DME Competitive Bidding Case manager/discharge Planner Satisfaction Survey Better Same Worse Comment Totals 416 Yes and No Question's Yes Comment

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1 No DME Competitive Bidding Case manager/discharge Planner Satisfaction Survey Better Same Worse Comment 1. Ability to obtain timely, necessary home medical oxygen from supplier Ability to obtain needed hospital beds to discharge Patients Ability to obtain ambulatory aids (walkers, canes) to discharge patients in a safe, timely manner Ability to obtain needed wheel chairs for patients Contracted suppliers respond in a timely manner to requests for service The discharge process is as smooth as before competitive bidding started Patients are generally pleased with the services provided by contracted suppliers The quality of services and equipment provided by contracted suppliers relative to prior to CB Patients questions are being answered by contracted suppliers in a timely manner Patient complaints about contracted suppliers relative to prior to CB Contracted suppliers repairing equipment in a timely manner Overall, my ability to obtain quality medical equipment in a timely manner is better or worse since implementation of CB My ability to efficiently discharge patients in need of home medical equipment since implementation of CB Totals No Yes and No Question's Yes No Comment Have you contacted your Federal representative with complaints about competitive bidding? Have you contacted either or both of your Federal senators? Would you like to see DME competitive bidding repealed or fixed? Comments: (Pulmonary Unit) Takes 2-3 days to receive Durable Medical equipment delaying discharges, unable to safely discharge without DME. Would return as a re-admit unnecessary and in respiratory distress, high risk for intubation I have called Medicare many times with complaints, one time they "pulled up" the list of vendors near me and the list had vendors from the mid west. Vendors are also forcing us to have medical equipment closets so they don't have to provide service. 1

2 I have found CB to be awful. It is beyond time consuming, the approved vendors seem overwhelmed and are often rude and shout on the phone. There are multiple calls that need to be done to follow up as the communication is poor. Also, it is sad that families can no longer choose preferred vendor and many feel pushed into a corner. Please send me anything that I can do to help STOP future CB! Emergency Dept. patients seen discharged on Friday, often need to wait until Monday for DME. The change has caused an increase in stay and puts patients at risk! Obtaining oxygen on weekends is a problem. We field many calls from patients who feel they are being short-changed or not serviced anymore. I'm scared for the patients, especially those with limited faculty. I am a hospital case manager and I make initial referral for DME before patient's discharge. Patients do complain then they have to use multiple vendors for DME needs. We have managed to use one company primarily, unfortunately they are not always able to keep up with the demand. This has also left other local vendors with very little business from us but for workflow purposes we needed to work with a vendor that could provide all of the equipment not just the oxygen they all want to do. We have incurred expenses due to providing equipment out of our stock and delays in discharges. Patients have also incurred out of pocket expenses. The rehab s and VNA s are in an even bigger mess. We re experiencing frustrations with some DME vendors who are listed as having won the competitive bid in a particular zip code area (off Cape), but they consistently do NOT have any equipment ( What can I tell you...we don t have any walkers or canes. ). It s crazy. Other vendors say that they can get the equipment in 14 days for a patient leaving the hospital in 2 days. Aside from it being frustrating to us as we try to do the right thing, the patients are the ones who get the brunt of it, often buying equipment elsewhere and paying out of pocket just so that they can get home. Any suggestions of what I can do in these cases? 2

3 It is taking 4+ weeks to set up patients who need DME. One patient shared that they received their CPAP machine in the mail with no instructions. There was a letter to contact the provider so that they would walk the patient through the process of setting the machine pressures. I'm not sure how the patient received their mask or if they were even fitted for a mask by the company. The Contract Providers are servicing the patients primarily through mail order; patients are reporting that they are receiving the wrong supplies through mail order. Mail order is particularly difficult for seniors. One patient reported that they were now dealing with a representative out of Pennsylvania because the local branches were overwhelmed. The DME company told the patient to bring their machine to the doctor s office, and have the doctor s office download the CPAP data to send to them. There are some independent DME companies that are subcontractors for companies outside of CT. The challenge in dealing with the subcontractors is that they have to be very selective, as the contract provider can only accept patient with specific secondary or supplemental insurances. Why contact when NO ONE cares about the patients. They only care about getting their names in the press. My tax dollars are being wasted once again. Pt care & discharge planning unsafe, 2* unsure if pt's are picking up equipment that's no longer deliverable or setup correctly in their homes. Pt care is last and no longer a priority and recommendations being made are xxxxxxxxxx. DME companies are not delivering at the facilities as needed. They state it's not cost effective for them, they don't put patient's needs first. Poor, poor, poor patient care or concern. 2* limited ability for pt to pick up equipment. It was going fine for me before they changed it. Patients should have choices. They should be able to deal with local providers if they so choose. Nothing about this CB is working to benefit the patients. They are getting inferior equipment without any options. All of the vendors that we currently use, at one time or another, have refused to give the patient the equipment ordered due to their inability to stock an item. Unable to provide patients equipment needed, at times having to have patients family members personally pick up equipment, difficult for family members. 3

4 No accountability for suppliers / providers sub-par equipment, often late or no show deliveries. Difficulty in getting specific needs for patients such as wheelchairs basic specifications; or they are not carrying basic equipment. Equipment doesn't arrive on time, difficult to contact vendor because we don't always have access to what vendor was utilized. Patients safety is a huge concern. Discharges are unsafe and patients are not getting recommended equipment for safe discharge. The backlash from patients unable to get necessary equipment can be detrimental with more hospital admissions. Patients are suffering because of the Competitive Bidding! We have a patient being discharged from a local skilled nursing facility who has decided to pay cash for her home medical equipment instead of processing a claim with Medicare. The reason being that she lives in a Competitive Bid area and she feels that the Contract Providers are too far away. We sold a hospital bed to a Medicare beneficiary because they didn't want to bother waiting. They paid $1,200 for a hospital bed that was covered by Medicare. We re experiencing frustrations with some DME vendors who are listed as having won the competitive bid in a particular zip code area (off Cape), but they consistently do NOT have any equipment ( What can I tell you...we don t have any walkers or canes. ). It s crazy. Other vendors say that they can get the equipment in 14 days for a patient leaving the hospital in 2 days. Aside from it being frustrating to us as we try to do the right thing, the patients are the ones who get the brunt of it, often buying equipment elsewhere and paying out of pocket just so that they can get home. - Spaulding Rehab Hospital, Cape Cod Thank you for your efforts to try to improve competitive bidding. I am affected even though we are in an exempt county. Some residents do live in countried with competitive bidding. 4

5 I just got off the phone with the Social Services Director for Douglas Manor. Douglas Manor is a skilled nursing facility located in Windham, CT. She contacted us to provide one of her patients with a rolling walker. The patient has Medicare and lives in Columbia, CT, which means he is subject to Competitive Bidding. We are not a Contract Supplier for walkers, a fact with which Elly is aware, but she contacted us because the patient is going to pay cash for the walker. The reason the patient is paying cash is due to the fact that she (director) is unable to find a Contract Supplier that will deliver a walker to the patient. Her comment to me is that she has called so many companies and is sick of the time it is taking her. Under Medicare guidelines, all Contract Suppliers are required to service the entire CBA, meaning that Elly should have only had to make one call. 5