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Florida Physicians Press Sen. Martinez to Support Reform of Medicare Bidding Program after Hospital Discharge Problems Emerge
Date:7/14/2008

Physicians Cited Concerns After Delays in Delivering Equipment, Lack of Trained Clinical Staff

ARLINGTON, Va., July 14 /PRNewswire-USNewswire/ -- Florida physicians have written letters to Sen. Mel Martinez (R-FL) citing numerous problems related to the new Medicare competitive bidding program for durable medical equipment that was implemented July 1 in Orlando, Miami-Ft. Lauderdale, and eight other metropolitan areas in the U.S.

The controversial bidding program has triggered widespread disruptions in service across the country for physicians, hospital discharge planners, home medical equipment providers and Medicare beneficiaries who require oxygen therapy, power wheelchairs, CPAPs, enteral nutrition, diabetic supplies, and other items and services that help them live healthy, independent lives.

The bidding program is also operating in Charlotte, Cincinnati, Cleveland, Dallas-Ft. Worth, Pittsburgh, Riverside, Calif., and San Juan, P.R.

Last week, Sen. Martinez joined with 68 Senators to approve the Medicare bill, which includes adjustments for physicians' reimbursement and important improvements to the competitive bidding program. However, the White House has said it will veto the Medicare bill.

Mounting complaints have been made to the American Association for Homecare (AAHomecare) about the bidding program including:

-- Delays in patients being discharged from hospitals because proper equipment cannot be obtained in a timely manner for their use in their homes;

-- Medicare beneficiaries calling their previous providers frustrated because they cannot find new providers to deliver equipment they need; and

-- Providers making referrals for their previous patients but finding that providers who won bids are unwilling or unable to service the patient needs as required by program rules.

"We are pleased that the Senate joined the House in imposing a moratorium on the program so that critical reforms can improve the bidding program," said Tyler J. Wilson, President and CEO of AAHomecare. "We hope that Congress will overturn the expected veto from the President. We are facing a potentially dangerous situation in which some of the most vulnerable people in our society are having difficulty getting the medical equipment that they need. Those who are in hospitals are being forced into longer stays in those expensive institutions because equipment can't be obtained in a timely manner to sustain them in their homes. This is a dire situation that must be corrected."

In Florida, at least two frustrated physicians wrote to Sen. Martinez.

On July 2, Dr. Natarajan Rajagopalan, M.D. placed an order for liquid oxygen for a patient on a high liter flow. Such equipment and services, he says, are usually delivered by a licensed respiratory therapist, who reports back to the discharging pulmonologist or critical care physician. "We found that none of the companies we called provide liquid oxygen systems," he said. "I found out that with the goal of finding the lowest bidder, Medicare is now allowing companies to sub-contract specialized oxygen services through un-accredited companies. They are not required to have the equipment set-up by or have the patient educated or evaluated by a respiratory therapist."

In his letter, Dr. Rajagopalan noted that in a separate case, his office manager at a local hospital, placed a call with a bid winner before noon last Thursday for oxygen equipment. She was told that the equipment could be delivered either the next day, or the day after.

"Typically oxygen is delivered to a patient in hours, not days," Dr. Rajagopalan wrote. "That policy will create countless problems for hospitals in the area. We cannot wait days for equipment to be delivered to the hospital or to the patient's home before they are discharged. The hospital needs the patient's room and we are unable to bill Medicare additional days for a hospital stay."

Furthermore, Dr. Rajagopalan wrote, "In the past local providers competed for our business on the basis of service, by working with case managers to help us with these sensitive issues. Today the lowest-priced bid method chosen by Medicare is costing the hospital in the form of increased hours required by case managers and juggling multiple bid winners trying to coordinate the discharge of a single patient. If a patient requires a hospital bed, walker, enteral tube feeding, therapeutic ventilation and oxygen, case managers may have to coordinate with five separate bid winners to get the patient home. Before this program, all we had to do was call one provider for all services."

Another physician, Dr. Seth Gottlieb, of Miami, is also upset at the new process. He also wrote a letter to Sen. Martinez, saying, "The competitive bidding program for home medical equipment is only a few days old and it has already caused major delays and problems for my staff and the discharge coordinators at the Mount Sinai Medical Center in Miami Beach."

In his letter, Dr. Gottlieb noted that nine of the oxygen providers that won bids in the area do not have the necessary licenses from the State Department of Health, despite Medicare program requirements that all winning suppliers comply with all applicable laws, rules and regulations. "Clearly there is a major loophole regarding quality and accreditation in Medicare's oversight of this program," he wrote.

Meanwhile, the daughter of an 82-year-old Sunny Isles Beach, Florida oxygen patient said consequences from the bidding program caused her mother to make an unnecessary visit to a hospital emergency room.

Wilson, of AAHomecare, said that similar situations developing across the country underscore the urgency for overriding a veto from the president. The measure is supported by AAHomecare, as well as the ALS Association, the Muscular Dystrophy Association, the National Spinal Cord Injury Association, the Paralyzed Veterans of America, and United Spinal Association.

Unless reformed and improved, the bidding program will eliminate thousands of qualified providers from Medicare and reduce services and access to care for Medicare beneficiaries. Wilson noted that providers as well as consumer advocates and other stakeholders have argued that the Centers for Medicare and Medicaid Services (CMS) were implementing a flawed bidding program that would put Medicare beneficiaries at risk, while failing to deliver on promises that it would increase competition and lower price over the long haul. Two recent economic studies predicted the program would fail to deliver on its promises.

"Unfortunately, the situations unfolding in Florida are occurring in the other locations across the country," Wilson said. "Our Medicare beneficiaries deserve better treatment."

The American Association for Homecare represents providers of durable medical equipment and related services and supplies as well as the manufacturers of that equipment. Members serve the medical needs of millions of Americans who require home oxygen equipment, wheelchairs and other mobility products, hospital beds, medical supplies, inhalation drug therapy, home infusion, and other medical equipment, products, and services, delivered in the patient's home. Provider members operate more than 3,000 homecare locations in all 50 states. See http://www.aahomecare.org.


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SOURCE American Association for Homecare
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