Efforts to Stop Competitive Bidding ‘Train Wreck’ Continue

ATLANTA–In an effort to halt the runaway train that is
competitive bidding, legislators in increasing numbers are
appealing to key congressional committee members, the Department of
Health and Human Services and the Centers for Medicare and Medicaid
Services to put the brakes on before proceeding to round two of the
project.

On Thursday, eight Republican senators led by Sen. George
Voinovich, R-Ohio, fired off a letter to HHS Secretary Michael
Leavitt seeking a meeting to address what they termed
“widespread issues” pertaining to DMEPOS competitive
bidding.

“We hope to have a conversation with you about our
outstanding concerns and a discussion about potentially delaying
the program until all of the issues can be addressed,” read
the letter, which was signed by Voinovich and fellow Sens. Wayne
Allard, R-Colo.; Richard Burr, R-N.C.; Saxby Chambliss, R-Ga.; John
Cornyn, R-Texas; Lindsey Graham, R-S.C.; Johnny Isakson, R-Ga.; and
Arlen Specter, R-Pa.

The letter cited issues including bidders who appear to have
been unfairly excluded from round one, program transparency and
data anomalies.

Meanwhile, on Friday, eight freshman Democrats sent a letter to
key House committee chairmen calling the bid program
“seriously flawed” and urging a six-month delay in
implementation.

Addressed to, among others, Reps. Charles Rangel, D-N.Y.,
chairman of the Ways and Means Committee, and Fortney
“Pete” Stark, D-Calif., chairman of the Subcommittee on
Health, the letter records an inventory of problems: the
overlooking of small providers, a flawed certification/application
process, unfair bidder exclusions and an excessively short period
(10 days) for contract acceptance.

“We respectfully request that your distinguished
committees or subcommittees hold hearings to review problems
encountered with the roll-out of the program,” the letter
said. It was signed by Reps. Jason Altmire, D-Pa.; Bruce Braley,
D-Iowa; Steve Cohen, D-Tenn.; Ron Klein, D-Fla.; Betty Sutton,
D-Ohio; Tim Walz, D-Minn.; and Peter Welch, D-Vt.

According to John Gallagher, vice president of government
relations for Waterloo, Iowa-based VGM Group, the letters are a
result of the industry’s intense efforts to point out to those in
positions of power the serious problems with the administration of
the competitive bidding program.

“We are trying to get all members of the House to support
the Altmire letter and contact [members of the Ways and Means
committee],” Gallagher said.

“We are just delighted that these champions are stepping
up and getting the word to leadership in Congress and also to CMS
that this is a train wreck,” said Michael Reinemer, vice
president, communications and policy, for the American Association
for Homecare.

“There are really two ‘asks,’” added Seth Johnson, vice
president of government affairs for Pride Mobility, Exeter, Pa.

The first request, he said, is to delay implementation of round
one at least until all disqualified providers who have filed
complaints with the CBIC have received a response. The second would
be a requirement that, prior to expanding to more areas, CMS must
first analyze the effects of competitive bidding.

“There would have to be a variety of [impacts] they would
have to analyze and report to Congress on prior to expanding the
program,” Johnson said.

Reinemer is hopeful CMS staff will hear those “asks”
very forcefully on Tuesday, when CMS officials are set to brief
legislative aides on competitive bidding. “CMS will be
talking to [congressional] staffers to tell them what a glorious
success competitive bidding is,” he said wryly.

Gallagher, who encouraged providers to get on the phone and urge
their legislators to send staff to the briefing, said he is hopeful
that at least some of the aides will ask “very pointed
questions about the incompetence of CMS and the CBIC.

“We want to make sure we don’t get the same spin from CMS
that they got ’64 percent of the bids from small business,’”
he said. “That sounds a whole lot better than the fact that
less than 5 percent of small providers eligible to bid received
offers. Why is CMS trying to mislead Congress?

“[The aides] need to ask CMS how they are going to get
this right,” Gallagher continued. “The message has got
to be the incompetence of CMS. They are incapable of administering
this program. They need to scrap it and start all over.”

He said he hopes that after the briefing, CMS has “a
better understanding of the concern on Capitol Hill. This is not
working.”

On another legislative front, stakeholders are urging inclusion
of supportive DME language in the so-called “doc fix”
bill–which would delay a 10-percent Medicare reimbursement cut for
physicians–being crafted by Sen. Max Baucus, D-Mont., chairman of
the Senate Finance Committee.

The language calls for a 12- to 18-month study of the impacts of
competitive bidding in round one prior to implementing round two.
The evaluation would be based on interviews with “Medicare
beneficiaries with various clinical conditions and product category
requirements, small business suppliers, community retail
pharmacies, representatives of minority communities, manufacturers
and other interested stakeholders and affected
populations.”

According to VGM, the doc-fix bill might be the only vehicle
available to get such stipulations into law.

Industry advocates also continue to fight the 36-month cap on
oxygen that will affect anywhere from 25 to 50 percent of Medicare
oxygen beneficiaries when it hits Jan. 1, 2009, Gallagher said, and
to stump for the rehab carve-out from competitive bidding. (See
“NRRTS, NCART Head to the Hill” in this issue.)

As well, AAHomecare has scheduled a Washington fly-in May 21 to
lobby Congress for suspension of round one and delay of round two
of competitive bidding.

“The key thing is to stop and … reexamine, reassess
and fix these problems,” Reinemer said. “The bottom line is
that people need to be on the phone and sending emails and calling
the district offices.”

Added Johnson, “I remain very optimistic that, as the
noise level continues to build and the political pressure continues
to mount on Secretary Leavitt and other senior officials with the
Medicare program, we will be able to secure a delay in
implementation. Our advocacy efforts continue to be in high
gear–and they need to remain in high gear in order to make that
happen.”

Gallagher said some members of Congress are telling him they are
not hearing from many providers. “It’s critical that over the
next couple of weeks, we get the phones ringing off the
hook,” he said. “We have got to stop this
mess.”

To locate your members of Congress, call the U.S. Capitol
switchboard at 202/224-3121.

For information on VGM’s Last Chance for Patient Choice, which
is supporting two lawsuits against the competitive bidding program,
visit www.vgm.com.

For information on AAHomecare’s May 21 fly-in, visit www.aahomecare.org.