Sweeping health care reform legislation was signed into law in
March, including a provision to expand and speed up Round 2 of
Medicare's "competitive"
bidding program for home medical equipment. Stopping the
bidding program and preserving the first-month purchase option for
standard power wheelchairs (which was eliminated in the new law)
are among top priorities for 2010.
The good news is that the bipartisan bill to eliminate the
bidding program in a fiscally responsible manner, H.R. 3790, had at
least 185 cosponsors in the House of Representatives at press time.
HME providers have done a terrific job of educating their members
of Congress about the downside of the bidding program and
convincing many Democrats and Republicans to support H.R. 3790.
The bad news is the persistence of some of the myths and
misinformation about the bidding program, which are being
circulated to convince Congress and the public that the program is
good for seniors.
We need to counter the misleading information. Here are some of
the specific myths, followed by the realities:
- Myth: The bidding program is good for patients
CMS claims the bid program is good for beneficiaries because it
will reduce cost-sharing requirements. The truth is patient
co-payments for HME have fallen dramatically for many years along
with decreasing HME reimbursement rates.
H.R. 3790 would reduce home medical reimbursements to offset
savings that the bid program would have realized, so the effect of
the bill would be a further reduction in co-payments for Medicare
patients. Moreover, most beneficiaries have Medigap policies that
cover co-payments, so insurance companies will be the primary
beneficiary of the lower co-payments.
The larger point is the bidding program triggers a race to the
bottom in terms of quality and access to care. Because losing the
bid means going out of business, many providers will engage in
suicide bidding that coerces them to bid at economically
unsustainable rates.
Patients and seniors lose under the bidding program.
Organizations that support the elimination of the bidding program
include the ALS Association, the American Association for
Respiratory Care, the American Association of People with
Disabilities, the Muscular Dystrophy Association, National
Emphysema/COPD Association and National Spinal Cord Injury
Association, among others.
deterrent
This is extremely misleading. The real solution to keeping
criminals out of Medicare is better screening, real-time claims
audits, tougher penalties and better enforcement mechanisms for
Medicare — not more red tape for legitimate providers.
AAHomecare has proposed an aggressive 13-point plan to combat fraud
(www.aahomecare.org/stopfraud), and many of those
provisions are included in two bills in Congress.
The Association endorses Sen. George LeMieux's anti-fraud
legislation, the Prevent Health Care Fraud Act of 2009 (S. 2128),
and its companion bill in the House, H.R. 4222. Also, two new
requirements that took effect in October 2009 — accreditation
and surety bonds for home medical equipment providers — will
go far toward eliminating fraud. Equating opposition to the bidding
program with opposition to fraud prevention is simply a lie, and a
disgraceful one at that.
The HME sector is the poster child for real cost control. No
sector has had more numerous or deeper Medicare reimbursement cuts
and red tape imposed on it. Oxygen rates have declined by about
half over the past 10 years. Wheelchair reimbursements have been
cut by about 35 percent over the past five years. The delay to the
bidding program in 2008 required a 9.5 percent cut effective in
2009.
The perfectly obvious reality is home medical equipment and
services enable Medicare, Medicaid, and private health care to be
cost-effective. HME speeds discharges from hospitals to quality
post-acute care. It helps keep people out of hospitals, nursing
homes, and the emergency room.
It is critical that every HME stakeholder make these messages
clear to Congress.
Read more AAHomecare
Update columns. View more competitive bidding
stories.
Tyler J. Wilson is president and CEO of the American
Association for Homecare, headquartered in Arlington, Va. You can
reach him at tylerw@aahomecare.org. For more
information on critical home care issues, visit the association's
Web site at www.aahomecare.org.
