Editor's Note

Time to Turn the Tide

Providers need to 'flip the script,' and reverse competitive bidding's pace.

• By David Kopf
• Dec 01, 2012

There are three things in this world that love momentum: avalanches, floods and competitive bidding. The Centers for Medicare and Medicaid’s entire game plan for competitive bidding seems based on the notion that as the bid program advances, simple inertia will ensure continued support for the program from Congress, because no one will want to change a system that’s in place.

If there is any doubt of that, just look at how CMS has handled the entire debate:

• When it became clear from economists’ reports that Round One of the program would shutter HME providers, it debated the notion.
  
  
• When it became clear that program has shuttered HME providers, it still debates that fact.
  
  
• When other reports showed that Round One would diminish patient access to care, CMS debated the argument.
  
  
• When records showed that Round One did diminish patient access to care and resulted in a cascade of complaints, CMS called the complaints “inquiries” and debated the rest. It even released a report (which most labeled skewed) arguing no ill effect to make its case.
  
  
• When an army of economists including Nobel Laureates told CMS its program was dangerously flawed, it called their assessment — and thus their expertise — into question.
  
  
• As providers and Medicare beneficiaries queasily stand on the precipice of Round Two, CMS continues to play up the notion that no harm can come from competitive bidding, and that the program is essential the fight against fraud.

The one thing that CMS has not done has been to collaborate with the industry, and this astonishes me. To my mind, when University of Maryland Professor Peter Cramton, backed with a legion of economists who were experts in auction theory developed the market pricing program and then staged a demonstration auction that worked, CMS was handed a golden opportunity to collaborate with the industry.

And I can’t stress the importance of that. I have worked in a few heavily regulated industries before I came to home medical equipment: telecommunications, powersports (a fancy word for motorcycles, scooters and ATVs), and finance. In each of those cases, the industries and the bodies that regulated them largely took a collaborative approach.

Am I going to say that, for instance, motorcycle manufacturers were happy with every piece of emissions regulation that the Environmental Protection Agency handed down? Of course not. But for the most part, the agencies and the companies they governed sat down at the table and hashed things out until a compromise was struck. Heck, the Personal Communications Spectrum auctions that were held by the Federal Communications Commission in the 1990s were considered a model for government auctions.

I’ve seen none of that with CMS. Instead, it continues to brief lawmakers on the bid program’s benefits (a specious case, in my book) and works to shoot down anything and everything the HME industry does to try and stop competitive bidding. In short its activities are all about momentum.

Well now is the time to make some momentum of our own. The industry has a golden opportunity: Congress is in a lame duck session until Jan. 1, and while it can’t forestall the fiscal cliff, it is desperate to pass an agenda that minimizes its impact. The “doc fix” to prevent cuts to physician Medicare reimbursement is a key item on that agenda, and H.R. 6490, the bill that would replace competitive bidding with the market pricing program can easily be attached to the doc fix if the bill gets enough support. So, it is imperative that you contact your Representative and continue following up during this session until he or she co-sponsors the bill.

If you feel like you’ve been getting buried in a competitive bidding landslide, here is your chance to reverse the process and give CMS a taste of its own medicine. Don’t miss out.

This article originally appeared in the December 2012 issue of HME Business.