Competitive Bidding? Is it really competitive or making it harder for patients to get what they need

Over the last few months, ever since Medicare started its competitive bidding process  my colleagues and I, in the UCSF Housecalls program have had a harder time getting our homebound patients the durable medical equipment (DME) they need.   The purpose behind the competitive bidding process seemed like a good idea–lower the costs and reduce fraud that has been occurring with DME.

From the Medicare site:

“The program:

• Helps you and Medicare save money

• Ensures that you have access to quality medical equipment, supplies, and services from suppliers you can trust

• Helps limit fraud and abuse in the Medicare Program”

But in reality, the effects have created less competition, worse access, worse service, and patients dying or declining functionally because of difficulty getting much needed equipment.

Case in point: a 90 yo woman died from advanced dementia and multiple worsening pressure ulcers, and was not able to get the Alternating pressure pump she needed for her hospital bed.

Here in San Francisco, the number of DME companies from which we can choose has gotten smaller and smaller.  Some refuse to work with UCSF.  Some have a turn around time of over 1 month.  How do you justify that delay and simultaneously explain and document why someone’s wounds are not healing.  And all of this is occuring, without yet talking about the increasing demands regarding documentation for equipment.  The Medicare website is clear about documentation requirements, yet DME companies are coming up with their own format and requirements.  And again, this delays the receipt of much needed DME.

To say that this is frustrating is an understatement.  But even more importantly, a policy aimed at saving costs is actually hurting patients.  Somehow I can’t get my patient a hospital bed, yet I continue to get faxes from DME companies claiming that my patient with dementia who can’t answer the phone ordered a back brace, or better yet a penis pump for erectile dysfunction.  It seems that we may need to refocus or better yet, rethink the goals of the competitive bidding process.

As our Housecalls group prepares to write letters to our Congressmen and women, we wonder if any of you around the country are experiencing similar phenomena?  Or is this just happening here in Northern California.

Please share your stories.

by: Carla Perissinotto MD