The 60-day comp bidding deadline extension riled some and pleased others, but most agree that those in the first 10 MSAs became reluctant guinea pigs.

CMS' 60-day deadline extension for the first round of competitive bidding has drawn mixed reaction from home care companies. "Yes, the extension gives extra time so that people can finish their bids, but the reality is that it now creates an opportunity for a whole new second wave of providers to jump in and start the bidding process—companies that were not planning to bid but now are saying to themselves, 'Oh, what the heck, why not?'," says Kim Brummett, vice president of contracting and reimbursement for Advanced Home Care in Greensboro, NC. "My concern is that these latecomers will submit less educated bids, which may have the effect of bringing down a CBA's bid price."

Moreover, she says, the extension might tempt those in the first wave of bidders to revisit their prices and alter what they already have submitted. Brummett believes that some who succumb to this lure might do so after heeding unsubstantiated rumors of where CMS plans to draw the proverbial line in the sand with regard to pricing. "The best advice I can give is to not listen to the rumors," she says.

At the other end of the spectrum, Mike Marnhout, president and CEO of Bluegrass Oxygen, with five Kentucky locations and one in Ohio, contends that "giving more time is an extremely good development." In particular, he believes the extra 8 weeks accords the home care industry an opportunity to further press Congress for favorable changes to the program. "Competitive bidding is going to hurt a lot of our small businesses, but it's our senior citizen patients who will feel it the most," he says. "We need to drive that home to our representatives and senators."

SIGNS OF TROUBLE

Along with the extended deadline for bidding, CMS added time for providers to complete the accreditation process. Marnhout is delighted by this as well. "It was the right thing to do, the fair thing to do, since there is still a very large percentage of our industry that hasn't yet been accredited," he says. "This gives them a window to become eligible to bid and, hopefully, stay in business."

Kim Brummett

Cynthia L. Wilson, general manager of UPMC Home Medical Equipment in Pittsburgh, does not share that upbeat view. "Extending the accreditation deadline won't make much difference where procrastinators are concerned; if you haven't yet started accreditation, this extension is not going to give you enough time to get it done," she says.

Wilson sees the twin extensions as evidence that competitive bidding is not working as planned. Says she, "CMS did not completely think this through before the rollout."

Marnhout agrees: "The bidding process has turned into a real debacle—worse than I imagined it would. For example, some of the things we're asked to bid on are items I've never even heard of—and I've been in this business 27 years."

Marnhout, who turned in on time his bid for respiratory, hospital beds, and CPAP, says his efforts to obtain explanations from CMS' Competitive Bidding Implementation Contractor (CBIC) about various facets of the process generally met with failure. "Calls to the CBIC help desk have been very frustrating," he says. "You get a different answer every time you talk to someone there. Some of the answers are ludicrous—even from the supervisors. The CBIC people are uneducated about our business and our product lines."

Larry Rice

Larry Rice, chief operating officer at In Home Products, Dallas, experienced the same thing. "I listened in on some of the phone conversations my people had with the people running the CBIC customer service center," he says. "It seemed like no matter how nice my people were, the CBIC representatives were ill-tempered, surly, unconcerned, uncooperative, and—to top it all off—not particularly knowledgeable. Part of the problem is that, with these customer service people, you get the feeling that they're just there to collect a paycheck and couldn't care less if you get the help you need. Your phone call seems like it's just a nuisance to them."

LOST IN CYBERSPACE

CMS decided an extension was warranted for several reasons. Brummett believes one was the federal administrative body's trouble-plagued Web site for electronic submission of bids. "The Web site was never able to let me view—let alone edit—the summary of our Form A," she reveals. "And it was impossible to update Form B without having all our previously entered values, capacities, and bid prices disappear. On the complex rehab category alone, I ended up having to reenter bid prices three times—a lot of needless extra work, a lot of frustration."

Rice seconds the notion that the Web site was poorly conceived and executed. "I guess that happened because the Web designer they hired was someone they picked through competitive bidding," he muses. "Maybe they chose the cheapest-priced programmer. If so, they definitely got what they paid for."

Mike Marnhout

A better-designed competitive bidding Web site exists, but not for accepting bids. This one is intended to search out names of Medicare-approved manufacturers, such as those that Marnhout had difficulty finding the old-fashioned way. He was steered to this site by a friend who had discovered it almost by chance. (Unfortunately, the site cannot be reached directly; you must instead follow a link trail. Start by going to www.palmettogba.com. On the home page is a section entitled Medicare Services, which contains a subsection—"Other Partners." You will find a link there for SADMERC. Clicking it takes you to another PalmettoGBA page. Just below the "Welcome to SADMERC" headline is a horizontal row of tabs. Click the one labeled DMECS. On the screen that comes up, find the left-side tab "Search for Codes or Fees." Click on it, then scroll to the bottom of the page, look for a banner emblazoned with "Search for DMEPOS Product Classification List." Below it is a box to enter the HCPCS code of your choice. Click the red "go" button on the right, and a few seconds later you will be presented with the names of recognized manufacturers of products so coded.)

YOU ARE NEXT

While some might write off the stumbles and fumbles plaguing the rollout of competitive bidding to government ineptitude, Wilson attributes them to government's lack of familiarity with the home care field. "CMS started from a position of simply not knowing anything about the side of our industry that successfully helps people every day," she asserts. "They know only the relative few companies that have engaged in fraud and abuse. And that's where all their attention has been focused, on the lawbreakers. They've never made the effort to understand the good companies. As a result, they have no idea what it takes for us to provide this service."

Wilson poses a question, which she then herself answers. "When Medicare patients go to a doctor, they get to choose who that doctor will be. Same with the hospital, the lab, and other providers. But when it comes to a home care provider, Medicare through competitive bidding is, in effect, eliminating the freedom of patients to choose. What I want to know is, why are we in home care so different from other providers that the freedom of choice needs to be stopped at our door? My fear is that we're not different at all."

By that, she says she means it could well turn out that home care is but the first step in a long march toward quashing patient choice across the board. "Eventually, it may turn out that Medicare tells patients which doctor they can see, which hospital they can go to," she says. "Competitive bidding might become something doctors, hospitals, and labs have to participate in too someday."

Rich Smith is a contributing writer for  HME Today.