CMS Competitive Bidding Program: What the Pulmonologist Should Know

It was hoped that the Medicare Modernization Act would reduce costs and improve access to home care medical equipment through a competitive bidding process. Centers for Medicare & Medicaid Services (CMS) accepted bids covering respiratory home care equipment for nine areas (Cincinnati, Cleveland, Charlotte, Dallas, Kansas City, Miami, Orlando, Pittsburgh, and Riverside, CA) starting January 2011. To obtain a list of vendors, access the medicare.gov site, and the Resource Locator will allow matching of patient zip code and the appropriate approved vendor. Current patients using oxygen/PAP, whose suppliers have not been contracted under the competitive bidding program, have the option to continue renting with their current providers as “grandfathered suppliers.” When traveling, patients will need to use contracted suppliers when they are in an area that is covered under the competitive bidding program.

Each contracted supplier is required to list the manufacturers and products they provide. Physicians should be specific when prescribing, including giving reasons that a product should be used. Not all approved providers are able to provide all products; it is possible that a patient could require multiple providers. In-home training is not a mandated component of the bidding process. If physicians would like patients to have education in the home, they will need to be very specific when scripting.

This is a dramatic change in how home respiratory care is provided. Physicians should document complications if access to care is limited or if patient care is affected. The program will be expanded to an additional 91 cities starting in January 2013. Now is the time for caregivers, durable medical providers, and Medicare to learn and correct problems, as delivery of home care moves to this new model.

Dr. Lisa Wolfe, FCCP
Vice-Chair