Message to Congress:

Last year’s success in getting Congress to delay the “competitive” bid program was undoubtedly due to the incredible grassroots effort that our industry pulled off. This year we must do the same, or more.

One of the biggest challenges is to communicate effectively with members of Congress and their staff about the ill effects of the program. Specifically, we must convey in lay person’s terms why CMS’ implementation of the program will be harmful to seniors and local providers. Here are a request and talking points to use.

• Overview and Request to Congress “Competitive” bidding will hurt seniors, patients and thousands of HME businesses nationwide, many of which are small businesses. The program selectively contracts with a limited number of HME providers based on the lowest bid prices, drastically reducing patient access to, and choice of, quality care. If CMS does not make changes that will ensure access and minimize business closures, Congress must intervene and require those changes. If the changes cannot be made, Congress must reconsider the bid program and repeal it in its entirety.
• The bidding program is bad for patients.
  • It forces out providers who utilize high-quality medical equipment, and forces patients to switch from providers they trust.
  • It ignores providers’ ability to serve a geographic market, resulting in fewer home visits to patients in rural areas.
  • A total of 2.6 million eligible beneficiaries will be impacted in the first nine markets.
  • The drastic reduction of eligible suppliers will result in an average increase of 339 percent in the ratio of beneficiaries per supplier, overwhelming the patient referral system and resulting in increased hospital stays since winning suppliers may be unable to handle the increased volume.

• Bad for patient access (anti-competitive).
  • “Competitive” bidding is actually anti-competitive. It is a selective contracting program that will lead to massive consolidation in the home medical sector.
  • Ninety percent of qualified HME and service providers were shut out of Medicare during the 2008 initial bid program, including 4,200 small businesses.
  • When fully implemented, the bid program will reduce up to 80 percent of the local businesses across the country — approximately 12,000 firms.

• Bidding is not a cost-effective solution.
  • Competitive bidding will increase Medicare costs because it will lead to more expensive, longer hospital stays.
  • Competitive bidding will increase Medicare costs in the long term because the program eliminates competition, creating oligopolies in the local market.
  • Home medical equipment and services is already a cost-effective alternative to expensive institutional care and a solution for controlling spending growth in Medicare.

• The HME community urges Congress to:
  • Review and address the patient care access and quality as well as small business concerns about the bidding program.
  • Seriously consider legislation to eliminate the competitive bidding program since it fundamentally misrepresents the critical services that are essential for delivering quality equipment and care to Medicare beneficiaries in their homes.
  • Require CMS to make substantive changes that align the bid program with other Obama administration bid program policy proposals, such as the proposal to competitively bid Medicare Advantage plans. To accomplish this, CMS must rescind the Jan. 16, 2009, Interim Final Rule; make substantive changes to provisions of the original (May 2007) CMS competitive bidding rule that address the fundamental flaws apparent in the 2008 bid program. The two key regulatory provisions are (1) the supplier selection process and (2) the pivotal bid calculation methodology.
  • Congress’ intent in delaying the bid program by 18 to 24 months was not simply delay for delay’s sake but instead to improve the program to ensure that beneficiaries and small businesses are not unfairly disadvantaged.

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 at 440/329-6226 or [email protected].