Round 2019: Plenty of questions, still no answers

WASHINGTON - With only seven months to go until the current competitive bidding contracts expire across the country, HME providers are getting antsy for information on Round 2019.

“We've heard nothing,” said Josh Eckstein, vice president of Complete Home Care in Buffalo, N.Y., which holds a respiratory contract. “I need to decide what my next move is. There's no chance there is enough time to evaluate my bid then figure out whether to accept a new contract.”

CMS has typically given the bidding process—from bid window opening to contract implementation—about 16 months. However, a new requirement that bidders obtain surety bonds for each CBA in which they bid means providers could need even more time.

Some providers are anxious to get on with it.

“I have been looking forward to a raise (in reimbursement) in Round 2109,” said Andrew Trammell, president of Carolina's HME in Charlotte, N.C., which holds contracts for general DME and standard mobility. “There will be fewer bidders and the bidders will be far more reasonable.”

CMS could buy itself more time by extending the current contracts for another six months beyond Dec. 31, 2018. If a current contract provider refuses to re-up, the agency could offer contracts to the next bidder.

That could be easier said than done, says Eckstein.

“I don't think there's enough providers left in our market,” he said. “Out of 23 companies, only four of them actually operate locally. Patients are waiting weeks and weeks for tanks.”

Ecsktein isn't sure, if it comes right down to it, whether or not he would extend his contract.

“Because of the hoops that Medicare makes us jump through to get oxygen covered, it's not worth it—it costs too much,” he said.

For Trammell, extending the contracts would be a survival tactic.

“The only benefit (to participating in the bid program) was maintaining our patient base until reimbursement improves,” he said. “And to be a one-stop shop for our referrals.”

On the bright side, the long delay could mean an improved bid program, say stakeholders.

“We'd all prefer a better program with more sustainable pricing,” said Cara Bachenheimer, vice president of government relations for Invacare. “The question is, how long can you muddle through from a business perspective?”

Department of Health and Human Services Secretary Alex Azar has said any changes to the bidding program would go through a full rulemaking process.

“I think for Round 2019, they are going to do a proposed rule with comment period and then a final rule,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “We're going to keep meeting with the folks at HHS and CMS, and push our recommendations for changes.”