The FUD Factor

• By David Kopf
• May 13, 2008

Don’t let concerns over competitive bidding throw you off your game.

Thanks to competitive bidding, fear, uncertainty and doubt — the dreaded FUD factor — seems to rein supreme over the HME industry these days. For a program that was supposed to shine a light on the Medicare funding process and ensure that tax payers were getting a straight deal, those very tax payers, as well as HME providers and their patients have been left with a process that has been as clear as mud.

The latest headlines have not been encouraging (read our news section starting on page 8 to learn more): at press time more than 150 complaints have been filed with the American Association for Homecare concerning contract refusals for round one of CMS’s competitive bidding program.

The complaints focus on bids being rejected due to either technicalities, or what some have alleged are errors. Providers participating in round one of competitive bidding submitted their bids to the Competitive Bidding Implementation Contractor (CBIC), which is Palmetto GBA, for processing and evaluation. Many of the providers complaining say they were refused contracts because they were told their bids were missing documentation such as financial statements or tax records. Needless to say the providers who are complaining are convinced they sent the information.

More importantly, some providers contend that CBIC should have let them know that the information was missing, according to its own description of the process. According to page 13, paragraph 3 from a transcript of a June 6, 2007 CBIC educational teleconference (found in the “outreach and education” section of the CBIC/Palmetto website, dmecompetitivebid.com), “If your bid is not considered complete, including hard copy documentation, you will receive an email advising you that your bid is not complete.” So why did these providers not receive that notification?

It seems pretty obvious that if CMS’s goal for competitive bidding is to get the most cost-effective bids from the providers who can best provision services, then it would want to ensure it had the best bids. To throw out a potentially cost-saving bid because it supposedly didn’t include, say, an easy-to-retrieve 2005 tax form, is completely counter-intuitive to the process.

The objective is to save money, not play bureaucratic “gotcha” with businesses that constitute a small segment of CMS’s overall budget. So why not contact the providers? Why not make the process actually work as intended?
I think it’s safe to say, the answer can be summed up in one word: “momentum.” Now that competitive bidding is rolling, as long as it keeps pushing along and making its dates, that steamroller effect shouldn’t give anyone a chance to scrutinize the process. At least that seems to be the game plan.

But it’s not working. Already two sets of economists have put competitive bidding under the microscope, and the “view” hasn’t been all that attractive. Those analyses have helped energize the industry’s continual efforts to halt and hopefully revise at least round one in the hopes of altering the program into something that works for all parties involved. Make sure to read this issue’s cover story (starting page 43) to learn more about why competitive bidding needs fixing and how the industry is working to halt it and find a workable solution.

And while the fight rages on, providers should continue to find, appraise and hopefully leverage new market opportunities in the hopes of expanding their businesses. Our feature on home sleep testing (page 34) is case in point. CMS’s decision back in March to expand coverage for CPAPs to include beneficiaries diagnosed with obstructive sleep apnea via home sleep testing devices types II, III and IV could be just one of those opportunities.

Forget the FUD factor — it’s never done anybody any good anyway. Keep the faith and keep fighting for your industry, your business and your patients. You’ll come out ahead.

This article originally appeared in the May 2008 issue of HME Business.