Contemplating Medicare's 'dark path'

WASHINGTON - Like teenagers and beer, Medicare's going to try competitive bidding - that's all there is to it, says one HME provider, who has resigned himself to the inevitability of the dreaded reimbursement methodology. "You can try to talk them out of it," the provider said. "You can stall 'em for a while, but eventually they're gonna try it - if they hurt themselves that's OK, but I'm afraid I'll be the hit 'n'run victim." Fear, outrage, defiance, resignation, incredulity, diplomacy, even complacency: It's all there when you mention competitive bidding to providers. "Home care is the least expensive delivery system for health care," said Les DeFelice, owner of DeFeliceCare in Wheeling, W.Va., who spent time this spring lobbying in Washington against competitive bidding. "That is our message loud and clear. I don't think the industry should be intimidated into accepting anything less than fair reimbursement and patient choice." Roger Miller, president of Dependicare in Broadview, Ill., called competitive bidding "the dark path that leads us right back to where we are now." "They say they are going to maintain the standards of care, but excuse me, I believe I heard the same things from managed care companies back in the early 1990s," Miller said. Competitive bidding will drive down the reimbursement and quality; beneficiaries and legislators will complain; and in five or six years, Medicare will address the complaints by raising reimbursement - just like managed care did in the late 1990s, Miller said. "Beneficiaries need a standard of care. If you drive down prices too low, you get providers who don't give it," Miller said. "Why do they think anything different should happen?" Jan Fisher, president of Respiratory Care Plus, Upper Nyack, N.Y., has also lobbied Washington lawmakers and collected hundreds of patient signatures to make lawmakers "aware that patients will not be happy with cuts if it affects their care." Fisher stands in the camp of diplomatic providers who say Medicare has to complete and study the results of its demonstration projects in Polk County, Fla., and San Antonio before rolling out competitive bidding nationally. "It they find that it works and is viable, so be it," he said. "I'm a babyboomer and I want to know the system will still be there. All we are saying is get the data back." While providers like Fisher, Miller and DeFelice are speaking out against competitive bidding, others express a "tragic lack of urgency that I hope is not tragic," said industry consultant Wallace Weeks. "I just left a provider who brought it up, said it might make them want to sell their business. But there was no sense that they're going to be active in lobbying to halt it." That lack of urgency worries some. "My fear is that the industry, the independents will not wake up," said a provider who asked to remain anonymous. "They are all planning their vacations for July. They don't know that their livelihoods may be coming to an end." HME