A Bad Program Producing Bad Results – Competitive Bidding Must Be Repealed

Tyler Wilson, President, the American Association for Homecare - February 17, 2011

Six weeks into Round One of the bidding program and AAHomecare has seen enough.  Competitive bidding for home medical equipment must be abolished.  The homecare system should not be characterized and viewed merely in terms of the lowest cost and who can provide it most cheaply.  Providing valuable healthcare services is much more than that.  The Medicare system should not ignore matters of quality, access, beneficiary satisfaction.

Congress must consider the aging U.S. population (the first baby boomer hit age 65 on January 1), the rising incidence of diabetes and other chronic conditions, the cost of treatment in hospitals and nursing facilities, and the long-established preference among people for care at home.  All of these factors argue for a stronger approach to providing homecare - not a tearing apart of the system.

The philosophy behind bidding as a way for Medicare to manage, deliver and reimburse for home medical equipment is simply wrong-headed and misguided.  For that, we can blame Congress.  Lawmakers can be roundly criticized for mandating the program that is now causing such terrible financial hardship and economic dislocation.  Congress bears the responsibility and we should let them hear our anger.

At the same time, the CMS program design is faulty and its administration has been a lesson in poor planning, arrogance, and clumsiness.  For this, the Agency bears the blame.  Repeatedly, CMS has shown itself incapable of putting together and getting right basic elements of the program.  Auction experts, economists, homecare companies, patient groups and stakeholders from across the homecare spectrum have repeatedly advised CMS they've gotten it wrong on a number of fronts - from program development through implementation and beneficiary education.

And looking ahead, nothing about CMS' handling of the program should give anyone comfort.  The Medicare agency has been alarmingly dismissive toward a host of issues and completely unwilling to do any of the self-examination that are necessary.

With a growing list of problems being reported from the nine initial regions, complete intransigence on the part of CMS, and every indication that Round Two will be implemented without proper analysis or insight into the failings of Round One, the alarm bells are sounding - loudly.

The only way to stop the problems is to stop the program.  Congress must step in and enact legislation that ends bidding for home medical equipment.  And Congress needs to act fast - while there is still a community of homecare providers that can put the pieces of a robust homecare system back together.  If Congress fails to act, the economic fallout and harm to the homecare system and those that rely upon it will be irreversible.

AAHomecare is focusing all of its energy on convincing Congress that it must act to repeal competitive bidding.  A full court press is underway to get the House and Senate to consider legislation to end the program.

This effort needs the full support of everyone in the homecare community.  Whether in a Round One or Two area, whether a bidding loser or "winner" of one or several contracts, whether a full line HME provider or a specialized supplier, the fight to repeal bidding is a cause for everyone.

AAHomecare will lead the fight but the Association needs all of its members engaged and it needs the full involvement of everyone else in the homecare community.  There is no better opportunity to make our case to Congress than the upcoming Washington Legislative Conference on March 16 & 17.  Everyone with an interest in good and financially sound homecare should be on Capitol Hill in mid-March letting the House and Senate hear our call for repeal.

The alternative is to take a front row seat and witness the dismantling of the homecare system as we've known it.

I urge all of you - member and non-member alike - to take up the cause and fight to repeal bidding.  The time is now because homecare can't wait.