Competitive Bidding will Eliminate Local Care Options for Beneficiaries

Flawed program will send Sranton disabled average 725 miles for a wheelchair

Obtaining home medical equipment such as wheelchairs, walkers and life-saving oxygen systems is about to get a lot more difficult for Medicare beneficiaries living in northeastern Pennsylvania.

Under Medicare’s national bidding program for durable medical equipment (DME), which is set to go live on July 1, a Scranton resident requiring a wheelchair will no longer be able to obtain that equipment from a local provider such as Andrew Brown’s Home Care located on Pittston Avenue in the city of Scranton. Instead, there will be only one wheelchair provider located within 50 miles of Scranton – currently there are 53 – and none located within the Scranton city limits.

“This is a terrible situation for seniors and the disabled,” said Robert Brown, vice president Andrew Brown’s Home Care. “Healthcare is a local activity. People, especially people who are limited by age and disability, look to local providers to take care of their healthcare needs.”

Under the new Medicare bidding regimen, the average distance to a wheelchair provider for Scranton residents will be 725 miles. “This system makes no sense for NEPA,” said Brown. “Medicare has awarded two contracts to Pennsylvania providers located within 100 miles of Scranton and six contracts to firms in Texas and Florida.”

Brown noted that putting a patient into a wheelchair is a process that normally requires the patient to visit the provider’s facility to ensure proper fitting and education on the proper use of the equipment.”

He also noted that other affected equipment such as continuous positive airway pressure (CPAP) machines require constant monitoring and tweaking to ensure proper fit and usage. The Medicare bidding program impacts eight categories of DME:

  • • Oxygen Supplies and Equipment
  • • Standard (Power and Manual) Wheelchairs, Scooters, and Related Accessories
  • • Enteral Nutrients, Equipment and Supplies
  • • CPAP Devices, Respiratory Assist Devices, and Related Supplies and Accessories
  • • Hospital Beds and Related Accessories
  • • Walkers and Related Accessories
  • • Support Surfaces (Group 2 Mattresses and Overlays)
  • • Negative Pressure Wound Therapy (NPWT) Pumps and Related Supplies and Accessories

According to John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers (PAMS), “84 percent of Scranton area providers (within 50 miles of the Scranton-WB bidding area) have been eliminated in favor of providers from as far away as Texas and California.” He said that the average distance to a medical equipment provider for Scranton-Wilkes Barre area Medicare beneficiaries will be “well over 500 miles unless Congress acts to ensure more-patient-friendly options.”

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“Similar beneficiary access problems have been created in the Lehigh Valley and the greater Philadelphia area,” Shirvinsky said.

“As homecare providers, one of our primary missions is to provide quality healthcare in the home environment. This results in tremendous savings to overall Medicare and Medicaid spending because it allows us to treat people with serious health conditions in their own homes rather than in higher cost settings such as hospitals or nursing homes,” he said.

The bid program is also having a negative impact on NEPA’s economy. “Major job creators such as Pride Mobility Products and Golden Technologies are being threatened due to the unsustainably low prices that have emerged from Medicare’s flawed bidding process,” Shirvinsky noted.

“Because of the way the Medicare bureaucracy manipulated the bidding process, many contract winners will choose low cost/low quality products from companies overseas, rather than higher quality products built in the USA. This program is creating a race to the bottom on price and will likely result in more jobs being shipped overseas.”

The program has also been besieged by licensing irregularities and it has recently been revealed that 30 firms in Tennessee and more than 100 firms in Maryland have been exposed as having failed to secure the necessary contracts to do business in those states.

According to Shirvinsky, “These firms should be excluded from serving any bid areas and most of these rule-breakers hold contracts in all four bid areas in PA.” He said that because these were clearly stated pre-bid requirements, the bids of these offending firms should be excluded from the bid calculations according to the program’s rules. “This will throw the entire bid process into a state of chaos, but the chaos is of Medicare’s own making.”

Last week, a bipartisan coalition of 227 Members of Congress, including 82 Democrats and 145 Republicans, sent a letter to the Medicare administrator that outlined critical flaws and abuses in the bid program and requested that Medicare delay further implementation until such issues are fully address and fixed. NEPA Reps. Matt Cartwright (D), Lou Barletta (R) and Tom Marino (R) all signed the letter, which asked for a delay in the program’s implementation.

“Last week, a bipartisan majority in the U.S. House of Representatives sent a letter to Administrator Tavenner documenting specific failures and abuses that took place under Round 2 of competitive bidding for DMEPOS,” according to Pennsylvania Congressman Glenn Thompson (R – Centre County), who led the effort along with Iowa Congressman Bruce Braley (D). “Since that time, the Medicare Administrator responded to members of the Tennessee delegation who sent a letter to the agency outlining a similar set of concerns. The Administrator’s response was evasive, incomplete, and failed to answer these serious questions. If this response is any indication of what the Administrator believes to be an adequate response, we have a problem.”

“Medicare has broken its own rules and the Administrator has neither addressed how these abuses occurred nor what corrective actions the agency will take,” Thompson added. “Unfortunately these failures are not limited to Tennessee, rather they illustrate widespread systemic flaws that have plagued the program. If the Administrator is incapable of rectifying this situation before July 1, alternative actions must be considered.”

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