HME Providers Call on Congress

The first time Michael Hamilton traveled from Alabama to Washington, D.C., to lobby on behalf of the HME industry, gasoline cost 55 cents a gallon, the Watergate scandal was playing out with the resignation of President Richard Nixon and work just started on the 800-mile-long Alaska oil pipeline.

For the past 37 years, Hamilton has visited Washington at least once annually on behalf of the HME industry, and he is now executive director of the Alabama Durable Medical Equipment Association. He was one of 300 HME advocates attending AAHomecare’s annual Washington Legislative Conference Feb. 15 and 16 at the L’Enfant Plaza Hotel.

A cold drizzle descended on Hamilton and a small group of HME providers from Alabama as they piled into taxi cabs and headed to Capitol Hill on Thursday morning, Feb. 16.

Hamilton and the Alabama providers—Stewart Pace, Bruce Ovitt, Lisa Willis, Jonathan Temple and Terry Adams—had come to Washington expecting to lobby for inclusion of the Market Pricing Program (MPP) in “doc fix” legislation. But Congress fooled everybody by acting quickly on that measure, which advanced without any extraneous legislation.

So the HME industry’s attempt to modify competitive bidding was sidetracked into an effort to get MPP legislation scored by the congressional budget office—analyzed to ensure it would be no more expensive than the Competitive Bidding Program.

That was the first lesson in lobbying these days on Capitol Hill. A cloud of austerity has engulfed the government, and nothing can cost anything, particularly when it comes to a group of mostly mom-and-pop small businesses selling goods and services to burgeoning Medicare program. MPP must be budget neutral to have a prayer for passage.

The second lesson is that when a group of people exercise their right under the Constitution to petition the government by visiting a U.S. representative or senator, they will most likely end up speaking with a young staff member, not an elected official. That’s not all bad, since elected officials depend on their staff members to brief them on issues and recommend legislative actions. However, sometimes it’s difficult to get an unfamiliar staffer to understand the subtle differences between Medicare’s Competitive Bidding Program and the HME industry’s fix, MPP.

Explaining MPP

The first stop was the office of Sen. Richard Shelby, R-Ala., and a visit with his legislative aide, Andrew Newton, who handles health care issues.

“I’m about to tell you the sky is going to fall,’’ Hamilton told Newton. “This Competitive Bidding Program is a train wreck.”

Newton listened as Hamilton and Alabama providers explained that MPP was superior to the Competitive Bidding Program because it would make bids binding, decrease the size of bidding areas and save the same amount of money while preserving more of the HME industry.

In return, Newton explained why it was impossible to get anything attached to the doc fix legislation and the intricacies of getting a bill scored by the Congressional Budget Office. Normally, he explained, bills scored by the CBO are those headed for a vote.

Pushing the MPP through the legislative process is pretty complicated for a variety of reasons. Leaders in the HME industry have promised that it will be budget neutral and produce the same savings as the Competitive Bidding Program. They have designed a program that is intended to accomplish that, but they won’t know for certain until CBO scores a bill with the MPP in it. If the cost of MPP comes back too high, the industry must make quick corrections to ensure the savings match the Competitive Bidding Program.

Hamilton told Newton that the HME industry was willing to “do whatever we have to do” to make MPP work.

“We’re prepared to take off what we have to take off across the board, decreasing all rates everywhere,’’ he said. “That will spread the pain around more, but it will save the industry. We’re looking at the loss of 100,000 jobs.”

Hamilton produced a copy of a Wall Street Journal editorial published Feb. 6. The editorial sharply criticized the Competitive Bidding Program and referred to it as a “scheme” that provides cover for Medicare officials to set arbitrary, below-cost prices for HME products. “Medicare cooked up an auction process that defies all economic sense,’’ the editorial said.

That captured Newton’s attention, but he remained noncommittal, and ended the meeting after about 20 minutes.

Walking the Lobbying Walk

Undeterred, Hamilton and the Alabama providers walked around the corner to the office of Sen. Jeff Sessions, R-Ala. The group met with C. Paige Hallen, a budget analyst who quickly grasped the issues and directed the conversation to money matters. “How is it budget neutral?” she asked.

Hamilton assured her that MPP would cost the same as the Competitive Bidding Program, and if the CBO score didn’t show that, the industry would immediately make adjustments.

That made an impression, and Hallen appeared willing to help get the bill scored by the CBO. “We know the CBO pretty well,’’ she said. “Maybe we can push that along.”

Hallen noted that the CBO sometimes provides unofficial scoring for legislation, and that could help MPP by allowing it to be adjusted before receiving an official score. Hallen said she was willing to contact the office of Sen. Orrin Hatch, R-Utah, ranking Republican on the powerful Senate Finance Committee.

Additionally, she noted, Sessions is the ranking member of the powerful Senate Budget Committee.
Both those committees can influence whether CBO scores a piece of legislation.

Hallen also explained the timetable for possible passage of MPP. It would be highly unlikely that the CBO could score the legislation before early April since the office will be busy until then scoring President Obama’s budget proposal. And it appears that Congress will be wrapping up its work in June or July, and then leave town until after the election in November.

Realistically, that gives the HME industry 60 to 90 days to get the MPP legislation put into legislative form, scored and attached to another bill moving through Congress. MPP might be able to make its way through Congress under that scenario if there is strong bi-partisan support and the HME industry is unified, Hallen said.

The meeting ended on a positive note, and afterward, Hamilton said Sessions’ position on the Senate Budget Committee makes it likely that he can help move MPP along through the process. “I have high hopes for some real help from that visit, along with something similar from Rep. Martha Roby, R-Ala.”

He said the meeting at Shelby’s office was important, too, because it would keep the senator in the loop on MPP and leave the door open for addressing any concerns that Shelby might have about MPP when it comes up for a vote.

AAHomecare reported on March 3 that the lobbying had paid off, and the CBO had agreed to give high priority to scoring the MPP legislation. “The bottom line is we are making real progress,’’ Hamilton said after that news was announced.

Crafting a Bill for MPP

There’s already a bill written to repeal competitive bidding, H.R. 1041, and it has 166 co-sponsors in the House. Earlier in the AAHomecare conference, Rep. Glenn Thompson, R-Pa., said the HME industry should continue building on that measure, and try to get a congressional hearing on it. Eventually, a replacement bill could be developed for 1041 that includes MPP. “You only want to do that once,’’ Thompson said.

It’s difficult to say what bill the MPP legislation could be attached to, but there are possibilities. For example, he said, the U.S. Supreme Court is preparing to rule on the Affordable Care Act, or health care reform. If the court overturns key provisions of that law, Congress may be forced to pass legislation to replace voids left in the health care system. MPP might be able to hitch a ride.

Thompson said he follows four principles when considering health care legislation. It must:
• Decrease costs
• Increase access
• Provide incentive for quality and innovation
• Keep consumers in control and maintain choice

“Competitive bidding violates all four of my principles,’’ Thompson said. “Reach out and have an impact. You can make a real difference in public policy.”

HomeCare March 2012