Centers for Medicare & Medicaid Services Special Open Door Forum

Centers for Medicare & Medicaid Services

Special Open Door Forum:

HHS and HUD Community Living Partnership to Expand Housing Options for People with Disabilities Including Older Adults

Tuesday, March 1, 2011 11:30 a.m.-1:00 p.m. ET

The U.S. Department of Health and Human Services (HHS) and the Department of Housing and Urban Development (HUD) will host a Special Open Door Forum on the HHS and HUD partnership that was developed in response to the President’s Year of Community Living proclamation and in conjunction with HHS Secretary Sebelius’ Community Living Initiative (CLI).

This Special Open Door Forum will focus on understanding the HUD HHS Collaboration: creating sustainable partnerships between the housing and human service agencies at the federal, state & local levels to improve the availability of affordable and accessible housing. This is being accomplished through two major efforts.

• HUD HHS Community Living Collaboration and its six initiatives

• Linking long term services & supports with HUD’s new Category I & II vouchers to assist individuals with disabilities

Following the presentation, the telephone lines will be opened to allow participants to ask questions of the subject matter experts from HUD and HHS, including CMS.

Information about the Community Living Initiative can be found at the HHS Office on

Disability http://www.hhs.gov/od/topics/community/olmstead.html.

Presentation materials will be posted to the Office on Disability webpage by Friday, February 25, 2011.

We look forward to your participation.

Special Open Door Forum Participation Instructions:

Dial 1-800-837-1935 Conference ID 44280806

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and a Relay Communications Assistant will help.

An audio recording and transcript of this Special Forum will be posted to the Special

Open Door Forum website at http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning on or around April 1, 2011.

A Bad Program Producing Bad Results – Competitive Bidding Must Be Repealed

A Bad Program Producing Bad Results – Competitive Bidding Must Be Repealed

Tyler Wilson, President, the American Association for Homecare
February 17, 2011

Six weeks into Round One of the bidding program and AAHomecare has seen enough. Competitive bidding for home medical equipment must be abolished. The homecare system should not be characterized and viewed merely in terms of the lowest cost and who can provide it most cheaply. Providing valuable healthcare services is much more than that. The Medicare system should not ignore matters of quality, access, beneficiary satisfaction.

Congress must consider the aging U.S. population (the first baby boomer hit age 65 on January 1), the rising incidence of diabetes and other chronic conditions, the cost of treatment in hospitals and nursing facilities, and the long-established preference among people for care at home. All of these factors argue for a stronger approach to providing homecare – not a tearing apart of the system.

The philosophy behind bidding as a way for Medicare to manage, deliver and reimburse for home medical equipment is simply wrong-headed and misguided. For that, we can blame Congress. Lawmakers can be roundly criticized for mandating the program that is now causing such terrible financial hardship and economic dislocation. Congress bears the responsibility and we should let them hear our anger.

At the same time, the CMS program design is faulty and its administration has been a lesson in poor planning, arrogance, and clumsiness. For this, the Agency bears the blame. Repeatedly, CMS has shown itself incapable of putting together and getting right basic elements of the program. Auction experts, economists, homecare companies, patient groups and stakeholders from across the homecare spectrum have repeatedly advised CMS they’ve gotten it wrong on a number of fronts – from program development through implementation and beneficiary education.

And looking ahead, nothing about CMS’ handling of the program should give anyone comfort. The Medicare agency has been alarmingly dismissive toward a host of issues and completely unwilling to do any of the self-examination that are necessary.

With a growing list of problems being reported from the nine initial regions, complete intransigence on the part of CMS, and every indication that Round Two will be implemented without proper analysis or insight into the failings of Round One, the alarm bells are sounding – loudly.

The only way to stop the problems is to stop the program. Congress must step in and enact legislation that ends bidding for home medical equipment. And Congress needs to act fast – while there is still a community of homecare providers that can put the pieces of a robust homecare system back together. If Congress fails to act, the economic fallout and harm to the homecare system and those that rely upon it will be irreversible.

AAHomecare is focusing all of its energy on convincing Congress that it must act to repeal competitive bidding. A full court press is underway to get the House and Senate to consider legislation to end the program.

This effort needs the full support of everyone in the homecare community. Whether in a Round One or Two area, whether a bidding loser or “winner” of one or several contracts, whether a full line HME provider or a specialized supplier, the fight to repeal bidding is a cause for everyone.

AAHomecare will lead the fight but the Association needs all of its members engaged and it needs the full involvement of everyone else in the homecare community. There is no better opportunity to make our case to Congress than the upcoming Washington Legislative Conference on March 16 & 17. Everyone with an interest in good and financially sound homecare should be on Capitol Hill in mid-March letting the House and Senate hear our call for repeal.

The alternative is to take a front row seat and witness the dismantling of the homecare system as we’ve known it.

I urge all of you – member and non-member alike – to take up the cause and fight to repeal bidding. The time is now because homecare can’t wait.

President's budget would squeeze Medicaid

President's budget would squeeze Medicaid

By Theresa Flaherty Managing Editor - 02.18.2011

WASHINGTON - President Obama's proposed 2012 budget contains no love for the HME industry. The $3.7 trillion package, released Feb. 14, proposes tying Medicaid reimbursement rates for home medical equipment to Medicare competitive bidding rates in those states where the program is in effect. The budget estimates such a move would save $6.4 billion over 10 years. "That's extremely significant," said Walt Gorski, vice president of government affairs for AAHomecare. "That's on top of $17 billion (lost) from competitive bidding. How much more can they squeeze out of HME?" In states where Medicaid discounts the Medicare rate, that would force Medicaid rates below the already low competitive bidding single payment amounts, which were reduced by an average of 32%, said Gorski. But Medicaid already has the authority to adopt bidding rates, says Cara Bachenheimer, senior vice president of government relations for Invacare. This proposal would simply make it mandatory. "We've always anticipated, assuming that the bid program continues, that everybody's going to be latching onto those ridiculously reduced rates," she said. "This should be a wakeup call to anyone who thought, "if I minimize my Medicare business, I will be safe.'" The budget also proposes a prepayment review for all power wheelchairs, for an estimated $240 million in savings over 10 years. "I view it, and I think providers view it, as an opportunity to work with Congress to advance reform within the Medicare program that moves away from the current pay and chase model to one that establishes a real time, efficient system," said Seth Johnson, vice president of government affairs for Pride Mobility. "That's something the industry has supported." The president's budget is the first step in a months-long process that will see both the House and the Senate come up with their own budgets, before reconciling them into one joint budget, and moving it forward.

CMS: NEW MEDICAL EQUIPMENT PROGRAM OFFERS VALUE FOR MEDICARE BENEFICIARIES

Press Releases

Details for: NEW MEDICAL EQUIPMENT PROGRAM OFFERS VALUE FOR MEDICARE BENEFICIARIES
For Immediate Release:	Wednesday, February 16, 2011
Contact:	CMS Office of Public Affairs 202-690-6145

NEW MEDICAL EQUIPMENT PROGRAM OFFERS VALUE FOR MEDICARE BENEFICIARIES

Competitive bidding program focuses on providing access to high quality products and services for people with Medicare

The Centers for Medicare & Medicaid Services (CMS ) launched the first phase of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program on January 1, 2011, in nine different areas of the country.

Through supplier competition, the program set new, lower payment rates for certain medical equipment and supplies, such as oxygen equipment, certain power wheelchairs and mail order diabetic supplies. CMS estimates that Medicare and beneficiaries will pay 32 percent less on average for these equipment and supplies. In most cases, Medicare beneficiaries who obtain these items in the nine competitive bidding areas will need to get them from the Medicare suppliers that were awarded contracts in order to have the items covered under Medicare. More than four million Medicare beneficiaries living in the nine competitive bidding areas can save money through this new program, while continuing to have access to quality medical equipment from accredited suppliers they can trust.

“We are pleased to report that implementation of the program is going very smoothly,” said CMS Administrator Donald Berwick, M.D. “We continue to deploy a wide array of resources across all of the competitive bidding areas to address any concerns that may arise.”

These resources include local State Health Insurance and Assistance Program (SHIP) offices, specially trained customer service representatives at 1-800-MEDICARE, and caseworkers in Medicare’s regional offices who all stand ready to assist beneficiaries who may have questions about the program. In addition, there is a complaint and inquiry process for beneficiaries, caregivers, doctors, referral agents and suppliers to use for reporting concerns about a contract supplier or other competitive bidding implementation issues. This process is designed to ensure that all complaints are correctly routed, investigated, resolved, tracked and reported. Further, there is a Competitive Acquisition Ombudsman who will respond to complaints and inquiries from suppliers and others about the application of the program and issue an annual Report to Congress.

Since the beginning of the program, CMS has received only a handful of beneficiary complaints and has acted quickly to resolve each one. While 1-800 MEDICARE has received a number of inquiries about the program, the majority of such inquiries are on routine matters, such as selecting a supplier.

“CMS continues to monitor the implementation of the program very carefully” said Dr. Berwick. “We urge all stakeholders to bring any issues to our attention in order for our caseworkers to resolve them as quickly as possible.”

Program monitoring includes the use of beneficiary surveys, active claims surveillance and analysis, contract supplier reporting, and tracking and analysis of complaints and inquiries in the nine initial areas, which include Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside. CMS has taken administrative actions against a small number of contract suppliers to help bring them back into compliance with Medicare’s rules.

Only the following categories of items are included in the first phase of this program:

• Oxygen, Oxygen Equipment, and Supplies

• Standard Power Wheelchairs, Scooters, and Related Accessories

• Complex Rehabilitative Power Wheelchairs and Related Accessories (Group 2 only)

• Mail-Order Diabetic Supplies

• Enteral Nutrients, Equipment and Supplies

• Continuous Positive Airway Pressure (CPAP) Devices, Respiratory Assist Devices (RADs), and Related Supplies and Accessories

• Hospital Beds and Related Accessories

• Walkers and Related Accessories

• Support Surfaces (Group 2 mattresses and overlays in Miami-Ft. Lauderdale-Pompano

Beach, FL only)

The Medicare DMEPOS Competitive Bidding Program was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and the program was briefly implemented in 2008 in 10 areas before it was temporarily delayed. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, terminated the supplier contracts in effect at the time, temporarily delayed the program, and made certain limited changes to the program. MIPPA also required CMS to conduct the competition again for Round One in 2009, and delayed competition for Round Two in 70 additional metropolitan statistical areas (MSAs) until 2011 and in additional areas of the country until after 2011. The Affordable Care Act of 2010 expands the number of Round Two MSAs from 70 to 91 areas.

CPAP Help

CPAP Help

Continuous Positive Airway Pressure, or CPAP, is the most effective treatment for OSA. A decision to use CPAP is a major step forward in the pursuit of a healthier life. The successful use of CPAP will help you breathe easier, sleep better, and live healthier.

Using CPAP can be a positive experience if you keep these 10 key points in mind:

1. Commitment
   CPAP is not a quick fix for your problem. It involves a long-term commitment to improve your sleep and your health.
2. Communication
   Stay in close communication with your Respiratory Therapist at Alpine. Ask a lot of questions and seek help when you need it.
3. Consistency
   Use CPAP all night, every night, and for every nap. You will receive the maximum health benefits from CPAP when you use it every time that you sleep. This will also make it easier for your body to adjust to the treatment.
4. Correction
   The machine and mask that you try may not be the same one you have five years from now. In the medical field change happens quickly and Alpine is the industry leader when it comes to staying current with these changes. That's why if you find your current mask is no longer satisfactory, it is important to report your problems to your Respiratory Therapist. The solutions are often easily solved. It is important that your mask is a good fit and you learn to use your equipment properly.
5. Challenge
   Tell a family member or close friend to ask you each morning if you used your CPAP the previous night. Have someone to challenge you to give it your best effort.
6. Connection
   Your adjustment to CPAP will be easier if you are able to connect with others who use the same treatment. Ask your Respiratory Therapist if there is a support group in your area for people who have sleep apnea, or look for one on the Internet.
7. Comfort
   Increase your level of comfort by using a saline spray, decongestant or heated humidifier if CPAP irritates your nose, mouth or throat. Most units have a "ramp" setting to allow you to get used to the prescribed pressure level. This happens by starting at a much lower pressure and "ramping" the pressure up slowly (usually over 20 minutes) until it reaches your prescribed pressure, the patient is usually asleep by that time.
8. Cleaning
   Clean your mask, tubing and headgear on a regular basis. Put this time in your schedule so that you don't forget to do it. Check and replace the filters for your CPAP unit and humidifier.
9. Completion
   Although you are never finished with CPAP therapy, you should reward yourself by celebrating the completion of your first month of treatment. Expect this first month to be your hardest period of adjustment. It will involve some trial and error as you find the machine, mask, and pressure settings that are right for you.
10. Continuation
    After your first month of treatment, continue to make a daily commitment to use your CPAP all night, every night and for every nap. CPAP is a long-term commitment, one that could make a dramatic improvement in your quality of life.

Making CPAP work for you

There are great advantages to using Continuous Positive Airway Pressure (CPAP) to treat Obstructive Sleep Apnea (OSA). The steady air flow of a CPAP machine keeps your airway open and prevents pauses in your breathing that can put your health at risk and keep you from a good night’s sleep. As a result, you feel more alert and refreshed when you wake up.

There are five common problems that are common to both new and experienced CPAP users. The following simple solutions should help you maintain a long-term commitment to improve your sleep and your health with CPAP. Remember to always talk to your CPAP supplier if you have questions about your CPAP machine. Contact a sleep specialist if you have ongoing problems.

Problem #1: You seem to have more nasal congestion from using CPAP.
Nasal congestion is the most common side effect of CPAP therapy. You may also have a runny, itchy or dry nose, or nosebleeds. Nasal congestion often goes away after your first month of use. Congestion is more common in the winter and during allergy season. It is not always a result of CPAP. Talk to your physician if your congestion is severe, or if you have nasal, sinus, or ear pain.

These tips can help reduce your nasal problems:

• Try using a saline nasal spray, which is a simple mixture of salt and water. Apply a few sprays in each nostril before using your CPAP.
• Try a nasal decongestant in either spray or tablet form. Ask your physician to recommend a decongestant for you. Never use a spray for more than a few days.
• Try using a CPAP humidifier. The moisture that it adds to the forced air may reduce your nasal symptoms. Some CPAP models come with a built-in humidifier that is connected to the unit. Be sure to keep your humidifier clean to prevent infections. Ask your Respiratory Therapist about using a humidifier with your CPAP. There are two types of CPAP humidifiers:
  • Cold "passover" humidifier
  • Heated humidifier

Problem #2: You have trouble breathing with so much air coming in through your mask.
This problem is common if your OSA is severe and a higher level of air pressure is required to keep your airway open. At times it can feel like you are getting too much air at too high of a pressure level. You should never reduce your air pressure setting without first talking to your Respiratory Therapist or physician.

Instead, try these tips:

• Begin using your CPAP for short periods of time during the day while you watch TV or read.
• Use the "ramp" setting on your unit so the air pressure increases slowly to the proper level.
• Use CPAP every night and for every nap. Using it less often reduces the health benefits and makes it harder for your body to get used to it.
• Newer CPAP models are virtually silent; however, if you find the sound of your CPAP machine to be bothersome, place the unit under your bed to dampen the sound.
• Make small adjustments to your mask, tubing, straps, and headgear until you get the right fit.

Problem #3: You have a dry or sore throat from using CPAP.
Anyone who breathes through his or her mouth while sleeping may have this problem. Talk to your so he or she can properly address the problem. Also, be sure to mention a painful throat to your Primary Care Physician.

These tips may help relieve throat irritation caused by CPAP:

• Using a humidifier, either cold passover or heated, usually solves this problem by moistening the air entering your airway.
• Using a chin strap with your nasal mask will keep your mouth closed while you sleep.

Problem #4: You have red eyes, continue snoring, or stop breathing during sleep.
These problems are all signs that air may be leaking out of your mask.

These tips can help you correct the problem:

• Adjust the straps and headgear on your mask to obtain a better fit.
• Check to make sure your mask is not worn or torn.
• Try a different size mask.
• Talk to your Respiratory Therapist about attending a CPAP class for a mask re-fitting in one of Alpine's comfortable and confidential CPAP fitting rooms.

Problem #5: You develop redness or sore spots on your face, nose or forehead from the mask or straps.
Most masks now have improved cushioning for a more comfortable fit.

If your mask does cause soreness, these simple steps can help solve the problem:

• Loosen your straps slightly so that they are not too tight. Make sure that your mask is still snug enough to prevent air leaks, but not so tight that it hurts your skin.
• Consider buying pads that slip over your straps. Made of fleece or other soft material, they keep the straps from rubbing against your skin.
• Contact the sleep physician and he or she may recommend attending a CPAP class.

The History of Valentines Day

The history of Valentine's Day — and its patron saint — is shrouded in mystery. But we do know that February has long been a month of romance. St. Valentine's Day, as we know it today, contains vestiges of both Christian and ancient Roman tradition. So, who was Saint Valentine and how did he become associated with this ancient rite? Today, the Catholic Church recognizes at least three different saints named Valentine or Valentinus, all of whom were martyred.

One legend contends that Valentine was a priest who served during the third century in Rome. When Emperor Claudius II decided that single men made better soldiers than those with wives and families, he outlawed marriage for young men — his crop of potential soldiers. Valentine, realizing the injustice of the decree, defied Claudius and continued to perform marriages for young lovers in secret. When Valentine's actions were discovered, Claudius ordered that he be put to death.

Other stories suggest that Valentine may have been killed for attempting to help Christians escape harsh Roman prisons where they were often beaten and tortured.

According to one legend, Valentine actually sent the first "valentine" greeting himself. While in prison, it is believed that Valentine fell in love with a young girl — who may have been his jailor's daughter — who visited him during his confinement. Before his death, it is alleged that he wrote her a letter, which he signed "From your Valentine," an expression that is still in use today. Although the truth behind the Valentine legends is murky, the stories certainly emphasize his appeal as a sympathetic, heroic, and, most importantly, romantic figure. It's no surprise that by the Middle Ages, Valentine was one of the most popular saints in England and France.

While some believe that Valentine's Day is celebrated in the middle of February to commemorate the anniversary of Valentine's death or burial — which probably occurred around 270 A.D — others claim that the Christian church may have decided to celebrate Valentine's feast day in the middle of February in an effort to "christianize" celebrations of the pagan Lupercalia festival. In ancient Rome, February was the official beginning of spring and was considered a time for purification. Houses were ritually cleansed by sweeping them out and then sprinkling salt and a type of wheat called spelt throughout their interiors. Lupercalia, which began at the ides of February, February 15, was a fertility festival dedicated to Faunus, the Roman god of agriculture, as well as to the Roman founders Romulus and Remus.

To begin the festival, members of the Luperci, an order of Roman priests, would gather at the sacred cave where the infants Romulus and Remus, the founders of Rome, were believed to have been cared for by a she-wolf or lupa. The priests would then sacrifice a goat, for fertility, and a dog, for purification.

The boys then sliced the goat's hide into strips, dipped them in the sacrificial blood and took to the streets, gently slapping both women and fields of crops with the goathide strips. Far from being fearful, Roman women welcomed being touched with the hides because it was believed the strips would make them more fertile in the coming year. Later in the day, according to legend, all the young women in the city would place their names in a big urn. The city's bachelors would then each choose a name out of the urn and become paired for the year with his chosen woman. These matches often ended in marriage. Pope Gelasius declared February 14 St. Valentine's Day around 498 A.D. The Roman "lottery" system for romantic pairing was deemed un-Christian and outlawed. Later, during the Middle Ages, it was commonly believed in France and England that February 14 was the beginning of birds' mating season, which added to the idea that the middle of February — Valentine's Day — should be a day for romance. The oldest known valentine still in existence today was a poem written by Charles, Duke of Orleans to his wife while he was imprisoned in the Tower of London following his capture at the Battle of Agincourt. The greeting, which was written in 1415, is part of the manuscript collection of the British Library in London, England. Several years later, it is believed that King Henry V hired a writer named John Lydgate to compose a valentine note to Catherine of Valois.

In Great Britain, Valentine's Day began to be popularly celebrated around the seventeenth century. By the middle of the eighteenth century, it was common for friends and lovers in all social classes to exchange small tokens of affection or handwritten notes. By the end of the century, printed cards began to replace written letters due to improvements in printing technology. Ready-made cards were an easy way for people to express their emotions in a time when direct expression of one's feelings was discouraged. Cheaper postage rates also contributed to an increase in the popularity of sending Valentine's Day greetings. Americans probably began exchanging hand-made valentines in the early 1700s. In the 1840s, Esther A. Howland began to sell the first mass-produced valentines in America.

According to the Greeting Card Association, an estimated one billion valentine cards are sent each year, making Valentine's Day the second largest card-sending holiday of the year. (An estimated 2.6 billion cards are sent forChristmas.)

Approximately 85 percent of all valentines are purchased by women. In addition to the United States, Valentine's Day is celebrated in Canada, Mexico, the United Kingdom, France, and Australia.

Valentine greetings were popular as far back as the Middle Ages (written Valentine's didn't begin to appear until after 1400), and the oldest known Valentine card is on display at the British Museum. The first commercial Valentine's Day greeting cards produced in the U.S. were created in the 1840s by Esther A. Howland. Howland, known as the Mother of the Valentine, made elaborate creations with real lace, ribbons and colorful pictures known as "scrap."

Round 2 of competitive bidding: CMS is working on it

General news

Round 2 of competitive bidding: CMS is working on it

By Liz Beaulieu Editor - 02.11.2011

WASHINGTON - There are more questions than answers about Round 2 of competitive bidding, but that may be a good thing, HME industry stakeholders say. The last they knew, CMS planned to announce the zip codes and product categories for Round 2 in the fall of 2010, open registration in the winter of 2010-11, accept bids in the summer of 2011 and implement the program Jan. 1, 2013. But so far, the agency has been "strangely quiet" about the next step in the program, they say. "I think it's good that they haven't finalized that information," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "Hopefully, what they're doing is a thorough review of the outcomes of Round 1, making sure, before they expand the program, that all the processes and procedures are in place to ensure positive outcomes." All stakeholders know for sure: That Congress has required CMS to start working on Round 2 some time this year in 91 metropolitan statistical areas. Stakeholders hope CMS is taking its time to, among other things, improve its outreach efforts to referral sources and beneficiaries. "That's always been an issue--what happens when they spread out the program to all of these additional areas," said Peter Amico, a member of CMS's Program Advisory and Oversight Committee (PAOC) for competitive bidding and the owner of Prime Care Medical Supplies in Holtsville, N.Y. "All the problems with Round 1, with doctors and patients being confused and misled--I hope CMS is trying to resolve those issues before Round 2 takes effect." Laurence Wilson, director of the chronic care policy group at CMS, told Wayne Stanfield, executive director of NAIMES, last week that "there was still some work to do" for Round 2. "Those were his words," Stanfield said. "He was non-committal about specifics, but he said that Round 2 would be going forward later this year." There may be work to do, but stakeholders don't expect CMS to overhaul the program for Round 2. "I think they may put manual wheelchairs in there--whether it's in addition to power wheelchairs or a substitute for them, I don't know, but my suspicion is that they'll be in there," said Cara Bachenheimer, senior vice president of government relations for Invacare. "Other than that, I suspect close to zero changes, because they're telling everyone it's such a wonderful program."

House First Month Purchase Option Letter | Co-signer List

House First Month Purchase Option Letter | Co-signer List

Download the 50/50 Brochure

Helping Siblings Overcome Family Conflict While Caring for Aging Parents

This guide is designed to help adult siblings and their aging parents deal with those sensitive situations that arise among brothers and sisters as their parents age and need assistance. The downloadable guide covers a variety of sibling caregiving topics such as: How do you divide workload with your sister? What’s the best way to build teamwork with your brothers? How can you reach agreement as a family on important topics to avoid family conflict?

Download the guide: The 50/50 Rule^SM brochure (PDF format – 950KB)

Medicare Patients Report Problems with Access to Medically Required Equipment and Services under Controversial “Competitive” Bidding System

WASHINGTON, DC, February 2, 2011 ---- After the January 1 implementation of Medicare’s controversial “competitive” bidding program in nine regions across the U.S., Medicare patients are reporting problems receiving home medical equipment and services that were prescribed by their physicians.

The bidding program was implemented on January 1 in nine metropolitan regions: Charlotte, Cincinnati, Cleveland, Dallas-Fort Worth, Kansas City, Miami, Orlando, Pittsburgh, and Riverside, California. The program is scheduled to start up in another 91 regions later this year. The bidding program affects millions of Medicare beneficiaries who require oxygen therapy, enteral nutrients (tube feeding), continuous positive air pressure (CPAP) and respiratory assistive devices, power wheelchairs, walkers, hospital beds and support surfaces, and mail-order diabetic supplies.

By design, this new Medicare program severely restricts the number of companies that are allowed to provide the equipment and services subject to bidding. Since the bidding program began on January 1, patients, clinicians, and homecare providers have reported:

• Difficulty finding a local equipment or service provider;
• Delays in obtaining medically required equipment and services;
• Longer than necessary hospital stays due to trouble discharging patients to home-based care;
• Far fewer choices for patients when selecting equipment or providers;
• Reduced quality; and
• Confusing or incorrect information provided by Medicare.

The Association has logged more than 100 complaints during the first four weeks since the bid program was implemented, including dozens from patients. Among those complaints are the following:

• A CPAP user in the Orlando area could not find the right supplies from the reduced number of local providers contracted under the bidding system. “I don’t like that the local people were cut out. In our area, there are very few suppliers to choose from.”
• A provider of home medical equipment and services in the Kansas City area reports that hospital discharge planners are sending patients only those equipment providers that won contracts for multiple categories under the bidding system, effectively excluding those companies that only won contracts for one or two service categories. This further shrinks the pool of homecare providers available to serve Medicare beneficiaries who depend on home medical equipment and services and does nothing to protect small providers.
• Home medical equipment providers in Cincinnati, Cleveland, and Dallas have laid off staff because of the bidding program.
• A patient in the Charlotte area was required to stay in the hospital for several extra days because of delay in delivery of oxygen equipment to the patient’s home, reports the North Carolina Association for Medical Equipment Services.
• A director of case management at a Dallas hospital said the bidding program has caused problems and burdens with respect to coordination of equipment and services. “Medicare is making it more difficult to provide services to people in need.”

The American Association for Homecare shared a number of problems with CMS earlier in January including:

• Companies awarded Medicare contracts that are bankrupt.
• Companies awarded Medicare contracts that are not licensed to provide items or services.
• Companies awarded Medicare contracts that have credit problems.
• Incorrect information distributed by Medicare about the contract winners and which beneficiaries need to change their home medical equipment providers.

MARKET EXPERTS, CONSUMER GROUPS OPPOSE THE BID SYSTEM

In November, more than 160 leading economists and auction experts, including two Nobel laureates, warned Congress in several letters that Medicare’s bidding design for medical equipment will fail. Those experts, who design market-based auction systems and do not oppose the concept of using a competitive bidding system to set Medicare prices, found that this particular bidding program designed by the Centers for Medicare and Medicaid Services has irreparable flaws that will prevent it from achieving its objectives of low cost and high quality equipment and services.

“It’s just four weeks into this program and we have received complaints from more than 100 patients, providers, and hospital administrators who have expressed grave concerns about this approach to healthcare,” said Tyler J. Wilson, president and CEO of the American Association for Homecare. “We agree with the many patient advocacy groups, the 167 economists, and the 257 members of Congress who have called for an end to this misguided pricing mechanism. Homecare is already the most cost-effective setting for post-acute care, and this bid system is merely a badly designed solution in search of a problem.”

Under the CMS-designed system, the bidding companies are not bound by their bids, which undermines the credibility of the process and encourages “low-ball” bids that create an unsustainable process and threaten the long-term viability of the program. Ultimately, the experts told Congress, the bid design provides “strong incentives to distort bids away from [actual] costs,” and lacks transparency, which is “unacceptable in a government auction and is in sharp contrast to well-run government auctions.” The experts’ letters conclude, “This collection of problems suggests that the program over time may degenerate into a ‘race to the bottom’ in which suppliers become increasingly unreliable, product and service quality deteriorates, and supply shortages become common. Contract enforcement would become increasingly difficult and fraud and abuse would grow… Implementation of the current design will result in a failed government program.”

Also opposing the controversial bidding program are more than a dozen national consumer and patient advocacy groups including the ALS Association, American Association of People with Disabilities, Muscular Dystrophy Association, National Council on Independent Living, National Spinal Cord Injury Association, and United Spinal Association. Last year, a bipartisan group of 257 members of the U.S. House of Representatives supported legislation to repeal the misguided bidding program.

Medicare beneficiaries, family members, caregivers, hospital discharge planners, and clinicians can report problems, concerns, and feedback about this bidding system by calling a toll-free number, 1-888-990-0499, or by visiting the website:www.biddingfeedback.com. To learn more, visit www.aahomecare.org/competitivebidding.

Aerobic Exercise for a Bigger Better Brain

Aerobic Exercise for a Bigger Better Brain

How Aerobic Exercise Improves Brain Function and Memory

By Robin Westen - Posted February 2, 2011 12:00 AM

Source: Goodshoot/Thinkstock

Sure, aerobic exercises such as walking fast, spinning, even jumping rope are great for keeping us in terrific physical shape – but new research shows getting our heart pumping also keeps the aging brain from getting “flabby.”

Scientists at the University of Pittsburgh, the University of Illinois, Rice University and Ohio State demonstrated that a program of aerobic exercise, over the course of a year, increases the size of the hippocampus. This is the part of the brain that is crucial to keeping the memory and understanding of spatial navigation in good shape, especially in adults ages 55 to 80. Without aerobic exercise the hippocampus is known to shrink in late adulthood, leading to memory impairment.

There’s nothing startling in these finding which back up earlier research that showed a connection between fitness level and brain function, but these results pump up the reason to get moving.

HOW THE STUDY WORKED

The researchers recruited 120 older people who didn't exercise regularly. Half were randomly assigned to an aerobic exercise program, walking around a track three days a week for 40 minutes per session. The other half embarked on a stretching-and-weights program. Both groups were carefully coached and monitored. They provided blood samples, performed spatial memory exercises and were given MRIs at the beginning, halfway point and end of the research period.

Scientists found that the group doing aerobic exercise had increases in hippocampus volume: up 2.12 % in the left hippocampus and 1.97% in the right hippocampus. The stretching group, on the other hand, had decreased hippocampus volume: down 1.40% on the left and 1.43% on the right.

The participants also performed spatial memory exercises. Again, the aerobic exercise group had better function by the end of the year of exercise. Blood tests also showed an increase in the levels of brain-derived neurotropic factor, a chemical involved with learning and memory, among the walkers. Increases in hippocampal size were associated with increased amounts of brain-derived neurotropic factor.

WHAT IT MEANS

The findings lead to great news. They show that the loss of hippocampal size as we age is not inevitable and can even be reversed with moderate-intensity exercise. Does this mean a few laps around the track might be a particularly cost-effective way to treat a widespread health problem -- without the side effects of medication? Well, there’s a good chance it might.

Even better news, it’s never too late to get going.

MODERATE AEROBIC ACTIVITIES

•Walking briskly on a level surface
•Swimming
•Gardening, mowing, or raking the lawn
•Cycling on a stationary bicycle
•Bicycling outdoors on a level surface

CAUTION: If you’ve been inactive for a long time or have certain health risks, speak to your doctor before beginning any exercise program.

MORE STRENUOUS ACTIVITIES

•Climbing stairs or hills
•Shoveling snow
•Brisk bicycling up hills
•Running or walking quickly on an inclined treadmill
•Aerobics classes at gyms such as spinning

These exercises should feel somewhat difficult to you, but not painful. You can divide your exercise into sessions of no less than 10 minutes at a time, as long as they add up to a total of at least 30 minutes on most or all days of the week. When you can safely and comfortably do 30 minutes of moderate cardio exercise at one time, you can add more time--or try more than one exercise during the same session.

NOTE: Doing less than 10 minutes at a time won't give you the desired cardiovascular and respiratory system benefits you are looking for.

REMINDER: Speak with your doctor before beginning any exercise program.

Robin Westen is ThirdAge’s medical reporter. Check for her daily updates. She is the author of “Relationship Repair.”

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