Impact of gap period? Too early to tell in most areas

Friday, March 22, 2019

YARMOUTH, Maine – What has been the impact of a two-year gap between competitive bidding contracts? It all depends who you ask.

The primary concern going into the gap period: Whether Medicare beneficiaries will lose access to HME if providers, no longer bound by contracts, shrink service areas, refuse to accept assignment, or otherwise limit how much Medicare business they want to accept.

In the short term, at least, an any willing provider provision may be softening the blow in some areas.

“There were a number of people (in our area) that came back into it, which we are thinking may have artificially filled what have been an automatic access problem right out of the gate,” said Steve Ackerman, CEO of Spectrum Medical in Silver Springs, Md. “But in six or seven months, that’s when the rubber meets the road.”

Ackerman said he’s pulled back his perimeter for delivering small-dollar items like walkers, although he’s giving more leeway to regular referral sources.

“If we are going to do walkers with you, we need to be doing something else with you,” he said.

In other areas, already underserved during the contract period, the situation has become dire.

“Hospitals are not able to get people beds and wheelchairs because they are not being taken assigned—the reimbursement rates are so low,” said George Kucka, president of Fairmeadows Home Health Center in Schererville, Ind. “It’s the same with liquid oxygen, and I think it’s going to get worse.”
For some, business is better than ever. Mesa, Ariz.-based Valley Healthcare, which previously held several contracts for respiratory, is adding business through Portland, Ore.-based Northwest Medical, which it acquired in September and which did not have contracts.

“For us, it’s all new business coming in and we are seeing a healthy increase of doctors who are happy to have another provider for Medicare,” said Ron Evans, founder and CEO. “We added two dedicated marketing professionals that are getting the word out.”