Medicare Procurement Program Creates Extreme Hardships for Patients without Options, Says AAHomecare

WASHINGTON, Oct. 24, 2013 /PRNewswire-USNewswire/ -- Only a few Medicare patients have reported problems related to the bidding program for home medical equipment that rolled out in 91 new areas on July 1, according to the Centers for Medicare & Medicaid Services (CMS). Yet, more than 2,000 patients have called an organization, People for Quality Care, desperately seeking assistance for situations jeopardizing their health and quality of life.

Take Norma Westbrook, 81, of Charleston, S.C. She needs a power wheelchair for her own mobility and for her role as the sole caretaker of her husband, who is in hospice. Norma has been diagnosed with congestive heart failure, as well as spinal stenosis. "I don't walk at all," she says. "I have a high risk of falls. You just never know if the leg is going to cave in, and I have bad nerve pain. I'm never walking, not as far as three feet, so the chair acts as my legs."

Her old power wheelchair won't hold a charge, making it difficult to accomplish even simple tasks around the house. Four months ago, Norma started trying to get a replacement. She had multiple medical examinations, filled out extensive forms, and called daily to speak with a new wheelchair provider that she was forced to switch to because of the Medicare bidding program, and who is based in Georgia. Despite her best efforts, Norma still doesn't have a usable chair.

The new provider did ship out a wheelchair, but it was too small, so Norma had to return it. She questions how the provider could have sent the wrong chair if they had read either her paperwork or her physician's instructions. Now, she's discouraged and doubts she'll ever get the chair she needs through Medicare. Instead, she has resorted to searching the local want ads on the off chance that a used one might become available.

Although Charleston used to have six Medicare-approved power wheelchair providers, there are none left because of the bidding program.

"Lots of dealers are deciding they just won't handle Medicare anymore," she explains. Norma doesn't want her or her husband to be institutionalized. She wants to stay in her home, but realizes that will be very difficult without the wheelchair that Medicare is supposed to provide.

"To be able to stay in your own home with hospice is a blessing. And it's the cheapest thing that the government can do to take care of people in their older age," Norma says. "It's scary to think that because you can't replace a chair, being put in an institution might be inevitable. I don't want to get to the point where my husband has to go to a nursing home, and I have to have someone come in to care for me. And that's exactly what would happen. In the long run it would be so much more expensive for everybody. It just doesn't make any sense."

Despite CMS claims to the contrary, people like the Westbrooks are suffering because of the badly mismanaged Medicare bidding program. It has put hundreds of providers of durable medical equipment (DME) out of business, created equipment shortages, and left beneficiaries without doctor-prescribed equipment, such as oxygen tanks, power wheelchairs, hospital beds, walkers, and diabetic supplies.

"It's disturbing that CMS is claiming everything is fine when people are suffering," said Tom Ryan, president of the American Association for Homecare (AAHomecare). "The bidding program is bad public policy that needs to be fixed or stopped. CMS must acknowledge the real problems that Medicare patients are encountering. How can they expect anyone to believe that they have only received a handful of complaints when more than 2,000 people have reached out to a private organization for help addressing their problems?"

According to a May 2012 GAO report titled Review of the First Year of CMS's Durable Medical Equipment Competitive Bidding Program's Round 1 Rebid, the agency may be intentionally undercounting the number of problems. "CMS's definition of inquiry and complaint may be an optimistic characterization of beneficiary calls," the report states. "According to CMS, all calls are first classified as inquiries and are only classified as complaints when they remain unresolved by CSRs [customer service representatives]."

Ryan said that CMS hasn't changed the way it classifies calls from beneficiaries, so it is not surprising that their numbers are unrealistically low. However, he believes that even the People for Quality Care number is "just the tip of the iceberg."

AAHomecare has contacted several Medicare patients who are not receiving quality service or equipment because of the bidding program. Here are their stories.

***

Louis Tarbarelli can't leave his house because he doesn't have the right oxygen. Although his doctor prescribed a new form of oxygen therapy several months ago, he didn't receive the new oxygen until October 1, and when it finally came, it had no instructions. Louis has been afraid to handle it.

He has reason to be hesitant; the temperature of liquid oxygen is -250 degrees Celsius and can cause serious burns if spilled. Louis immediately called his new provider, who is located in Massachusetts, several hours from his Rhode Island home. But they told him they wouldn't be able to help him until the following week.

"Which means I have no way to go and no place to go," Louis says, "because I can't leave my house …This company is supposed to be 24/7. I'm on Medicare. You're telling me you can't come until six days from now? What if I had to leave the house, what would I do then?"

Louis has chronic obstructive pulmonary disease, emphysema, and bladder cancer. Not being able to leave the house means he has to miss important doctor appointments. "This is terrible," says his wife, Barbara. "He has an appointment with his pulmonary doctor, and he's not going to be able to make it because he doesn't have the proper oxygen to go with him. This has really gone beyond."

The stress is taking its toll on Louis, who feels he won't survive long under the new conditions. "Everything's going to get worse," he says. "These companies will do a lot less because they're getting paid a lot less. I'm 70, but I'm not going to make 71 the way they're treating me."

***

Joseph Metts, 73, of New Bern, N.C., has had non-Hodgkin's lymphoma for twenty years and diabetes for just as long, mainly as a result of his cancer treatments. He can't get his blood sugar testing strips sent to him anymore. When the Medicare bidding process started in his area in July, he and his daughter started making calls, hoping to stay ahead of the curve. They were given the phone numbers of five different dealers and contacted them all, but three didn't carry Joseph's equipment, one never answered, and the last didn't have them in stock and didn't know if they ever would.

So far, it doesn't appear that he'll ever be able to get them without driving to another town to pick them up.

This change will be difficult for Joseph, whose cancer has recently returned, and whose wife is homebound on a ventilator and feeding tube—Joseph is her primary caretaker. "We choose to have her at home," says Joseph's daughter, Tina Metts, "because the closest nursing home that allows for ventilators is three hours away. There are no home help agencies in our area that work with ventilator patients. Everything is out of pocket, so he stays home with her 24 hours a day. The cost of care is so burdensome. We can't get any help, they're using their life savings, and he's sick, too."

Meanwhile, Joseph's sisters, who are also diabetic, have had the same trouble getting their supplies that Joseph has had, which leads Tina to believe the problem is widespread. "The sad thing," she says, "is that the people we're supposed to be taking care of, our seniors, don't make a very loud voice, so they're getting treated wrong. It's sad. Thankfully we have a family and can lean on each other, but I'm pretty sure there are lots of people out there that don't have that luxury."

***

Victor Williams, 61, of Turrell, Ark., used to be a train conductor, but for the past 20 years he's mostly been homebound. A back injury in 1983 forced him to stop working, and despite five surgeries and regular cortisone shots in his joints, he's never made a full recovery. He started using a power wheelchair ten years ago and found it extremely helpful, but for the past two years it's been breaking down.

Despite originally being promised a replacement chair on January 1, 2013, he's now been told that he's not eligible. His new supplier, he says, told him he doesn't need one. "When the chair's not working," Victor says, "I don't go anywhere…It's how I get around in my house."

Since the chair doesn't work about a third of the time he tries to use it, he's started using an "old, raggedy" manual wheelchair, which is hard to maneuver due to his chronic back and joint pain. There's no one helping Victor at home. "I'm depressed all the time," he said. "I'm about to turn 62, and I'm not getting stronger; I'm getting weaker."

Victor has made numerous calls to his medical supplier, called his congressman, and submitted all the forms he's been told to submit, but his outlook is bleak. "The only thing I can do," he said, "is use the chair until it totally quits. My doctor tells me I need one. He says I've got some of the worst bones he's ever seen. But unless they change this competitive bid system, I don't think I'll be getting a chair."

The American Association for Homecare represents providers of home medical or durable medical equipment and services who serve the needs of millions of Americans who require prescribed oxygen therapy, wheelchairs, enteral feeding, and other medical equipment, services, and supplies at home. Visit www.aahomecare.org.

SOURCE American Association for Homecare



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