Skip to main content

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

Comments

LindaB said…
My cousin's company in NY lost out on the competitive bidding by bidding real cost. The successful bidder underbid, did not have the paperwork necessary to participate in the Medicare program and put a well known, reliable and ethical concern out of business. My experience with this Med`care reform is 1) the devil is in the details and 2) patients are the big victims
Dear GeriPAL readers, please send me your stories about problems with Competitive bidding. This is a critical issue that needs national attention.
LindaB please send me information on your cousin's company! carla.perissinotto@ucsf.edu

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Survival from severe sepsis: The infection is cured but all is not well

Severe sepsis is a syndrome marked by a severe infection that results in the failure of at least one major organ system: For example, pneumonia complicated by kidney failure. It is the most common non-cardiac cause of critical illness and is associated with a high mortality rate.

But what happens to those who survive their hospitalization for severe sepsis? An important study published in JAMA from Iwashyna and colleagues provides answers and tells us all is not well. When the patient leaves the hospital, the infection may be cured, but the patient and family will need to contend with a host of major new functional and cognitive deficits.

Iwashyna examined disability and cognitive outcomes among 516 survivors of severe sepsis. These subjects were Medicare enrollees who were participants in the Health and Retirement Study. The average age of patients was 77 years.

When interviewed after discharge, most survivors were left with major new deficits in their ability to live independently. …