Any willing provider? It’s not a unanimous decision

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Friday, July 20, 2018

YARMOUTH, Maine – Reaction among providers to CMS’s any willing provider provision run the gamut—with some feeling disbelief, some contemplating new opportunities, and some discounting the idea outright.

In a proposed rule released July 18, CMS stated that when the current bid contracts expire Dec. 31, 2018, any Medicare-enrolled provider will be able to supply DMEPOS items to beneficiaries until a new round of bidding is implemented—a process that could take 18 to 24 months. The catch: They’ll have to do it for the current reimbursement rates in bid, non-bid and rural areas.

“They’ve admitted the rates are unsustainable, but they are also delaying the program for a few years and we are going to be stuck with these same rates,” said Gary Sheehan, CEO of Sandwich, Mass.-based Cape Medical Supply. “There are a lot of people hanging on by a thread as it is, and if they wait two years to put these corrections in place, how many more providers will be lost?”

For many of the providers still standing—an estimated 30% have closed their doors since 2016—the decision to take back Medicare business will require some hard number crunching.

“I took all the SPA amounts and put them on spreadsheet and am really looking at exactly what I can sustain and what I can’t,” said Josh Eckstein, vice president of Complete Home Care in Buffalo, N.Y., which holds a respiratory contract. “I would consider additional Medicare business so I can be a one-stop shop, but, again, I have to look at what I can sustain and what I can’t.”

Provider David Chase says he’s not thrilled with the rates, especially compared to the cost of doing business with Medicare, but he welcomes the opportunity to get back his CPAP and oxygen business.

“They are not doing anything about the burdensome documentation that’s part of Medicare,” said Chase, CEO of Hampton Home Care in Southampton, N.Y. “We’ll take it because it’s in our wheelhouse and it’s better than nothing.”

If the SPAs stay the same, provider Mike Bailey simply won’t participate.

“We declined contracts when they were offered to us three years ago,” said Bailey, CEO of Saint Paul, Minn.-based Handi Medical Supply. “I don’t send my sales staff out looking for negative or low-margin business.”

One of CMS’s ways of justifying the lower rates of the bid program is that contract suppliers would see an increase in market share—something that theoretically goes away under the any willing provider provision. But providers say that’s not a concern.

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“In our market, there really aren’t any other providers,” said Andrew Trammell, president of Carolina’s HME in Charlotte, N.C., which holds contracts for general DME and standard mobility. “The few that are left already have contracts.”