can. Limiting providers will be a … Continue Reading

July 17th, 2009 at 10:53

The DMEPOS competitive bidding program will be harmful to both small business and to Medicare beneficiaries. Due to the fact that the program will exclude all but a handful of DMEPOS suppliers, and Medicare provides nearly 50% of industry revenues, literally thousands of small businesses will be thrown out of business by the program. In addition, beneficiaries will be left having to go to multiple DMEPOS suppliers for their product needs. For example, a beneficiary who needs oxygen, power mobility, orthotics, and aids to daily living will be forced to do business with 4 or … Continue Reading

July 17th, 2009 at 08:44

While I believe that the results of round 1 prove that a gross amount of flaws exist in the competitive bid program I am further perplexed that CMS has decided to proceed without the corrective action plans in place to proceed.I listened to everthing CMS had to offer at the PAOC meeting in Baltimore and the 8 hour day did not scratch the surface to address the flaws and yet here we go full speed ahead. If the current administration has success in providing a national healthcare program the insured ranks would grow by … Continue Reading

July 17th, 2009 at 08:26

Medicare spokesmen have repeatedly stated that it is there specific intention to drastically reduce the number of DME suppliers. Rather than do their job and properly screen those to whom they issue provider numbers they are resorting to a ’scorched earth’ policy in an attempt to reduce cost and get rid of providers that should have never been allowed into the system in the first place.
There are sufficient regulations on the books now that would permit them to shut down any DME provider in the country that they deemed to be abusive or fraudlent.
Right … Continue Reading

July 17th, 2009 at 07:32

It appears to me after reading this it is the plan and hope of the government to use competitive bidding as the tool to put solid, ethical, small mom and pop DME’s out of business at the expense of the locate residences that use them. So, set the prices and let the small business serve their communities and neighbors. Where is the free enterprise, boundries of forming monoploy

It appears to me that we should save the money of going through the bidding process. If you are in this business you already know if you are not a National company you are already out of business, so save the money of the process.

My company was a winner in the first round of competitive bid in the
Dallas/Ft Worth area. We won all the areas that we bid including high
end rehab power chairs. We are a RESNA certified ATP company.

However, we would have been a big loser had competitive bid been fully
implemented. Let me explain.

We bid a very low price base on the fact that we would have a quasi
monopoly. Some 75% to 85% of my competitors were supposed to be
eliminated from the market that I had won. However, that was not the
reality!!!

I’m a Resna certified ATP servicing the Great City of Houston, Texas. The Medicare bidding program is fundamentally flawed and stifles competition. It does not account for “Low-Ball” out of state bidders that never develop any meaningful relationship with their patients. These same “out of sight & state” providers will also be nowhere to be found when emergency and repair services are needed. This program will only drive out of business a large portion of high-quality, local homecare providers who have served their communities for many years. Problems with the design and operation of the bidding program will seriously … Continue Reading

In today’s financial environment it is unthinkable that CMS is proceeding with implementation of a bidding system that will put so many small DME businesses out of business. Not only will these companies be forced to close, but all their employees will be out of jobs at a time when jobs are difficult to come by. In addition it will make it very difficult for those needing equipment to find it in a timely manner. Will hospitals release patients to go home when they need equipment that is supplied by competitive bid of a company 200 miles away?

DME competitive bidding will without a dobt put several small companies out of business as they cannot compete with the pricing of large compnaies. The process itself if very flawed. DME accounts for 2 % of Medicare expenses yet has been subjected to the most scrutiny of price cuts already not including competitive bidding. Why not start with the hospitals having to submit bids for Medicare and take a 30% pay cut like DME has done over the last few years. Or the doctors who have had raises or a freeze every year for the last 5 years when DME … Continue Reading

July 16th, 2009 at 17:31

While I am a firm believer in free enterprise, competative bidding simply isn’t competative. If it were, there would not be a cap.

Think for a moment about one of your dearest family members. Imagine if you will that the were the unfortunately suddenly in grave neeed for a wheelchair. They would be unable to be independent without this equipment. Due to lack of sensation your loved one develops pressure uclers where the bones in their tailbone break through the skin. They are in depserate need of a custom molded seating system and pressure mapping. (Lets … Continue Reading

July 16th, 2009 at 17:02

I am very concerned about this plan. It seems it will limit the number of suppliers that my parents can use. And I can tell you that they are not all the same. The quality of care suffers tremendously when you limit suppliers. It seems the larger the more impersonal and the longer the wait. Please don’t limit my choice. Thank you for consideration of this matter

Since CMS has done such a lousy job of identifying fraudulent providers, here’s a low-tech way that should keep a sizable percentage of the bad guys from getting provider numbers.

First, CMS makes a bunch of postcards that have questions to be answered regarding the physical facility: Is this address a) a residence b)a strip mall c)an office buildingan d) other? (this is where you would put “airport runway” or “Wrigley Field”). Then you ask questions to determine whether or not a viable business exists there.

Then, you send the postcard to the USPS letter carrier for that address … Continue Reading

● CMS (Medicare) seems to do a “poor job” of administering their policies.
Yet, they cry out “fraud and abuse” of the durable medical equipment industry (DME). CMS actually issues the “provider numbers”. CMS supposedly investigates and checks the validity of each durable medical equipment provider before they issue a provider number. So, why are they issuing numbers to crooks? If CMS investigated them, why does CMS allow fraudulent provider numbers to be issued in the first place.
… Continue Reading

So I made 3 trips yesterday to a ALS patient who was becoming more and more anxious as she became more and more short of breath. Mind you respiratory therapy visits are non reibursed and provided as part of the service we offer. Had she capped (which will happen in 6 months) she would have been sent to the ER admitted, intubated and sent to ICU. So which plan is more cost effective?? Keeping her home or capping her and causing an addmission.

The National Competitive Bidding program was created to “control” the increasing costs to the Medicare program. Contrary to it’s purpose, it will eliminate competition, put 1000’s of small business and their employees out of business and eliminate the freedom of choice to the Medicare recipient. As we move forward with Health Care Reform, the Competitive Biidding program needs to be eliminated as an outdated and ill conceived method to control Medicare costs.

CMS can not initiate the competitive bidding program until OMB approves its information collection request ( ICR) pursuant to the Paperwork Reduction Act. CRE has identified a number of deficiencies which demonstrate that the CMS ICR is not PRA compliant.

CRE also recommends a solution to the problem: allow all qualified small suppliers to provide equipment at the single payment amount if the suppliers meet the SBA definiton of a small business.

CRE comments are appended hereto.

CMS Competitive Bidding ICR Comments.pdf (146 KB)

The goal of CMS must be to put DME companies out of business. After the recent cut in reimbursement for oxygen services, many DME companies are already struggling to survive. If CMS again reduces reimbursement and reduces the caps on payment, it will put many DME providers out of business. The other factor that has compounded the reimbursement issue, is the increased requirements, i.e. CMS standards, accreditation, surity bond, etc., all which have increased the cost to provide oxygen services.
I’m a firm believer that we need standards and such to insure quality, but ther has to be … Continue Reading

competitive bidding is acctualy the complete oposite. it turns a life saving service into a walmart type of homecare. the service that has long defined the care provided will be gone. no provider will be able to send a thereapist out to see grandma at no charge to re-instruct her or check her sat because she seems less able and more short of breath. patients will head to the ER rather than calling their provider because their provider is now more interested in selling scooters than oxygen.

That would surely cut alot of providers out. They would be closing there doors and telling employees ” I’m sorry…..the Government has put us out of business” You think unemployment rates are high now, wait til that happens. I am sure there would be no way for small DME’s to get a bailout package. People who don’t pay ourselves million dollar bonuses and then ask Congress for a BAILOUT. If we make bad decisions then we must live with the outcome. DME makes up about 4% of the medicare budget but gets the most cuts. My favorite quote, ” If … Continue Reading

why after decades of saving CMS untold amounts of money by assisting in timely disharges from the hospital while demonstrating that good service prevents readmission, are we the DME idustry being made out to be the evil step child. Our costs are a tiny portion of the CMS budget yet we save them millions. Our industry thrives because competition forces service to be the driving factor for the care we provide. Remove the competition from the mix by forcing a bidding program will remove the service that the medicaly fragile needs.

the only approach to reforming our healthcare system that has any chance of making a difference is this: Find out what is inefficient and fix it and find out what is working well and structure the healthcare system around it. Home Medical Equipment certainly falls into the latter category, particularly home oxygen therapy. Since reimbursements have, for the most part, been the same for all providers, we have been competing with each other on the basis of service. Prior to the 36-month cap, we would do whatever it took to keep our patients satisfied (and maybe even … Continue Reading

Today we compete for every referral based on quality service. I have been in the industry for 34 years and that basic standard has NEVER changed. With this illconcived consept called Competitive Bidding will terminate compition in the market place and erode quality service. An example of what I am talking about. Round 1 CMS awards a contract to the SCOOTER STORE to provide Home Oxygen. Are you kidding me? Someone with ANY knowledge of Oxygen Therapy should have raised the Red, White and Blue flag and asked the question. Does the SCOOTER STORE has a record of billing us … Continue Reading

Recent news reports are stating that the Cleveland MSA has lost more than 10% of it’s population since the last census. The population is now less than 433,000. We are now 46th in poulation size. Far less than the mandated number of 500,000 or more to be included in round one. Why then is CMS including Cleveland in round one if it does not meet their own citeria.

We are a mom and pop DME company which specializes in ostomy care. As you know ostomy care falls unders the consolidated billing. When we give patients ostomy supplies we always call to get an eligibility. Many times the Home Health episode does not show up as soon as they go under the Home Health episode. Later on we get recouped and when we approach Home Health agencies their respond is they did not order these supplies from us therfore will not pay for them. Home Health agencies do not report to Medicare as soon … Continue Reading

We got a referral from a local hospital for home Oxygen last Wednesday. The patient came to Los Angeles on vacation from Ohio, without bring oxygen with them. Once in LA the patient was hospitalized for Shortness of Breath, and upon discharge the attending phyician order O2. After learning that the patient was capped we declined the order and the discharge planner started calling other Oxygen vendors with NO takers. The results was that the patient was unable to be discharged until Friday at 4PM, after we worked out a creditcard payment for 1 month rental and a $2000.00 deposit … Continue Reading

We are a provider in Texas. We had a patient move another state up north. The patient was capped out and in our attempt to find a new provider, no one would accept this patient. That said Medicare requires us to provide and maintain the equipment.We are only have a license to dispense oxygen in the State of Texas. Medicare reuires us to follow all State laws. Since we cannot dispense oxygen out of state ,how is this patient to be taken care of if we cannot provide for them by law and no other provider will take them onto … Continue Reading

The competitive bidding program is a race to the bottom for the healthcare industry. It is based on the mistaken impression that the DME companies are ripping Medicare off! I have yet to meet a patient who WANTS to carry an oxygen vessel around in order to breath! Patients use medical equipment because they HAVE TO!! Currently DME companies compete based on service. The prices are fixed by Medicare and allow only a modest 20% profit which we finance interest free over 13 months for rental items. Oxygen reimbursement is causing all the uproar … Continue Reading

nursing homes thus, enhancing their quality of life and cutting medical costs. Competitive bidding and oxygen reduction will cut costs but it will also force whatever companies survive to cut costs by providing less services, inferior equipment and less control of the patient outcomes. I don’t care what kind of standards and regulations CMS puts in place, no one is going to be able to provide the same level of care with cuts of this nature. Eliminate competitive bidding and stop the oxygen cuts now.