Q&A: Dennis Rosen

BOSTON - Dennis Rosen, M.D., a pediatric pulmonologist and sleep specialist at Boston Children's Hospital, entered the competitive bidding debate with an op-ed in The New York Times on May 15. Since then, his piece has been making the rounds on Capitol Hill. Rosen fears that the program, which spreads to Boston and 90 other cities next year, will result in sub-par care for his patients. Here's what he had to say about the important role that HME providers play in allowing his patients to succeed with CPAP and other therapy.

HME News: How did competitive bidding get on your radar screen?

Dennis Rosen: I first came across it when I met with one of the DME companies that I work with. I asked them if they would consider providing vents, as well as CPAPs, and they said it was something they thought about doing but decided against it because it wasn't economically viable. Then they mentioned that CMS planned to push competitive bidding into our area and I asked what they meant. They explained it to me and my first reaction was, this could be detrimental to my patients.

HME: Who are your patients and how could competitive bidding be detrimental to them?

Rosen: I care for a lot of kids with chromosomal variances or development delays. Many of them have unusually shaped heads and faces, and many of them are small. They require small headgear and masks. So I need the DME supplier to work closely with the child and his family to get him acclimated to this. A lot of this is done in our sleep lab but having a good technician or an RT who goes into the home is key to getting this to succeed.

HME: There's this perception out there that HME providers are equipment jockeys, but it sounds like you value the service and expertise they offer.

Rosen: I'm sure that perception is based on less-than-stellar practices by some professionals. I know this because I see patients in the clinic who describe equipment being dropped off and being told how to use the device for only 15 minutes. There are a number of companies that I work with in my area and there are a number that I stay away from. I worry that, with competitive bidding, I may not have a choice.

HME: What's preventing lawmakers and others from realizing that preserving less expensive homecare services will reduce more expensive hospital stays?

Rosen: I think it has to do with the fragmented way that health care is provided and paid for. In our cystic fibrosis center, we care for more than 600 patients with cystic fibrosis who often have lung diseases that require intravenous antibiotic therapy. The therapy can last two weeks or three weeks or more. If it can be given at home, once the appropriate levels are determined, there's a huge savings for the system. I was talking to one of the nurses who coordinates and oversees these patients, and she says it's like a roller coaster. You have really good success, then things change for whatever reason, the quality of care provided by the homecare company shifts and patients are stuck in this poor service.

HME: What's one way to improve how health care is provided right now?

Rosen: I'm working on a book about communication between doctors and patients—why it's so important, what are some of the reasons it has deteriorated in the last few decades and how it can be improved. But that's only one bond in health care; it extends to nurses and patients, and DME suppliers and patients. With asthma, for example, we know that improving communications can cut costs dramatically, but there's little willingness to do this. Having these connections has everything to do with success.