CMS’ Kuhn: ‘We’re Thinking about Round Two Already’

WASHINGTON–Home medical equipment providers from around the
country got a reality check last week from CMS Acting Deputy
Administrator Herb Kuhn.

Speaking at the American Association for Homecare’s Legislative
Conference, Kuhn told the group that CMS is moving toward full
implementation of competitive bidding and will enforce its final
rule on the program–mandated by the Medicare Modernization Act of
2003–as it stands.

“We’re thinking about round two already,” Kuhn said, adding that
“what we learn in doing this first round will be absolutely
essential for us as we make refinements for round two.” He
emphasized that providers in the initial 10-MSA roll-out must act
now to get their bids in and to get accredited.

Because CMS is working on a “fundamental transformation” from
being a passive payer of claims to an active purchaser of health
care, Kuhn said, the agency is looking for value in the dollars it
spends. That means focusing on prevention, pay for reporting, pay
for performance, transparency, cost-effectiveness–“and yes, it
also means competitive bidding.”

While one provider said he thought Kuhn had done an “eloquent
job of sugarcoating” competitive bidding, the message was not
exactly what most attendees at the association’s annual lobbying
conference said they wanted to hear. An estimated 225 providers and
industry advocates traveled to the nation’s capital to push
Congress for support of H.R.1845 and S.1428, companion bills that
would ease some effects of the national bidding program.

Under the final rule, only providers that win contracts will be
able to provide DMEPOS bid items to Medicare beneficiaries. The
proposed legislation would allow qualified providers that had
submitted bids to continue serving Medicare patients at the
single-payment rates that are set.

In a question-and-answer period after Kuhn’s June 6 speech, a
provider asked whether Kuhn favored the legislative efforts,
telling the CMS official he thought competitive bidding would
“bring this industry to its knees and as a result put in jeopardy
the patients we serve.”

Kuhn responded that the agency has not taken an official
position on the legislation. “What we’re committed to right now is
implementing the MMA and the competitive bidding program as part of
the law,” he said.

To another question on CMS’ view of shortening the current
oxygen rental cap from 36 to 13 months, Kuhn answered, “Nothing’s
changed on that … that’s still the administration’s position on
oxygen right now. We’re part of the administration.”

And asked why power mobility was included in the first round of
bidding–on the heels of massive coding, coverage and payment
changes in the sector–Kuhn said CMS’ charge was to “really look at
where the areas are we could have the greatest impact.” After
reviewing the volume of power mobility claims, he said, “we thought
that it was absolutely appropriate for [power mobility] to be
included in competitive bidding.”

But many conference attendees complained that the bidding
program is being rushed to implementation following a rule more
than three years in the making. After release of its final rule
April 2, CMS opened the first-round bid window on May 15 and has
scheduled its close July 13. (See HomeCare Monday, May 21.)

If the current time frame for the program is maintained,
providers pointed out, data from the first round of bidding won’t
be analyzed before the second round begins.

Several attendees said they hadn’t really expected to hear
anything different from Kuhn. “There are lots of questions about
competitive bidding, and not enough answers and not enough time,”
said one angry provider, who asked not to be identified. “I give
Mr. Kuhn credit for showing up–that took some courage–but he’s
lucky he got out of that room alive.”

Also at the conference:

–Douglas Holtz-Eakin, Ph.D., former director of the
Congressional Budget Office and economic policy director for the
McCain 2008 presidential campaign, labeled competitive bidding as a
“recipe for disaster.” The economist said competitive bidding will
keep new companies from getting into the market, thereby lessening
competition.

An AAHomecare issues summary echoed that interpretation. “We
believe in fair competition. But the Medicare competitive bidding
program eliminates competition and it will reduce patient access to
home care, the most cost-effective setting for health care in
America.”

–Several lawmakers gave attendees strong rallying calls before
their lobbying visits to the Hill. “It’s important to show that
home care saves money,” said Rep. Mike Ross, D.-Ark., the only HME
owner in Congress. He added that providers should contact their
representatives and invite them to visit. “You’ve got to get that
message out,” Ross urged his audience.

Rep. John Tanner, D-Tenn., who introduced H.R.1845, said 45
representatives have signed on as cosponsors of the competitive
bidding bill. He added it will take from 75 to 100 to gain
attention in Congress.

Sen. Arlen Specter, R-Pa., described a full plate for Congress
with immigration, the war in Iraq, no child left behind and
homeland security. But, he said, “you’re on the right track being
here in Washington. It’s a crowded floor time, but maybe we can
attach [your legislation] as an amendment or rider … You’ve got
to keep it up.”

Specter said he would write HHS Secretary Mike Leavitt asking
CMS to exclude complex rehab from competitive bidding, and offered
to set up a meeting for an AAH committee with President Bush’s
nominee to head CMS, Harold Weems.

–Association delegates completed visits to more than half of
all U.S. House and Senate offices to push for the competitive
bidding bills and the Home Oxygen Patient Protection Act, which
would repeal the Deficit Reduction Act’s 36-month oxygen cap and
return equipment ownership to providers. Before the lobbying push,
H.R. 621, the House bill, had picked up 83 cosponsors. An identical
Senate bill, S. 1484, was introduced shortly before the conference
(see HomeCare Monday, June 4).

–The 25-member delegation from North Carolina met with all of
that state’s legislators. With a number of its members in the
Charlotte CBA, the North Carolina Association of Medical Equipment
Suppliers subsidized the Washington visits. Said NCAMES Director
Beth Bowen, “Our board felt it was important for us to be
here.”

“This excellent showing is the result of hard work and
leadership by many in the home care community. Our goal is to have
home care advocates from all states and every congressional
district come to Washington, and we will continue to shoot for that
goal,” said Tyler J. Wilson, AAHomecare president.

–AAHomecare elected a new slate of officers, including: Alan
Landauer, CEO of Landauer Metropolitan, Harrison, N.Y., chairman;
Joel Mills, president and CEO of Advanced Home Care, High Point,
N.C., vice chair; Wayne Knewasser, vice president of Premier Home
Care, Louisville, Ky., secretary; and Georgie Blackburn, compliance
director for Blackburn’s Physicians Pharmacy, Tarentum, Pa.,
treasurer.