As Congress lurches forward with its health care reform
packages, some representatives have a whole new competitive bidding
idea: Let home medical equipment manufacturers competitively bid
under the Medicare program.
Buried in the House-passed health reform package is a provision
that would have the General Accountability Office conduct a study
on the concept. The basic framework would be to replace competitive
bidding for HME providers with a competitive bidding program for
manufacturers of HME products.
We know that the current bidding program will hurt seniors,
patients and thousands of HME businesses nationwide. The program's
purpose is to contract selectively with a limited number of home
care providers based on the lowest bid prices — drastically
reducing patient access to, and choice of, quality care.
Replacing it with another program that would prove equally
unworkable doesn't make a lot of sense. We need to figure out a
workable solution.
Before the House of Representatives left Washington for the
holiday recess, the Meek bill (H.R. 3790), which would repeal the
current bid program, had an impressive list of cosponsors. The bill
will stay alive as this is the second year of Congress' current
two-year term. That means we must continue with our diligence and
gather more supporters for this bill.
Remember, with Medicare's ability to use bid prices in non-bid
areas, the current “competitive” bid program will
impact every HME provider and every Medicare beneficiary with HME
needs. None of us can afford to sit on the sidelines and watch. If
we all take an active role with our own member of Congress, we can
move this bill through the House of Representatives.
A cautionary note, however. Two hurdles must be overcome to be
successful in getting Congress to repeal the competitive bid
program. First, we will have to somehow “pay” for
repeal of the bid program. Congress has “pay-go” rules
that essentially require any legislation that will cost the federal
government money to pay for it. While at press time there had not
been an official score on the bill by the Congressional Budget
Office, H.R. 3790 largely pays for repeal of the program through
elimination of the annual price increases and modest reductions
(e.g., less than a percent a year) to the fee schedule over a few
years. The second hurdle is that Congress must be convinced that
the price Medicare pays for HME is reasonably related to a
“market” price.
There are numerous dangerous aspects of the concept of DME
manufacturer competitive bidding, not the least of which is how
Medicare would compensate HME providers for all the services
beneficiaries rely upon. As far as we know, there is no model for
“unbundling” payment for equipment acquisition cost and
the varied services that HME providers furnish to beneficiaries.
This would be a dramatic change for the HME industry, particularly
given that Medicare has done a poor job of defining the specific
services it expects beneficiaries to receive in conjunction with
their HME items. Clearly, this is a critical issue and one for
which the American Association for Homecare can provide detailed
input.
In addition, if the Medicare program were to limit the
beneficiary's choice of product, how will patients have access to
new technology that might be available but that might not be
included in the Medicare's contract(s) with the contractor
manufacturer(s)? How would Medicare ensure that contracted
manufacturers' products would meet the full array of all
beneficiaries needs? How would Medicare ensure that beneficiaries
will have access to quality products and that price will not be the
sole determinant? What criteria would be required of
contractors?
Looking at VA contracts, there are multiple complex and
sophisticated requirements.
While it is good news that we are gaining support in Congress to
get rid of the current bid program, we must ensure that Congress
does not replace it with something that would prove equally
disastrous.
Read more Washington Wit & Wisdom
columns.
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 at 440/329-6226 or cbachenheimer@invacare.com.
