Driving around Los Angeles to deliver oxygen tanks and concentrators along with a good dose of caring, Will L. Weatherspoon, RRT, owner of Advanced Respiratory Medical Systems Inc, a small oxygen equipment and respiratory services company, sees inequality daily. As an African American HME company owner, he is especially cognizant of the fact that not only do many minorities have higher rates of heart disease and diabetes, but in Los Angeles, many live in neighborhoods to which his competitors refuse to deliver except during certain daytime hours.

It is because of this that Weatherspoon has an additional concern about competitive bidding. As it is currently structured, competitive bidding will be implemented first in large metropolitan areas, such as Los Angeles, where Medicare beneficiaries are more likely to be poor and minority than in smaller cities and suburbs, such as the retirement communities just south of Los Angeles in Orange County. In Weatherspoon’s opinion, this would be like creating two separate and unequal Medicare systems, one for middle-class people who live outside big cities and another for poor inner-city minorities.

Now Medicare might say this is not a problem because the products and services delivered in both systems will be the same, but Weatherspoon does not buy that argument. If the competitive bidding Medicare system in the cities pays significantly less than the traditional fee-schedule system in the suburbs, they cannot be 100% the same. Somewhere the people in the inner city would get less and Medicare’s argument that the system is fair because products and services under competitive bidding would be the same as under traditional Medicare would be no more valid than the argument that racially segregated schools were fair because the education delivered was the same.

“It is ridiculous and I can’t see it happening,” Weatherspoon says. “If we do [have competitive bidding] we are going to have a lot of lawsuits.”

He is not alone in his concern. In October of last year, Congressman Edolphus “Ed” Towns (D-NY) wrote a letter to Congressman Bill Thomas (R-Calif) and Senator Charles Grassley (R-Iowa) asking them to consider the disproportionate impact competitive bidding was likely to have on minorities as they worked on a compromise Medicare bill. The letter was co-signed by Vito Fossella (R-NY), Bobby Rush (D-Ill), Albert Wynn (D-Md),

and Major Owens (D-NY). John Gallagher, vice president of government relations for the member services organization The VGM Group, in Waterloo, Iowa, thinks it may be time to revive this argument.

Last month Senate Majority Leader Bill Frist (R-Tenn) and Senators Mary Landrieu (D-La) and Thad Cochran (R-Miss) introduced the Closing the Health Care Gap Act, which they say aims to address racial health disparities. If they are serious about this, there is an argument to be made for revisiting how competitive bidding will be implemented, Gallagher says.

On the opposite coast from Weatherspoon, Zeb Pirzada, owner of Medstar Surgical in College Point, NY, thinks Gallagher may be right. Pirzada is concerned about what will happen to his inner-city clients if competitive bidding forces companies like his out of business. Will a company that can bid low enough to win a Medicare contract for New York offer interpreters for people who cannot speak English? Will it have the resources to deliver emergency oxygen tanks during a black out or other disaster? Will its drivers be willing to go into dangerous neighborhoods late at night? Without additional payment, chances are it will not.

“We have employees that are willing to go anywhere and do anything for the business,” Pirzada says. “People are willing to do anything to be part of a good company.”

However, making the argument that competitive bidding will create two separate and unequal Medicare systems will not be enough, Pirzada cautions. To really turn the tide, the industry has to get behind its state and national associations and offer policy makers alternatives to competitive bidding. Home health care can save Medicare money, we just have to show the people in power how.

Lena Lindahl
llindahl@medpubs.com