By Sean Schwinghammer

"With both bid winning and bid losing medical equipment companies closing, how am I going to get my oxygen?"

That's the question that oxygen dependent Medicare beneficiary, Wanda Revercomb, wanted to ask Senator Nelson (D-FL), Tuesday afternoon in his Miami Regional office. Wanda suffered quite an ordeal over the past 2 months and she wanted Nelson, a member of the powerful Senate Finance Committee to do something about it.

On Tuesday afternoon, alongside three contracted suppliers, Mrs. Revercomb explained what happened to Nelson's Regional Director, Pedro Villa.

Revercomb told the group that 2 months ago she was very short of breath and tried to use her home oxygen concentrator, but it was not helping her as it usually did. Her sister noticed that a yellow light was flashing on the machine indicating 'Low Oxygen', so she called her oxygen company expecting the prompt service she was getting over the past two years.

"They used to come around every few months to change the filters and check my machine, and they were past due for service." Revercomb explained.

"I called the phone number on the top of the machine for days, but no one answered, there was not even a recording to leave a message. My home health nurse called Medicare and they explained that my oxygen supplier closed their account and that I had to find a new supplier, one that won a bid in their new Competitive Bidding program."

Revercomb, a resident of North Miami, told the Senator's staff that Medicare gave her different contracted suppliers to work with her, but all refused because of her location and the fact that she already had oxygen for nearly 2 years. Medicare's '36 Month Oxygen Cap Rule' meant that any new supplier would only be paid 12 more months for oxygen equipment and that in 12 months, after her 36th month of oxygen equipment was paid, the new company would have to provide service and equipment for the next 2 years for free.

It turned out that was the least of her problems.

Revercomb finally found a local contracted supplier that would consider helping her, City Medical Services of North Miami Beach, but they were unable to provide immediate service and equipment as she was now caught up in the system's 'Red Tape'.

Since her existing supplier was closed and could not provide the required documentation for Medicare to consider her oxygen use "Medically Necessary", she had to have a new examination from her Pulmonlogist. She also had to have new diagnostic tests required by Medicare to support the physician's order for oxygen. It took more than 2 weeks for Mrs. Revercomb to meet all of Medicare's standards required for her to obtain oxygen paid for by Medicare. Medicare requirements included: an open appointment and a visit to the doctor's office, the new diagnostic test, the ability to obtain Medicare's required signed physician progress notes (detailing the patient's diagnosis and medical need for oxygen), a signature attestation statement and a valid physician order indicating her diagnosis, length of need, liter flow per minute and frequency.

Revercomb told the Senator's Miami staff that nearly a month had past from the time she noticed that her home oxygen unit was not working, until to the time she met all of Medicare's requirements to pay for oxygen. She told the group that on certain days she was so short of breath she nearly went to the hospital, but she was concerned about calling for an ambulance and the unknown expense involved. She was also concerned about her son, rushing across the state in a panic to visit her in the hospital.

"I thought it would be such a waste of time and money to go to the hospital for my oxygen needs. Why should Medicare pay thousands of dollars per day for me to get oxygen treatment in the hospital when for only a few dollars a day, I can get the same treatment at home."

Just when Senator Nelson's Regional Manager thought Mrs. Revercomb's problems were finally solved, Rob Brant, the General Manager of her new, bid winning contracted supplier gave him the bad news, "the competitive bidding program is forcing me to close my doors in four days and Mrs. Revercomb now needs to find a new contracted supplier."

Brant, along with 2 other bid winners in South Florida spent the next 30 minutes explaining how Medicare's flawed bidding program was forcing local, experienced bid winning suppliers to operate at tremendous losses. They all discussed the problems providers are experiencing from competitive bidding, even as bid winners they were suffering from the 40% lower rates. Each provider had laid off significant amounts of their staff and by doing so the negative affects to the patients were made clear , "without my staff, I cannot keep the same level of quality service that patients are not only used to, but they need to stay healthy and at home".

It was noted that timely service is not required by competitive bidding, and that providers could, if they chose, declare that they would only operate in different areas of the MSA on different days. This type of inconsistent low quality service is the result of bidding, but the negative affects can be much greater. Providers brought up the fact that South Florida is a little more than a month away from Hurricane Season.

Five years ago, during Hurricane Wilma, there were 400 Medicare approved oxygen providers in South Florida. Today, because of the bid results there are less than 80 and many are closing and many are located outside of South Florida. If a hurricane hits, providers do not have the capacity to tend to their patients.

Robert Mendia from Bayshore Duramed said "we normally call each of our patients prior to storms to make sure they have all they need in advance and we follow up with each patient after storms. In the aftermath of a storm many patients who rely on oxygen and other life sustaining services will find their original suppliers closed and there is no way that the remaining 'bid winners' can cover patients in the entire tri-county area".

Senator Nelson's Regional Director listened intently and wrote down the comments to discuss them with his boss. At the end of the nearly 45 minute meeting Providers asked that Senator Nelson introduce HR 1041 in the Senate immediately. The providers emphasized that doing so is the only way to retain businesses and restore quality service to patients. Senator Nelson has been more than reluctant to work to stop competitive bidding, but the more he hears about its negative affects, the more concerned he and his staff are becoming.

In closing Mrs. Revercomb expressed her concerns for her ongoing needs and asked for the Senator to take a stand for seniors like her, and those unable to speak up, to stop the flawed bidding program.

We ask for all providers in Florida to contact Senator Nelson's District offices and call his Washington Office and ask him to introduce HR 1041 in the Senate. Only by hearing from everyone will be motivated to act.