Not every category of medical equipment is included in the Medicare competitive-bid program.
The program does impact purchases for:
Oxygen supplies and equipment
Standard (power and manual) wheelchairs and scooters
Enteral nutrients and equipment
CPAP and respiratory assistance devices
Negative pressure wound therapy pumps
Group 2 power wheelchairs cost about $8,750, and Dick Drake of Seabrook Island is waiting patiently for one.
It’s not that Drake, 81, can’t afford the $1,750 co-payment for the chair, which his doctor recommended so he can move independently from one room to the next without the help of a home health care aide. In fact, he’s ready and willing to pay his share.
The problem is that Medicare’s federal competitive-bidding program for durable medical supplies, new to the Charleston market on July 1, has slowed the purchasing process to a near halt. It means that Drake, diagnosed with hereditary neuropathy, and other elderly Medicare patients are waiting much longer than usual for some categories of medical equipment.
“There is no cure for the malady that I have, and I am further inhibited because I’m a COPD (chronic obstructive pulmonary disease) sufferer, which tends to limit the amount of air handling I can do if I were able to have the motions I need to move anyway,” Drake said. “So it’s kind of a double mixture.”
Before July 1, there were at least six companies in the greater Charleston area that Medicare would have reimbursed to provide Drake a Group 2 power wheelchair. Now, because of the entitlement program’s competitive-bidding process, there are none able to fill this order, even though several companies submitted bids to win the contract. Drake must work with a Savannah-based company to purchase his chair.
“What I’d like to do for this kind of money is for (the company) to bring a like chair up here for me to view, sit in, determine if I can get in and out of the darn thing and can, in effect, function,” Drake said.
So far, that hasn’t happened.
“I am spending a minimum of an hour or two every day handling these issues,” said Sarah Gassman Schultz, director of home health for PHC Home Health in Charleston.
Gassman Schultz, who is working with Drake to help him navigate this new process, said there are other patients with similar frustrations about the competitive-bid program.
A Bishop Gadsden resident has been waiting for weeks to receive a manual wheelchair because only one Charleston company was awarded a Medicare bid to sell that type of chair to Medicare patients. Another local patient has been waiting more than a month for a pressure relieving mattress, she said.
“They are way more than kinks, and I’m not exactly sure how it could all be resolved unless they say we’ll just take a break from (the competitive-bid program), re-evaluate and see, when we do it next time, if we could add more companies and more options,” she said.
Medicare’s competitive-bid program for durable medical equipment was established by the Medicare Modernization Act of 2003, but wasn’t implemented until January 2011, and even then, only in nine metropolitan regions in the country. On July 1, the program rolled out to 91 other areas in the country, including Charleston.
Medical equipment companies were asked to submit bids to supply certain categories of durable medical equipment to Medicare beneficiaries in order to secure the best prices for Medicare. Critics of the program say many companies submitted artificially low bids, then weren’t obligated to fulfill them. Also, some companies were awarded bids to supply equipment that they previously had no experience handling.
In a June letter to the Centers for Medicare & Medicaid Administrator Marilyn Tavenner, several Republican members of South Carolina’s congressional delegation, including Sens. Tim Scott and Lindsey Graham, wrote that the competitive-bid program was seriously flawed and needed to be reviewed by Congress.
“One company in particular won bids to provide oxygen in all of the South Carolina competitive-bid areas, but this company is located in California,” the congressmen wrote. “Bids on more than 200 contracts have been awarded to companies in states that do not even share a border with South Carolina.”
The larger issue is that Medicare is going broke.
The program was established in 1965 to provide health insurance to the elderly and disabled, and its Hospital Insurance Trust Fund, which is financed by payroll taxes and covers expensive benefits like hospital care, is expected to become insolvent in 2026, according to recent federal projections. Medicare’s financial problems are exacerbated by an aging population that is living longer than ever before.
The competitive-bid program is just one way the government is trying to save Medicare money. The Centers for Medicare & Medicaid’s Office of Chief Actuary estimates that further expanding the program over the next 10 years will save $43 billion.
A report published by the U.S. Government Accountability Office in 2012 determined that the initial implementation of the competitive-bid program in the first nine metro areas did not negatively impact access to equipment or customer satisfaction, but that “it is too soon to determine its full effects.”
Meanwhile, medical supply companies, health care providers and patients are adjusting to their new reality. Some experts complain that delaying access to equipment in order to save money will only end up costing Medicare more in the long run, as patients with medical complications are readmitted to a hospital.
Beth Cox, a spokeswoman for a national group called People for Quality Care, said the group’s hotline has fielded nearly 1,000 complaints about the competitive-bid program since July 1.
“We’re continuing to get more calls in every day. I only see this number increasing,” Cox said.
Reach Lauren Sausser at 937-5598.