New System Limits Medicare Patients’ Provider Choices

From: WSOCTV.com/Channel 9 Charlotte

About a quarter-million people in the Charlotte area are Medicare patients, and many of them have been or will be affected by a new system that significantly limits their provider choices for certain services.

Members of Congress, caretakers and patients are already raising red flags, claiming the new system is flawed.

Marilyn Graham said she is concerned about how well Medicare patients will be able to navigate the new system. She has a condition called sleep apnea and uses a continuous positive airway pressure machine — known as a CPAP machine — to help her breathe at night.

“There are times when I gasp for air,” she said, describing the condition. “To my husband, there are times when it seems like I’m not breathing at all.”

In mid-January, she accidentally tore the face mask, which pumps oxygen into her lungs. Graham called her provider but was told the business couldn’t help her anymore because it didn’t win a Medicare competitive bidding contract for CPAP machines.

“I was so unprepared,” Graham said. “I mean, totally unprepared.”

Starting Jan. 1, 2011, Medicare patients were required to use companies that won bids in Charlotte’s competitive bidding system. If they don’t, Medicare won’t pay for their services.

“It was a relationship with a provider,” Graham said. “And so all that changes. You have no control over who you go to.”

Medical equipment providers competed in nine categories, including CPAP machines and other equipment, like wheelchairs. Companies with the lowest bids won the right to keep providing equipment and services to Medicare patients.

If a company didn’t win certain bids, its patients were out of luck.

“They may need to go to four different places fo four different services,” Graham said.

Bill Griffin of Griffin Home Health Care said he laid off eight employees after winning only one bid, which was for oxygen equipment.

“We can’t sell Medicare walkers anymore,” he said.

Griffin has spent nearly 30 years in Charlotte providing CPAP machines, walkers, hospital beds and special feeding machines to Medicare patients, but he said he couldn’t bid low enough to win in any of those categories.

“The providers that bid, bid such low prices that it’s not only suicide for the industry but the companies involved,” he said. “I think there is a world of companies that will go out of business.”

Eyewitness News went through the list of more than 200 bid contracts and found that Medicare awarded more than half of the contracts to providers outside the Charlotte market.

Some are in places like Goleta, Calif., and Naperville, Ill., but are providing services and equipment to people in Charlotte.

Medicare tried to launch a competitive bidding system in 2008. A report from the Government Accountability Office cited “numerous concerns,” like companies “missing financial documentation” or not meeting “accreditation requirements.”

But Medicare officials said this time around will be different.

As for Graham, she found a list of providers online and said she spent days calling them and Medicare. She finally received a new mask more than a week later, but she said she’s worried about the 250,000 other Medicare patients in the area who don’t know about the changes.

“There’s no way they’re going to know until they actually have a need,” she said.

Members of Congress, including Sue Myrick, supported a House bill to repeal the competitive bidding system, but it never gained momentum in the Senate.

Medicare set up a toll-free number for patients to call with complaints and concerns. It’s 888-990-0499. About a quarter-million people in the Charlotte area are Medicare patients, and many of them have been or will be affected by a new system that significantly limits their provider choices for certain services.

Members of Congress, caretakers and patients are already raising red flags, claiming the new system is flawed.

Marilyn Graham said she is concerned about how well Medicare patients will be able to navigate the new system. She has a condition called sleep apnea and uses a continuous positive airway pressure machine — known as a CPAP machine — to help her breathe at night.

“There are times when I gasp for air,” she said, describing the condition. “To my husband, there are times when it seems like I’m not breathing at all.”

In mid-January, she accidentally tore the face mask, which pumps oxygen into her lungs. Graham called her provider but was told the business couldn’t help her anymore because it didn’t win a Medicare competitive bidding contract for CPAP machines.

“I was so unprepared,” Graham said. “I mean, totally unprepared.”

Starting Jan. 1, 2011, Medicare patients were required to use companies that won bids in Charlotte’s competitive bidding system. If they don’t, Medicare won’t pay for their services.

“It was a relationship with a provider,” Graham said. “And so all that changes. You have no control over who you go to.”

Medical equipment providers competed in nine categories, including CPAP machines and other equipment, like wheelchairs. Companies with the lowest bids won the right to keep providing equipment and services to Medicare patients.

If a company didn’t win certain bids, its patients were out of luck.

“They may need to go to four different places fo four different services,” Graham said.

Bill Griffin of Griffin Home Health Care said he laid off eight employees after winning only one bid, which was for oxygen equipment.

“We can’t sell Medicare walkers anymore,” he said.

Griffin has spent nearly 30 years in Charlotte providing CPAP machines, walkers, hospital beds and special feeding machines to Medicare patients, but he said he couldn’t bid low enough to win in any of those categories.

“The providers that bid, bid such low prices that it’s not only suicide for the industry but the companies involved,” he said. “I think there is a world of companies that will go out of business.”

Eyewitness News went through the list of more than 200 bid contracts and found that Medicare awarded more than half of the contracts to providers outside the Charlotte market.

Some are in places like Goleta, Calif., and Naperville, Ill., but are providing services and equipment to people in Charlotte.

Medicare tried to launch a competitive bidding system in 2008. A report from the Government Accountability Office cited “numerous concerns,” like companies “missing financial documentation” or not meeting “accreditation requirements.”

But Medicare officials said this time around will be different.

As for Graham, she found a list of providers online and said she spent days calling them and Medicare. She finally received a new mask more than a week later, but she said she’s worried about the 250,000 other Medicare patients in the area who don’t know about the changes.

“There’s no way they’re going to know until they actually have a need,” she said.

Members of Congress, including Sue Myrick, supported a House bill to repeal the competitive bidding system, but it never gained momentum in the Senate.

Medicare set up a toll-free number for patients to call with complaints and concerns. It’s 888-990-0499.

See, WSOC televised story at http://www.wsoctv.com/seenon9/26778895/detail.html