Gorilla at the Gate: NCB Dominates Discussion at Legislative Update

ATLANTA — AAHomecare officials at Medtrade
acknowledged that’s it’s not easy to bring down an 800-pound
gorilla. The beast in question is national competitive bidding,
and without a legislative Hail Mary, the program will go into
effect on Jan. 1, 2011, in nine cities across the United
States.

According to Walt Gorski, vice president of government affairs
for AAHomecare, unprecedented budgetary pressures and a competitive
bidding Congressional Budget Office (CBO) score of $20 billion
combine to make a miracle unlikely. “Unless we can find $20
billion, legislatively it is going to be very difficult or
virtually impossible to stop competitive bidding,” said Gorski to a
packed house at the association’s Legislative Update session Nov.
17 during Medtrade. “We are going to fight these next 45 days, and
if we can’t stop it, we are going to fight next year.”

Elimination of the first-month purchase option for power
wheelchairs also looms, and Gorski warned that if the provision
goes forward next year, it would result in a 40 percent cash flow
shortage the day it kicks in. AAHomecare is advocating for a
one-year delay to give cash-stricken mobility providers a
reprieve.

The problem for providers, said Tyler Wilson, president of
AAHomecare, is that sweeping election changes, health care reform
and a soon-to-be released deficit commission report combine to
lower the chances for compromise.

“You have must-pass pieces of legislation poised in front of the
House and Senate,” said Wilson. “What are they going to do with tax
cuts? What are they going to do with the doc fix? And what are they
going to do with a continuing resolution to fund the
government?”

Factor in the Thanksgiving break with lawmakers still sorting
out crucial leadership positions, and the chance for substantive
work, let alone compromise, remains unlikely.

“We have a time of ultimate gridlock where compromise is
capitulation,” said Gorski.

Also on the horizon, AAHomecare is anticipating that a GAO
report next year will likely advocate cutting oxygen payments that
are still deemed too high. All of it, said Gorski, serves as a call
for membership gains in AAHomecare. “Currently there are 500
members with 3,000 locations across the country,” he said. “There
are about 15,000 true HME companies across the country. Imagine if
we had 1,000 or 2,000 [members]. Think about what we could do.”

Washington insider Stan Collender, partner in Qorvis
Communications, confirmed the no-compromise sentiment in a
45-minute talk that sought to prepare providers for what could be a
tough road ahead. “Nothing anybody here has ever seen in American
politics has prepared you for what is about to happen over the next
two years,” said Collender. “Governing is no longer the goal in
Washington. The goal these days is you get elected to get
re-elected.”

Despite the seeming disconnect in Washington, Collender said
that all bets are off, and hope should not be lost. “Your efforts
are not a waste of time,” said Collender. “Nothing is really ever
final. Anything that happens can be changed. The fact that it
[competitive bidding] is happening does not mean that it can’t
unhappen. However, it will not unhappen if you think the fight is
over and you stop.”

“If you do nothing, then you are defenseless, and Congress and
regulators can do what they want,” added Gorski. “If you don’t
raise the volume on an issue, consider yourself dead before you get
out of the starting blocks.”

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