Doug Harrison: Competitive Bidding Is “Disastrous” in Current Form

Doug Harrison, founder of The Scooter Store, says he is not opposed to competitive bidding if parameters are in place to ensure patient access to the DME benefit and to guarantee “market-based” bids.

The Scooter Store, a nationwide mobility dealer based in Texas, came under fire in January for supposedly supporting competitive bidding and opposing a competitive bidding carveout for complex rehab.

As a result, Invacare Corp. announced it and its rehab divisions would no longer sell new vehicles or supplies, except for replacement parts for previously sold scooters and power chairs, to The Scooter Store. The move was applauded by several industry organizations, while several other organizations quickly issued statements affirming its support for a rehab carveout.

So during a Jan. 23 interview, the question was put to Harrison: If he had the power to wave a magic wand and make competitive bidding go away tomorrow — would he do it? Or does he support competitive bidding as a valuable thing, perhaps not in its current form, but in some form?
“In its current form, it’s disastrous,” Harrison says. “I think the way (The Centers for Medicare & Medicaid Services) have defined it and to call the current form ‘competitive bidding’ is I think being overly generous. It’s not a very competitive program.”

Harrison takes issue with the parameters CMS has put on so-called “acceptable” bids. “For it to be a free market-based bid, you can’t have the bidding agency set a market cap and say, ‘Bid anything you want to, as long as it’s less than the allowable, or we’ll throw your bid out,’” he says. “That’s pretty absurd. It’s automatically no longer a market-based bid.”

But setting his objections to the current competitive bidding program aside: Would Harrison make competitive bidding go away if he could? Or does he think it’s valuable in some form?
“As a consumer, aside from CMS-acquired products, if I’m having work done on my house or my car, I’m always going to get a couple of bids if I think I’m overpaying,” Harrison says. “Does Medicare have the right to run a true market-based competitive bid? I think Medicare has the right to make sure it gets the best price and the best product and the best services for its beneficiaries all the time in whatever way it sees fit, as long as quality is not jeopardized, as long as access to the benefit is not jeopardized. And there’s nothing in this bid program that ensures either one of those is still going to be in place.

“Am I opposed to it? I’m not opposed to it if it has the appropriate safeguards that ensure quality and access.”
The Scooter Store, headquartered in New Braunfels, Texas, recently launched a complex rehab division named Alliance Seating & Mobility. Given that new launch, does Harrison really oppose a carveout for high-end seating & positioning products?

Harrison offered a Sophie’s Choice-like metaphor in response.
“I have three kids,” he said as a comparison. “If someone said, ‘But which one do (you) love the least?’ There’s no answer to that; I love them all.”
Harrison uses that comparison to express, he says, that he acknowledges a difference between so-called “consumer power” and complex rehab — but that doesn’t mean he favors a carveout for rehab without a twin carveout for consumer power.
“So is there differentiation in the product? Of course; it’s absurd for anybody to think that we don’t think there’s differentiation in the product,” Harrison said. “We think all power mobility should be exempt from this current, so-called national competitive bidding, because the product’s underutilized, and the process as rolled out is pretty Draconian.”
Harrison added that he dislikes the term “consumer power.”

“I’m fundamentally opposed to a lot of the high-end rehab groups that would try to demean the definition of geriatric mobility by saying, ‘It’s just a strength-and-stamina thing,’” he said. “They love to call geriatric mobility ‘consumer power’ because it sounds like something that maybe people just want, but they really don’t need.
“If someone needs mobility to get around their house, and the next best option is a nursing home, to say, ‘Well, that’s just strength and stamina — they didn’t need a ventilator, so they’re not really disabled’ is intensely insulting to a huge number of disabled seniors that face giving up their home and going into long-term care because they can’t take care of themselves inside of their own home anymore.”

But does Harrison acknowledge the difference in equipment needs, for example, between a young child with Duchenne muscular dystrophy and a senior who’s had a hip replacement surgery? Or for the sake of competitive bidding, does he believe that all seating and mobility equipment should be given the same weight?
“I think they all have a lot in similar and clearly they have a whole lot that’s different as well,” he said. “Both of them right now, for geriatric mobility and complex rehab products, pediatric or adult, are being substantially underutilized for Medicare.

Since we went through the last four years of Operation Wheeler Dealer and recoding and repricing, the entire industry, all mobility products to Medicare beneficiaries, is being grossly underutilized in all categories. Medicare’s own estimate of appropriate utilization shows that today’s utilization is grossly less, 30 to 40 percent less than what Medicare’s own estimate of what beneficiary access and utilization ought to be.”
And that, Harrison said, is at the heart of his concern over carving rehab out of the competitive bidding program while leaving consumer power products to be bid.

“So if both groups are being hurt, which they are, do you all want to differentiate between the two and say, ‘Well, bid this one and not that one?’” he asked. “Those are both bad answers. If you say, ‘Yeah, but if you had to bid one or the other, which would you bid?’ There’s not a winning answer to that.”

This article originally appeared in the March 2008 issue of Mobility Management.

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