H.R. 3790 Continues Gains

ATLANTA — Proponents continue to track the progress of
H.R. 3790, which would repeal DMEPOS competitive bidding.
Introduced Oct. 13 by Rep. Kendrick Meek, D-Fla., the bill had
picked up 75 cosponsors as of Friday.

Last week, representatives from the Accredited Medical Equipment
Providers of America, the American Association for Homecare, VGM
and state associations in Florida, Texas, California, Kentucky,
Georgia, Indiana and Missouri met with staff from 52 congressional
offices about bill.

“In general we were well received,” AMEPA officials reported in
a Friday afternoon update. While there were questions, the group
said, “we made clear that Congress mandated CMS attempt to fix the
program, but the fundamental elements of the program which make it
flawed — no accountability in bidding, no physical location
in an MSA required, no guaranteed times for service, the ability to
flip and walk away from Medicare contracts, the elimination of
patient service as a priority — all remained in the
system.

“We emphasized that fixing [the program] would take time that
first-round providers, especially, do not have.”

The new Round 1 bidding window closes Dec. 21; Saturday (Nov.
21) was the cutoff for bidders to gain a review of financial
documents from CMS. According to the agency’s current timeline, the
program will go live in January 2011.

On Nov. 16, the Pennsylvania Association of Medical Suppliers
held a press conference in support of the Meek proposal, noting it
already has “strong bipartisan support” from House members and
national disability groups. Cuts in the bill, together with a 9.5
percent cut on bid items that took effect this year, would
represent a 19.5 percent savings to Medicare.

PAMS Executive Director John Shirvinsky told reporters there
were 4,127 DME providers in the first nine bidding areas in 2008.
But only 376 — a 90 percent reduction — won contracts
in the original Round 1. “Eliminating such an overwhelming
percentage of providers from the program will impact patient choice
and access to cost-effective medical care and threaten the economic
survival of the companies involved,” Shirvinsky said.

He also noted that in the Pittsburgh bidding area, 40 percent of
the winners were from out of state.

“There are many examples where competitive bidding makes sense,
but durable medical equipment is not one of them,” added Rep. Jason
Altmire, D-Pa., who spoke in support of H.R. 3790. He pointed out
that CMS also should consider the quality of care provided, the
personal relationship between providers and patients and the
bidding program’s impact on jobs.

“When national providers come in and they’re able to undercut
local providers, that’s clearly not good for the local provider,
but more importantly, it’s not good for the patient,” Altmire said.
“The patient has to have that personal relationship with the
provider for follow-up care over the course of a lifetime.”

“Competitive bidding, as CMS has framed it, is anything but
competitive,” said Rep. Glenn Thompson, R-Pa., who joined Altmire
on the call. “Looking at savings solely on a balance sheet is not a
smart government solution. If the number of smaller home providers
of durable medical equipment declines, I’m concerned that more home
care patients will need to be hospitalized, particularly in rural
areas because of their distance from one of the massive contract
holders.

“CMS should be working to keep homebound Medicare recipients in
their homes — the quality of life is better for the patient
and will involve an overall cost savings to Medicare.”

Thompson, who worked for 18 years in rehab services, said HME
companies “were lifesavers to the thousands of patients that I
interacted with.” He is concerned, he said, “that if the number of
providers, especially small providers, declines, we’ll wind up with
a monopoly and we’ll see costs grow tremendously, because when you
create a monopoly, that’s what happens.”

Reporters also got an earful from Lucy Spruill, director of
public policy and community relations for United Cerebral Palsy of
Pittsburgh, who said she, too, is concerned with both access to
providers and their expertise under the bidding program.

According to Spruill, a power wheelchair user herself, last
year’s implementation of the bid (delayed by Congress July 15 after
a two-week run), “would have shunted all of the work currently
being done by eight or 10 small- to medium-sized companies in
[Pittsburgh] to two companies, and the business already exceeds the
capability of all those companies. There are often very long waits
between ordering a wheelchair and getting it delivered and for
getting repairs. If the number of providers is drastically reduced,
that’s just going to make a bad situation just completely
intolerable.”

She pointed out that under the bid program, dealing with several
different companies that win bids for different items or
out-of-town companies to get basic medical needs met could also be
difficult for patients. “Let me tell you that is so difficult for
an older person or a person with disabilities who is living alone
with a complex medical condition,” Spruill said.

She also voiced concern that “if we again end up with inexpert
bidders, that we’re going to consistently get equipment that’s not
right for us. We know when that happens, one of the results is
secondary conditions like bed sores, pneumonia and other
infections, depression from staying in the house and placement in
institutions, which is very expensive.”

View more competitive bidding
stories.

To contact your representative in support of H.R. 3790 to repeal
competitive bidding, call the U.S. Capitol switchboard at
202/224-3121. The operator will connect you directly to your
congressman’s office using your ZIP code.

Read
background and talking points for H.R. 3790.

View the
full text of H.R. 3790.