Stay Tuned

In its final regulation on the Medicare physician fee schedule for 2005, issued Nov. 3, the Centers for Medicare and Medicaid Services (CMS) announced that it will implement its “face-to-face examination” requirement at a later date.

Last year’s Medicare Modernization Act (MMA) required the Secretary to establish types or classes of covered items, including power wheelchairs, that require a face-to-face examination of the individual by a physician or specified practitioner. But CMS stated that “due to the timeframe and the extensive number of public comments received, we will implement this provision at a later date. We will address all public comments in a future Federal Register Notice.”

A number of clinical groups, including physicians and therapists, submitted comments strenuously opposing CMS’ proposed implementation of this provision. CMS may issue its regulation implementing this provision in a rule that would eliminate the requirement that only certain physician specialists can prescribe power-operated vehicles.

Stay tuned.

Legislative Strategy for 2005

While CMS is moving forward under its statutory mandate to implement competitive bidding for certain geographic areas beginning in 2007, our industry must move quickly to implement a collective and unified legislative strategy to eliminate the competitive bidding statutory mandate. MMA requires CMS to implement competitive bidding in 10 of the largest metropolitan statistical areas (MSAs) in 2007, and 80 additional large MSAs in 2009.

Our legislative strategy for 2005 to repeal competitive bidding must focus on building a determined groundswell of support to repeal the competitive bidding law. We can only enlist members of Congress to support us on this endeavor by having solid arguments, backed up by sound data.

We were successful this year in garnering significant support for H.R. 4491, the bill to repeal the payment reductions based upon the Federal Employee Health Benefit Plans (FEHBP) pricing. We enlisted the support of approximately 110 members of Congress, and we did so by having sound arguments backed up by data.

We need to use the lessons of H.R. 4491 in getting Congress to support our efforts to repeal the competitive bidding mandate.

That leads us to the hard part: sound arguments backed up by data — arguments that dispel the notion that competitive bidding is a better way to set Medicare pricing, with no negative access or quality impacts.

Our first argument must question the assumption that competitive bidding will yield sufficient savings to justify the increased administrative costs. With the payment reductions from the January 2005 FEHBP-based cuts, much of the potential savings will already be realized. Related to the savings argument is the administrative cost argument. At some point, the costs of administering competitive bidding will not yield savings that can justify the administrative costs.

Our most important argument — that competitive bidding can limit access to quality services — is one we must bolster with data.

There is some data in the final CMS Report to Congress on CMS’ two previous competitive bidding demonstration projects, namely that portable oxygen utilization decreased by 50 percent in Polk County, Fla., compared to before the demonstration, and that beneficiaries in San Antonio had problems accessing certain accessories for their manual wheelchairs in that demonstration. But we must dig deeper to find better and compelling facts to prove this assertion.

What do we need to repeal the competitive bidding statutory mandate? Two things: sound arguments backed up by sound data, and committed members of Congress to carry the message.

We must begin now to engage our representatives and senators on this issue, begin the education process and lay a foundation to repeal this ill-founded policy.

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 by phone at 440/329-6226 or by e-mail at [email protected].