Delay of NCB Comes Down to Home Stretch

WASHINGTON–Congress is racing against the clock to craft
legislation that would stop a cut in Medicare physician
reimbursement, which, like national competitive bidding, is set to
take effect July 1. According to HME insiders, the industry’s
best chance to derail NCB lies in attaching delay language to that
legislation–commonly known as the “doc fix”–and its
fate is changing by the day as only Washington politics can.

On June 12, Reps. Fortney “Pete” Stark, D-Calif.,
and Dave Camp, R-Mich., introduced H.R. 6252, which called for an
18-month delay of round one, with the bill on a fast track for a
vote. Mirroring the House bill, a Senate companion, S. 3144, was
introduced Tuesday by Sens. Max Baucus, D-Mont., and Charles
Grassley, R-Iowa.

But the industry barely had time to celebrate that monumental
leap forward when, later in the week, Congress decided to add the
delay language into a larger Medicare package currently working its
way through both chambers.

According to John Gallagher, vice president of government
relations for Waterloo, Iowa-based VGM, the industry was hoping the
House and Senate doc fix bills would be identical.

“If they have two identical bills, it would not go into
conference, but would go directly to the president for
signing,” he said in a VGM “Lunch Bucket” update last
week.

But so far, that hasn’t happened.

The House Medicare legislation, under development by the Ways
and Means Committee, was to be introduced on Friday, said Cara
Bachenheimer, senior vice president of government relations for
Elyria, Ohio-based Invacare. The legislation folds in language from
H.R. 6252, which also includes a 9.5 percent reimbursement cut for
the 10 product categories included in competitive bidding to
“pay for” its delay. However, the House bill does not
mandate further cuts to oxygen or power wheelchair reimbursement,
Bachenheimer said.

The House package could go to a vote as early as Tuesday,
according to the American Association for Homecare.

A different bill is being put together in the Senate,
Bachenheimer said Friday. “We don’t have all the details.
Those details will be worked out over the weekend.”

The Senate version, being developed by Finance Committee Chair
Baucus and Ranking Member Grassley, differs from the House
legislation. The delay to competitive bidding will be included. But
a late Friday update from AAHomecare said, “as it stands now,
this Baucus-Grassley package will also cut more deeply into oxygen
therapy payments than the 9.5 percent cut to offset the DME
competitive bidding delay. The Baucus-Grassley proposal will also
include a provision that would eliminate the first-month purchase
option for power wheelchairs.”

“We are working to ensure that there is not a double-cut
to oxygen and power wheelchairs,” Bachenheimer said.
“Our goal is to not have [those cuts].” The Senate
package could also be voted on as early as Tuesday, she added.

News of the two packages followed a week of mercurial changes
that happened so fast even those involved in the issues were having
trouble keeping up.

Baucus announced he was attempting to meet with House lawmakers
about pushing through the Medicare bill by the end of the month,
but the Senate got bogged down in how to pay for the doc fix. That
prompted House Ways and Means Committee Chair Charles Rangel,
D-N.Y., to announce that the House would draft its own version of
the bill.

“There are a lot of political shenanigans going on,”
said Bachenheimer. “There’s a lot of fluidity …
But it’s movement. Clearly, there is an impetus to move and
be done by the July 4 recess.”

Meanwhile, the crusade to delay competitive bidding continues.
Last week, the National Community Pharmacists Association endorsed
both the House and Senate bills calling for a delay, and the number
of legislators from both sides of the aisle supporting such an
action is growing. But industry organizations warned there are
still not enough supporters and urged providers to keep up the
pressure on their legislators.

“We need Democrats and Republicans in order to get the
overwhelming support this bill requires to succeed,”
AAHomecare said about the House package.

Regarding the Senate package, the association implored members
to “call your senators and tell them … The home care
community strongly opposes ANY additional cuts to durable medical
equipment such as further cuts to oxygen and power
wheelchairs.”

Gallagher, however, said home care has never been in a better
position to affect change. “We’ve never had the
chairman of the Ways and Means Committee and the ranking member
standing up for [us],” he said. “If we let this pass
now, we will never again have those people standing up for us.

“We are the buzz on the Hill,” he noted.
“We’ve never been the buzz. We’ve always been the
hit. [Legislators] understand that [competitive bidding] is a train
wreck, it’s a mess. CMS has messed this up so badly it does
need to be delayed.”

But to make it happen, all providers–even those not in the
competitive bidding areas in the first two rounds–have to contact
their legislators and strongly urge them to support a competitive
bidding delay, Gallagher said.

“If we don’t come together as an industry and defeat
round one, the government has already said it would use the law of
inherent reasonableness and use the crazy bids in round one [to
establish payment rates for all Medicare providers],” he
said. “If you don’t support this, in eight to 10
months, you will be looking at a 26 percent cut,” the average round
one reimbursement reduction.

“We’re that close,” Gallagher added.
“We’re that horse coming into the final stretch and
we’ve got to make sure this goes through.”