In its final regulation on the Medicare physician fee schedule
for 2005, issued Nov. 3, the Centers for Medicare and Medicaid
Services (CMS) announced that it will implement its
“face-to-face examination” requirement at a later
date.
Last year's Medicare Modernization Act (MMA) required the
Secretary to establish types or classes of covered items, including
power wheelchairs, that require a face-to-face examination of the
individual by a physician or specified practitioner. But CMS stated
that “due to the timeframe and the extensive number of public
comments received, we will implement this provision at a later
date. We will address all public comments in a future Federal
Register Notice.”
A number of clinical groups, including physicians and
therapists, submitted comments strenuously opposing CMS' proposed
implementation of this provision. CMS may issue its regulation
implementing this provision in a rule that would eliminate the
requirement that only certain physician specialists can prescribe
power-operated vehicles.
Stay tuned.
Legislative Strategy for 2005
While CMS is moving forward under its statutory mandate to
implement competitive bidding for certain geographic areas
beginning in 2007, our industry must move quickly to implement a
collective and unified legislative strategy to eliminate the
competitive bidding statutory mandate. MMA requires CMS to
implement competitive bidding in 10 of the largest metropolitan
statistical areas (MSAs) in 2007, and 80 additional large MSAs in
2009.
Our legislative strategy for 2005 to repeal competitive bidding
must focus on building a determined groundswell of support to
repeal the competitive bidding law. We can only enlist members of
Congress to support us on this endeavor by having solid arguments,
backed up by sound data.
We were successful this year in garnering significant support
for H.R. 4491, the bill to repeal the payment reductions based upon
the Federal Employee Health Benefit Plans (FEHBP) pricing. We
enlisted the support of approximately 110 members of Congress, and
we did so by having sound arguments backed up by data.
We need to use the lessons of H.R. 4491 in getting Congress to
support our efforts to repeal the competitive bidding mandate.
That leads us to the hard part: sound arguments backed up by
data — arguments that dispel the notion that competitive
bidding is a better way to set Medicare pricing, with no negative
access or quality impacts.
Our first argument must question the assumption that competitive
bidding will yield sufficient savings to justify the increased
administrative costs. With the payment reductions from the January
2005 FEHBP-based cuts, much of the potential savings will already
be realized. Related to the savings argument is the administrative
cost argument. At some point, the costs of administering
competitive bidding will not yield savings that can justify the
administrative costs.
Our most important argument — that competitive bidding can
limit access to quality services — is one we must bolster
with data.
There is some data in the final CMS Report to Congress on CMS'
two previous competitive bidding demonstration projects, namely
that portable oxygen utilization decreased by 50 percent in Polk
County, Fla., compared to before the demonstration, and that
beneficiaries in San Antonio had problems accessing certain
accessories for their manual wheelchairs in that demonstration. But
we must dig deeper to find better and compelling facts to prove
this assertion.
What do we need to repeal the competitive bidding statutory
mandate? Two things: sound arguments backed up by sound data, and
committed members of Congress to carry the message.
We must begin now to engage our representatives and senators on
this issue, begin the education process and lay a foundation to
repeal this ill-founded policy.
A specialist in health care legislation, regulations and
government relations, Cara C. Bachenheimer is vice president,
government relations, for Invacare Corp., Elyria, Ohio.
Bachenheimer previously worked at the law firm of Epstein, Becker
& Green in Washington, D.C., and at the American Association
for Homecare and the Health Industry Distributors Association. You
can reach her by phone at 440/329-6226 or by e-mail at cbachenheimer@invacare.com.
