Editor's Note

CMS vs. My Mom

The reality of Round Two’s ridiculousness sinks in as contract holders are unveiled.

• By David Kopf
• May 01, 2013

Chances are, you’re aware that CMS has debuted the contracted providers for Round Two of its national competitive bidding program. If you haven’t, turn to “News, Trends & Analysis,” on page 8, to get the details. The figures should astonish you: CMS awarded a total of 13,126 contracts to just 799 providers to serve all of the categories for Round Two’s 91 CBAs.

We in the industry find this jaw dropping, but I wonder what it will be like when the average Medicare beneficiaries and their families discover what they’re in for with this program. Well, I’d like to share my personal story: I’m the youngest of three siblings, and my surviving parent, my mother, is in her 80s (she’d ground me if I shared her actual age) and lives in a nearby. She’s doing great. We have her over multiple times a week; she loves visiting with her grand kids; and when she’s not running circles around us, she’s out and about doing all sorts of activities with her friends.

However, like a lot of seniors, she depends on DME to live this independent lifestyle. Specifically, she needs a walker. She is not stable to walk on her own, and uses it nearly every moment of every day to get around. That walker is a part of her.

Well, that walker is getting a little long in the tooth at the moment. I do a lot of work in the garage, and the other day I gave it a much-needed overhaul. The bolts and bushings on the wheels were falling apart; multiple fasteners were loose; and I had to extract a broken bolt from a threaded star nut insert in one of the tubes and replaced it with a good one. A thorough cleaning and liberal lubrication finished the job.

I probably breathed another year or two of life back into that old piece of “bent metal” that she dearly depends on, but I told her that we had to hit up her local provider soon to get a replacement. That’s really not a big deal, as there are multiple providers in her area, and a really good one about a mile and a half away. She could take her bus service, or I could drive her over at some point.

Well not under competitive bidding Round Two. I used the handy online Supplier Search that CMS provides (again, turn to “News, Trends & Analysis” to read where to find the tool and how to use it) to check out where her providers will be. That’s when things got plain, old fashioned ridiculous.

The search yielded 18 providers. The first provider was roughly four miles away. That’s not too bad. The next was 16.5. Then the mileages started getting higher — 22 miles, 28 miles, 35 miles, 45 miles. Look, we live in Southern California. If you’re not familiar with it, there are roughly 8 million people living in the Los Angeles and Orange County basin and getting around is hard. Traveling 22 miles is a bona fide pain in the neck for me to drive at rush hour, but if my mom were alone and had to use the bus? It would take her the better part of the day. And traveling 45 miles up to L.A.? She might as well get a hotel room, because the busses will stop running before she can get enough transfers to get home.

But what really threw me was the out-of-state bidders. Contract holders hundreds and thousands of miles away in Texas, Kentucky, Alabama, North Carolina, and Florida are somehow supposed to start serving my mom by Round Two implementation. There is virtually no way they are going to be able to site locate and fund commercial real estate in Southern California of all places by July — or even December — let alone set-up shop, staff and start serving patients. (One wonders if they accepted the contract simply to sell it.) How did CMS deem their viability as potential providers?

And my mother’s dilemma is for a simple walker. What about an oxygen patient? Trust me, the results are just as surreal. This is the ridiculousness of competitive bidding on parade for everyone to see. The question is, when is the public going to see it? Hopefully in time to build enough support to stop this program before implementation.

This article originally appeared in the May 2013 issue of HME Business.