Tag Archives: competitive bidding

My first scooter: Originally published as a Valentine to the Durable Medical Equipment Industry

 [The following was originally published in the February, 2011 edition of HME News as a Valentine to the Durable Medical Equipment industry. The love continues.]

I was so angry, wild with fatigue, that I lifted my ugly drug store cane intending to destroy my employer’s computer printer. This was in California’s Silicon Valley. The printer was networked to nine computers. After a late night writing a portion of a manual on silicon wafer inspection, I commanded the computer to print.

After I weaved my way to the printer (seemingly miles away from the computer), there was no document. Five trips back and forth (nothing each time) and my level of frustration caught up to my level of exhaustion. My control was at the breaking point.

Six months previously, I had lost my ability to walk. The concepts I was writing about were hard to understand even when I had been healthy and well-rested. My ability to physically support my body was shaky. I fell several times a day. My right arm had been badly dislocated in a fall. What I needed was a fore-arm crutch with properly fitted prosthetics or a scooter. My doctors focused on understanding how I lost the ability to walk and little on how I could live without walking.

Mortgage payments were due. Home was North Carolina where a wife and two elementary-school-aged children waited. The local economy determined technical writers were not currently needed. At the same time (1996), California needed my skills as of yesterday and I was promptly hired for KLA-Tencor, a company paying large sums to do fascinating work.

I did not break the printer. I drove to my apartment, slept and thumbed the yellow pages praying for relief. I did not know what I was looking for. After a while, I left a voice mail with a dealer in wheelchairs and scooters (not knowing then what a scooter was). That is how I purchased my first mobility device.

Scott returned my call and listened to my situation. We talked price. He recommended a used front-wheel drive scooter. I was skeptical. “Let me show you how it works,” he said, crossed town quickly and lifted a scooter from his truck. I sat down and drove circles around the empty street. My able-bodied college friend David Phillips, in whose house I had an apartment, was fascinated. Keeping David from driving my scooter was hard.

I had discovered three important things about mobility devices:

    • They are fun.
    • They take away the drudgery of not being able to walk.
    • They remove the image that I am someone to be pitied.

I arrived at KLA-Tencor, having:

    • Given Scott a down payment (the beginning of many, mostly personal, expenditures, on equipment, including rear-wheel  drive scooters, power chairs, wheelchair lifts and ramps)
    • Taken the scooter apart myself and shakily inserted the parts into the trunk
    • Slid sidewise hugging the Pontiac’s body
    • Reversed the process

My colleagues applauded. I had solved a physical problem with a technical solution and in the Silicon Valley that was worthy of commendation.

As I look back on the past 14 years, especially worthy of commendation are you, the suppliers of DMEPOS. My time with you here is almost up. Traditionally a column is about 750 words. I have used most of them. A 750-word column can express effectively only one major idea. That idea is that you, the medical suppliers, and people like me, your customers, are a family.

We are a family surviving in a world where David Stockman, Ronald Reagan’s former budget director, said in November on ABC News that the United States can no longer afford to provide its disabled citizens with “scooters.” As competitive bidding illustrates, clearly a bipartisan effort is underway to make it difficult for the disabled to receive mobility and other DMEPOS devices and for you, our local medical suppliers, to get paid for them or even to stay in business.

The pain is especially felt by indigent consumers and small suppliers. In this month where every day is Valentine’s Day, it is helpful to remember the words of Benjamin Franklin (an amorous man if ever there was one) on the signing of the Declaration of Independence: “We must all hang together or assuredly we shall all hang separately.”

–Joel Solkoff is a monthly columnist on disability and elderly related issues for Voices in State College, Pa. He is the author of three books, including The Politics of Food and Learning to Live Again: My Triumph Over Cancer. He served in the Carter Administration as Special Assistant to the Under Secretary of Labor. He has a bipartisan loathing of anyone trying to keep assistive technology from individuals with disabilities—a loathing he is trying to turn into corrective love.

What’s the fuss? [Grilled 101]

What’s the fuss? [Grilled 101]

I originally created this blog as a convenient way for readers to have access to my monthly column in Voices of Central Pennsylvania, published from October 2009 to February 2011. While recovering from minor cardiac surgery where the medical standard of “do no harm” was once again violated, I decided to quit my column rather than continue to be a person unable to change Medicare and thus always angry all the time. I wanted to love.

I am a frequenter of hospitals for pneumonia, rehabilitation to a right shoulder that cannot be repaired, diabetes, etc.–invariably released by Medicare dictate before it is necessary; frequently saved by homecare agencies now foolishly required to reduce their services.

In writing my column for February (the one below that begins with bull riding), I opted to reject anger.
Similarly, the once favorable economic conditions in downtown State College, PA where I live had given me the hope that government favorable to the disabled and elderly might provide us with the infrastructure, training, and understanding required to develop and benefit from the talent of those of us who are broken in body but sound in mind.

It is foolish to be angry at my fellow-town mates (in a place that is rapidly turning into a Bruce Springsteen song) who are so beset with troubles of their own that…

So, I gave up the column to work with engineers, architects, and designers who are planning a future that follows the Americans with Disabilities Act (ADA) and where segregation of the sort I experience daily at Ye Olde College Diner and the like (whose lack of access is grandfathered ) does not exist.

What does exist is that I continue to live an independent life. I cannot get from my bed to the bathroom without a scooter or other mobility device. Yes, there is a point where reality requires that I cannot engage in submission, cheerful or otherwise.

I must have access to mobility devices. President Obama, for whom I worked and voted, should be ashamed of himself for not only tolerating, but personally advocating a competitive bidding program for durable medical equipment.

This plan, which the President inherited from President Bush (who used it as part of an effort to gut Medicare) is already, in Pittsburgh and other locations, so altering the process of providing medical supplies such as oxygen, wheelchairs, power chairs, scooters and other mobility devices that local suppliers, such as the three here in State College, would only be able to serve the rich.

The rest of us are or would be at the mercy of often out-of-state suppliers of dubious reputation who would take their sweet time providing batteries and maintenance, resulting in people like me falling and going into assisted living facilities. Thus savings in Part B of Medicare would result in large costs in Part A.

Last year’s measure to end competitive bidding received the bipartisan support of so many members of the House that if the Democratic leadership had called it up for a vote it would have passed. The Senate followed the lead of Senator Robert Casey, Jr. (D-PA) and no member of the Democratically-controlled senate endorsed the legislation.

While Sen. Casey publicly dithered about his position on the subject, his real position appeared to become clear. Sen. Casey is reportedly a friend of the President. The President, for reasons of his own, an informed source told me, personally believes in competitive bidding. Sen. Casey is not going to take a position that would make his friend angry.

Two columns below express the views of Rep. Jim Langevin, a liberal Democrat from Rhode Island, and Rep. Glenn Thompson, a conservative Republican who represent me here in the Fifth Congressional District of Pennsylvania, expressing their opposition to competitive bidding. Their specific advocacy was to the legislation introduced last year, but this year’s legislation is déjà vu all over again.

My friends who meet regularly at the Corner Room in this sliver of left wing political power here in the small borough of State College (surrounded on all sides by Republicans; Republicans to the north; Republicans to the south; Republicans to the east, and Republicans to the west) cherish the liberal’s dream that someday these evil Republicans will turn into progressive Democrats.

My fixation on competitive bidding has made me a source of jest and some mistrust. My support of Rep. Thompson, especially, has made some Democrats suspect my loyalty to the party.

I am a loyal Democrat who believes in the party of Eleanor Roosevelt and Adlai Stevenson. I have no trouble picturing Eleanor Roosevelt shaking her trademark index finger at President Obama and Senator Casey. If they want my vote, they had better start acting like Democrats. Democrats don’t treat people who cannot walk in a way that causes us to feel like cripples.

Shame on you President Obama. Shame on you Senator Casey.

I will pray that you find your way back to the ideals of the Democratic party.

Shame. Shame. Shame.

–Joel Solkoff, March 2011

Exclusive Written Interview of Rep. Jim Langevin (D-RI)

Exclusive Written Interview of Rep. Jim Langevin (D-RI) by Joel Solkoff, Voices of Central Pennsylvania
1. Why do you oppose the Obama Administration’s efforts to create competitive bidding for medical suppliers of durable medical equipment, such as medical oxygen, power chairs, scooters, wheelchairs, and other mobility devices?

The competitive bidding program was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) in an effort to improve quality of service and eliminate excess costs in Medicare. While I support these overall goals, flaws within the bidding process sparked early concerns within the program.


Competitive bidding was implemented in July 2008. However, Congress delayed the program two weeks after it began, recognizing the new system was not generating the savings and competition the law had intended. Further, the program was acknowledged to be a potential threat to access and quality of services, vulnerable to corruption, and resulting in fewer suppliers capable of meeting the unique needs of patients.


During the moratorium, the Centers for Medicare and Medicaid Services pursued other avenues that achieve higher quality care and succeeded in cutting costs, yielding savings of 16.5 percent. These alternatives underscore my belief that the original program is ineffective and unnecessary to keep as written law. For this reason, I cosponsored H.R. 3790, which would repeal the Competitive Bidding Program.

2. What are your objections to the attempt to repeal the first month purchase option for users of mobility devices?

Currently the Medicare program allows beneficiaries a choice as to whether they want to purchase the power wheelchair that is right for their size, disability, functional level and home situation, or if they want to rent it. Over 95 percent of beneficiaries choose the first month purchase option because their disability often involves a chronic, long-term condition and they require use of a power wheelchair to remain active and independent in their homes and communities.


The Affordable Care Act repeals the first month purchase option and requires a mandatory 13-month rental, regardless of the acuity of the condition or long-term need of the patient. Unfortunately, many power wheelchair providers do not have the capital or lines of credit in the current economy to bear the burden of paying the up-front costs to procure the appropriate wheelchairs from the manufacturers. Without a one-year delay, this policy could create significant access and quality-of-care issues as providers of this equipment struggle to make the significant changes to their business model to adapt to a new payment model, which has the costs front-loaded with reimbursements from Medicare spread over 13 months. They may also simply go out of business.


A one-year delay of this provision will allow providers of power wheelchairs more time to implement this significant policy change.

3. Why do you think President Obama waited so long to appoint an administrator of Medicare and Medicaid? (I would think a Medicare Administrator could have given the President valuable information and advice during the health care reform process.)

While I cannot speak for the President, I believe that vetting and selecting high-caliber individuals to lead departments and agencies can be a long and challenging process, particularly those that require Senate confirmation. As health reform was considered in Congress, counsel was sought from numerous stakeholders at all levels and throughout all steps of the process. Now that the law has been enacted, the Administrator of the Centers for Medicare and Medicaid Services (CMS) is one of many Administration officials tasked with its implementation, which is equally, if not more important to the success of health reform.

4. What affect will Donald Berwick’s recess appointment, with its limited duration, have on the future of Medicare and Medicaid, especially given the strong Republican and Tea-party desire to cut Medicare even more.

Donald Berwick is a highly respected leader in the field of health policy. His knowledge and experience make him uniquely qualified to head CMS, particularly as we begin to institute payment and delivery reforms to maximize quality and efficiency in Medicare and Medicaid. While a Senate confirmation would have been preferable, some senators intended to make Donald Berwick’s confirmation process a referendum on health reform, placing ideology over his qualifications as a potential administrator. Republicans have long stated their intentions to “repeal and replace” the health reform law. We cannot dismiss the probability that they will use every means at their disposal to accomplish this, including the use of controversial amendments, defunding the program through the appropriations process, and blocking future nominees for positions in the Administration.


5. What are your views on the half trillion dollar cuts in Medicare as a way of helping to pay for the health care reform bill?

Health care costs in the United States are rising at an alarming rate. Yet despite the fact that we spend more per capita on health care than any other industrialized country, we produce disappointing outcomes by a number of important health measures. Furthermore, the U.S. remains the only developed nation that does not guarantee health coverage as a right to its citizens.


Health reform will expand coverage to 32 million Americans, promote a strong health care workforce, reduce the deficit by $143 billion over 10 years and protect Medicare for our seniors by extending the trust fund by a decade. These reforms are funded in part through Medicare savings, not benefit cuts.


Reducing health care costs and expanding insurance coverage does not mean we have to raid Medicare. On the contrary, we can and must use the money already in the system more efficiently to ensure a sustainable health care model.

6. As a Democrat who worked for President Obama’s election (and as a paraplegic), I have been disappointed by the President’s insensitivity to issues relating to disability, especially as they relate to the on-going difficulties in obtaining needed assistive technology. What are your views on the subject?

On July 26, 2010, we celebrated the 20th anniversary of the Americans with Disabilities Act (ADA). This was an opportunity to both celebrate our accomplishments, and reflect on the continuing challenges.


Individuals with disabilities remain one of our nation’s greatest untapped resources, and they continue to face challenges in accessing employment, transportation, housing and even health care. This will only continue as we see increasing numbers of veterans returning with Traumatic Brain Injury, Post Traumatic Stress Disorders and other disabling conditions.


It is more important than ever that we educate businesses and connect them with proper resources to create more employment opportunities in our communities. We must collaborate with local and state governments to ensure that transportation is available and accessible to everyone so they can get to their job, or the doctor, or the grocery store. We need to provide more resources for our teachers so that every child can receive a proper education, which is the stepping stone to a better future.


We must also continue the development of assistive technologies and make sure that computers, PDAs and phones are fully accessible for the vision and hearing impaired. To that end, on the 20th anniversary of the ADA, the House of Representatives passed the Twenty-first Century Communications and Video Accessibility Act, which would require that certain technologies be compatible with devices used by individuals with disabilities, and attempts to increase access to technology through various funding and regulatory requirements. This was signed into law by President Obama on October 8th.

7. Here in State College, PA, I am a constituent of Rep. Glenn Thompson, a Republican with whom you have been working on issues affecting local suppliers of medical equipment. Would you describe what your working relationship with Rep. Thompson is like?

Disabilities don’t discriminate on the basis of party affiliation. I have a long record of working in a bipartisan fashion to enact policies that increase the quality of life for all individuals with disabilities. My relationship with Representative Thompson is no exception.

8. What are your views on the future of productive working relationships with Republicans on health care-, Medicare-, and disability-related issues over the next two years?

While the climate in Washington has been particularly partisan during the elections, it is my greatest hope that we will not let the issues that divide us keep us from the work we were elected to do. Nothing would be more detrimental to our economic, fiscal and social progress than the continuation of partisan rhetoric and the lack of courage to make the tough choices that will ultimately lead us into a more prosperous future.

9. Do you think a Republican-dominated Congress will be effective in preventing full implementation of the health care reform bill?

Passage of the health reform bill wasn’t the end; it was the beginning of a new chapter for health care in America. This law will be judged by the court of public opinion, just as it will be challenged in the courts and in Congress. Some changes will have to be made, and the policy will evolve as our society does. At the end of the day, I believe the reforms will prove popular and successful.

10. Donald Stockman, budget director for the late President Reagan, says the country is out of money, must cut back on everything, and said on ABC’s This Week with Christiane Amanpour that scooter manufacturers should cut back on production. Is the country out of money? Can we afford to provide our disabled population with the assistive technology we need to be productive? Can our economy afford not to develop the talent of people with disabilities?

Americans are innovative and resilient. Although we will have to make tough budgetary decisions to put our country on a fiscally sustainable path, we still have the resources to invest in key areas that will plant the seeds of economic and social growth. We can make transportation and technology even more accessible and available. We can provide more resources to teachers and students to achieve a better education. We can focus on income and asset development so families have the means to become productive members of their communities. If we act with courage and commitment, then we will provide the means for every individual to realize their true potential.


Thank you.

Joel Solkoff, November 19, 2010, Voices of Central Pennsylvania

[Please note: As a columnist, I have the liberty of injecting personal notes in my writing, such as the fact that I am a Democrat.]

MY CHOICE TO HEAD MEDICARE a.k.a. Administrator for the Centers for Medicare and Medicaid Services

[The following is my March, 2010 column for Voices of Central Pennsylvania see http://voicesweb.org/archive/10mar/10mar-community-lifestyles.pdf (end of pdf.) or visit a newstand in Centre County.]

Strangers, snow and rehabilitation

From where I sit

Thanks to a failure to act in January, the Obama administration has made a serious
mistake in allowing competitive bidding for durable medical equipment such as oxygen
canisters, wheelchairs, power chairs and other devices.


I believe that if President Obama had a Medicare adviser of stature to explain the
consequences, Obama would not have made this mistake that will continue to hurt
people with disabilities—including me.


As a result of this competitive bidding process, T&B Medical and Dick’s Homecare—the only two companies providing power chairs, scooters and other equipment in State College—are in danger of losing to outside competitors, including
competitors outside the state. What they are at greatest risk of losing are contracts to provide Medicare recipients such as myself with equipment and maintenance reimbursements.


Maintenance is the issue I worry about most. Some legislators have put together a plan, supported by a sizeable non-partisan group in the House, that would end the bidding process.

One of the authors of the legislation is Rep. Glenn (“GT”) Thompson, who represents Pennsylvania’s Fifth Congressional district, of which Centre County (his home)
is one of 18 counties in a huge, 11,000 square mile district.


I asked Tina Kreisher, Thompson’s press secretary, for a 20-minute exclusive telephone interview because I thought we could cover the details on Thompson’s health care background so readers can see the link between what our congressman knows and
the unsolved problems he is equipped to solve.


Thompson and I spoke by telephone for over an hour on Tuesday, Feb. 9 at 6 p.m. I did not realize the degree of detail we would get involved in, especially since Thompson is himself the father of a disabled Iraqi war veteran. Thompson does not make a practice of talking in public about 22-year-old Logan, who was wounded when shrapnel and explosives caught him by surprise.


Thompson called me from Tucson, Ariz. where he was attending Logan’s graduation from Army intelligence training, an experience that filled him with the special gratitude we in the disability community feel when someone we love makes progress toward
independence. The two feet of snow in Washington had left him stranded in Tucson and he observed, “There are worse places to be stranded.”


Thompson’s advancement in health care followed two tracks. Academically, he received a bachelor’ degree from Penn State in Therapeutic Rehabilitation, a master’s degree from Temple for Health Science Recreation and a certification from M a r y w o o d
University in Nursing Home Administration.


M e a n w h i l e , Th o m p s o n ’s career involved working in central Pennsylvania a a residential services aid, a recreation therapist and a rehabilitation services manger at Susquehanna Halth Services in Williamsport.


Thompson was at one time an orderly at Centre Crest Nursing Home, and for three years cleaned out bed pans, changed patients out of soiled clothes and changed bedding. He worked with his wife Penny, who did similar work as a nursing assistant.
At the same time, Thompson’s mother was a patient at Centre Crest’s Alzheimer’s facility.


Glenn Thompson [everyone calls him (“GT“)] developed a reputation for good work and excellent managerial abilities, including people skills. When GT visited State
College on Labor Day weekend, his charm was evident. He talked about health care in the social hall and bingo parlor (across the hallway from where I am keyboarding this
column) of Addison Court, which is an apartment house for senior citizens and those with disabilities. The Congressman arrived for the 8 a.m event just as the Webster’s coffee and goodies arrived. (It helps turnout for these events when food is present and Elaine Madder-Wilgus has been most obliging in providing the coffee
Thompson was so grateful to drink.) The 10 additional members of the audience were mostly men and women in their 70s, 80s and 90s.


GT charmed everybody—83-year-old Lilian Huffman, put her hand on my shoulder and said, “I like that fellow” and Lilian is very influential at Addison Court. Win Lilian Huffman and you have won votes at Addison Court. Lilian is a registered
Republican who voted for Obama.


In my interview with Thompson, I asked about each portion of his 31-year career, which ended when he was supervising 25 rehabilitation specialists and coming up
with strategies for improving ongoing rehabilitation.


For me, sitting in a power chair right now, Thompson is the guy to know. I am at a point where I can now go back to rehabilitation to Dr. Colin McCaul, a brilliant rehabilitation physician at Healthcare South, because I recently passed a cardiac stress test. Since I cannot walk, cannot stand without holding on to something and can dislocate my shoulder if I throw my right arm straight in the air, I need a specialist to adapt special exercising tools so I can get the cardiovascular exercise I need. In my considerable experience with physical rehabilitation in three states, the people who do
the hands-on work, the people who touch my body to show me how to do special exercises, when touching is appropriate (a pat on the back is always useful)—these people are uniformly kind and helpful.


I am impressed by the kind of work Glenn Thompson did and taught other rehabilitationspecialists how to do. Based on his experience, his testimonials, his conversation and his education, I feel sufficiently trusting to put my exercise program in his hands if he has time.


Obama, the president I helped elect, is doing some truly bad things to Medicare that will have severely negative effects on the disabled. They have potentially disastrous affects on me. I use my power chair frequently; I require battery replacements every six months. What if the competitive bidding process the Obama administration
is implementing results in requiring me to get batteries from an out-of-area supplier and I have to wait too long?


Right now, Travis would be right over with the batteries. With competitive bidding, I have to depend on some anonymous supplier. During that wait, if my batteries won’t take a charge and I soil my bed repeatedly, I might have to move to Centre Crest, which would severely limit my opportunities.


The failure of the Obama administration to reach across the aisle, as it promised to do, is shocking when Glenn Thompson’s special knowledge is going to waste. At the time of my interview with Rep. Thompson on Feb. 6, the President had yet to announce
an Administrator for Medicare and Medicaid. Medicare is the largest health insurance company in the United States. Medicare needs an administrator who can be confirmed by the Senate. Thompson would be confirmed by the Senate.

Or, President Obama, please find him a better job. Or wake up the Republican House Leadership and have him put on the Ways and Means Committee where he will have oversight over Medicare. Given the overwhelming Republican composition of the Fifth Congressional District, Thompson will eventually gain the seniority he needs.

I don’t want to wait. I want Thompson‘s special skills available to me now because I believe he can assure me a more secure future.


—Joel Solkoff, author of The Politics of Food ,can be reached at his Voices of Central Pennsylvania blog http://voicesweb.org/blog/1242