A Blueprint for Success

With the March 30, 2012, bid submission deadline behind us, and the Centers for Medicare & Medicaid Services’ (CMS) announcement of the rebid schedule for the initial nine Round 1 bid areas, it may be difficult to imagine that there is the possibility that we can collectively change the course of the current Medicare durable medical equipment (DME) bidding program. I am here to tell you that we can change the course.

Get actively involved in making sure that Congress adopts the HME community’s proposed Market Pricing Program. The current law requires CMS to continue with Round 1, continue implementation of the 91 metropolitan areas in Round 2, rebid Round 1 and then, by 2016, apply bid rates nationwide or conduct bidding nationwide. But as we have all witnessed through the years, Congress often steps in and changes the law. We need to make sure that happens this year.

The industry—in conjunction with allied stakeholder groups such as many national consumer and clinical groups—is vigorously lobbying Congress to adopt the proposed Market Pricing Program as a significant improvement over the current bidding program. To achieve our goal this year, however, we must all get actively involved. The following is an update on where we are, our next steps and what you can do to help ensure our collective success in having Congress pass into law the Market Pricing Program.

The industry has developed detailed legislative language that would require CMS to use outside experts to develop and implement the Market Pricing Program. The proposal requires CMS to contract with independent outside experts who have demonstrated real-world experience in developing, implementing and monitoring a sustainable bidding/auction program. This language has been submitted to the Congressional Budget Office to determine whether the proposed plan would be budget neutral in comparison to current law. Current Congressional and political dynamics require that our plan be at least budget neutral, or Congress will not act on it. Once we have a score, we will work with our Congressional allies to determine whether it makes sense for them to introduce bills in the House and/or Senate.

In the next few months, the House Ways and Means Committee and the House Energy and Commerce Committee’s Health Subcommittee will likely hold hearings on the Medicare DME bidding program. Congress will call CMS and other government witnesses. This hearing will also provide the industry, economists, consumers and others an opportunity to tell our side of the story. 

Probably the most important component of our messaging throughout the next several months will be relaying to members of Congress real-life stories of the impact on consumers from the first nine bid areas. The VGM Group’s People for Quality Care has produced some compelling videos that help tell the story, but we need more. Contact them if you know of a good story. Most consumers in need of HME don’t have the resources or wherewithal to contact their congressional representatives. Their focus is on getting the products and services they need, not on calling members of Congress. We need to facilitate those communications so that consumers can be heard.

Bear in mind that CMS is highly politically motivated to continue rolling out the current Medicare DME bidding program, as it is required to do so under current law. As we have recently witnessed, CMS has a powerful public relations machine. CMS churns out press releases touting the great success of Round 1 of competitive bidding. If members of Congress don’t hear from you, then they only have the information that CMS has provided.

I cannot overemphasize how important it is for every HME provider to reach out to his or her congressional representatives and tell them about the impact of the Medicare DME bidding program on the member’s district. You need to tell them what this bid program means for your company, your employees, your consumers and others. There are talking points available online at www.invacare.com, www.aahomecare.org, www.vgm.com and www.medgroup.com, as well as through your state and regional associations.

Our opportunity for real legislative movement comes at the end of the year. Congress is disinclined to act on legislation unless it’s a “must do” bill in an election year. For example, Congress will have to act on the “doc fix” (physician payment formula issued to avoid a Medicare physician payment cut of almost 30 percent in January 2013).

But to have a decent shot at getting in the end-of-year package, we need each and every one of you to do your part, so be sure and get started today!