DeParle in Top Health Reform Post; More Public Forums Set

WASHINGTON — For home medical equipment industry
long-timers, it was, as the venerable Yogi Berra said, déjà vu all
over again when President Obama tapped Nancy-Ann Min DeParle,
former HCFA admnistrator, to lead the White House Office of Health
Reform.

Obama also nominated
Gov. Kathleen Sebelius, D-Kan., as Health and Human Services
secretary. If Sebelius is confirmed, together the two women will
oversee the crafting and implementation of the nation’s health
reform effort.

The announcement came a month after former Sen. Tom
Daschle, D-S.D., withdrew his nomination to head HHS following
an admission he had failed to pay $128,000 in back taxes. Daschle
also stepped away from the newly created White House office, which
would have given him a dual role in directing the push for
reform.

The president’s health team got another setback when CNN’s Dr.
Sanjay Gupta, a neurosurgeon, recently withdrew as Obama’s nominee
for surgeon general.

In announcing his new health care duo last week, Obama said
health reform will require a commitment that focuses “on ideas that
work to rein in costs, expand access and improve the quality of
health care for the American people.”

The
announcement labeled DeParle “one of the nation’s leading
experts on health care and regulatory issues.” In her new role,
DeParle will act as a counselor to the president and is expected to
coordinate White House reform efforts with Congress.

DeParle was the administrator of the Health Care Financing
Administration, precursor to the current Centers for Medicare and
Medicaid Services, when the first competitive bidding demonstration
projects were implemented in October 1999. A year later to the day,
she resigned her position, which she had held since 1997.

She had previously been associate director for health and
personnel in the White House Office of Management and Budget and
was commissioner of the Department of Human Services in Tennessee.
In addition, she served on the Medicare Payment Advisory Commission
(MedPAC), which advises Congress on Medicare reimbursement
issues.

During DeParle’s term at HCFA, the agency established new codes
for oxygen concentrators, added supplier standards and began an
effort to deal with Medicare fraud and abuse in its original
proposal for a provider surety bond and additional site visits.

DeParle supported the DMEPOS competitive bidding initiative,
saying the first demonstration in Polk County, Fla., achieved
Medicare savings without compromising patient access to quality
care. “Competition helps Medicare beneficiaries receive quality
medical supplies at fair market prices,” she said at the time. “Old
laws have forced Medicare to spend more for equipment than market
prices or common sense should allow.”

In announcing the winners of the Polk County project, which
resulted in reimbursement reductions of 13 to 31 percent in five
product categories, DeParle said the results “show that competition
can work for Medicare beneficiaries.”

DeParle’s background as a proponent of competitive bidding could
be a concern to the home medical equipment sector, said Don
Clayback, vice president of government relations for The MED Group in
Lubbock, Texas. But, he added, “we have to see what her current
view is on that once she gets into office and assimilates what’s
been going on the last few years relative to competitive bidding.
Certainly things have changed, and there are new facts.”

Since DeParle was at HCFA, CMS has carved signficant savings out
of the HME industry, he noted.

Seth Johnson, vice president of government affairs for
Pride
Mobility, Exeter, Pa., agreed. “I’m not that concerned with
Nancy-Ann DeParle having this elevated role as counselor to the
president for health policy because there have been so many changes
to the health care spectrum, especially when you look at the DME
industry within that, since she was administrator of HCFA,” Johnson
said.

“One of the challenges we’ve always had with competitive bidding
is that it sounds like motherhood and apple pie,” he continued,
“but I think once we have an opportunity to go in there and bring
[DeParle] up to speed on all these changes — which I’m
confident she may be largely aware of — I think we will be
able to make a very compelling case to her that will hopefully lead
to some type of change as far as the future of competitive
bidding.”

But Joan Cross, co-owner with her husband Alan of C&C
Homecare in Bradenton, Fla., said she remembered DeParle during
the implementaton of the competitive bidding demonstration project
in Polk County and had hoped to see a non-bureaucrat in the new
White House position. “I would have loved to have seen them give it
to somebody with a nursing background [or] a physician … I would
like to have seen somebody [who was not a bureaucrat]. At least
Sebelius has some experience in the field.”

Sebelius, who has served as Kansas governor since 2003, has
championed universal health care in the state during her tenure but
has not been able to achieve it. She also served as the state’s
Insurance Commissioner from 1994 to 2002, successfully blocking the
Anthem-Blue Cross of Kansas merger on the theory — correct,
it turned out — that premiums would rise under Anthem.

Her nomination was greeted with some optimism by many in the HME
sector. Clayback said it was promising that Sebelius “has a pretty
good relationship with Sen. Pat Roberts [R-Kan.], and he is attuned
to some of the issues relative to the HME industry. I assume they
have a working relationship, and that is a good thing going
forward.”

AAHomecare reported in its Wednesday newsletter that
many HME stakeholders in Kansas support Sebelius’ nomination. “They
personally think she will be great because she really understands
the issues that we have in the Midwest — especially the rural
communities,” Rose Schafhauser, executive director of the Midwest Association of
Medical Equipment Services, told AAHomecare.

However, Sandra London-Leib, CEO of Advanced
Homecare in Lawrence, Kan., was more cautious. “Do not look for
any sweeping changes from her,” she said. “She will definitely be
in agreement with the president. After hearing the president
… talk about the bidding process for all government contracts
and payments, it is very clear that competitive bidding will be the
standard course of action for her department.”

On Thursday, the White House held a health care summit that
brought together members of Congress and stakeholders from the
health care and insurance industries — including DeParle
— to discuss the reform effort. Participants ticked off
various health care difficulties that require reformative action:
the vagaries of health care costs around the country,
out-of-control maplpractice costs, inflated health insurance costs,
bloated prices for prescription drugs, a shortage of medical
professionals, divergent standards of care.

While those at the summit might not have agreed on how to fix
the health care woes, they did agree on one thing: Health care
reform must be achieved.

On Friday, President Obama announced that a series of public
health care reform forums would be held in California, Iowa,
Michigan, North Carolina and Vermont as a follow-up to the White
House summit. The forums will provide “an opportunity for Americans
from all over the country to voice their concerns and ideas about
reforming our health care system,” according to a White House press
release.

“The time for reform is now and these regional forums are some
of the key first steps toward breaking the stalemate we have been
stuck in for far too long,” Obama said in the release. “The forums
will bring together diverse groups of people all over the country
who have a stake in reforming our health care system and ask them
to put forward their best ideas about how we can bring down costs
and expand coverage for American families.”

The president has said he wants to achieve health care reform by
the end of this year.