Review the Codes before Rebid, Representatives Say

WASHINGTON — In April, the Rehabilitation Engineering and Assistive Technology
Society of North America wrote CMS Acting Administrator
Charlene Frizzera asking that specialized wheelchair seating
cushions be exempted from competitive bidding. In May, the ITEM Coalition, a
70-group-strong disability advocacy, wrote HHS Secretary Kathleen
Sebelius about the matter. Now Reps. Jerry Costello, D-Ill., and
John Shimkus, R-Ill., are circulating a sign-on letter that will be
sent to Sebelius about exempting the cushions — plus
some.

In fact, the representatives’ letter urges the HHS secretary to
exclude any HCPCS codes from the DMEPOS bidding program “that would
negatively impact the health of Medicare beneficiaries or would not
produce significant savings to the program.”

The litmus test for whether codes should be excluded, the letter
states, is based on any of three conditions:

1. The code does not represent a unique, distinguishable and
   easily replicated group of items and/or services;
2. The inclusion of the code would jeopardize beneficiary access
   to quality items and/or services; or
3. The code is not likely to produce significant savings to the
   Medicare program.

“To illustrate our point,” the congressmen wrote, “specialized
wheelchair seating is a vital component to managing skin integrity
and avoiding costly hospital stays resulting from the occurrence of
wounds for wheelchair-bound individuals.

“The HCPCS codes that specialized seating products are assigned
to are not specific enough to represent unique, distinguishable
groups of items; including such items in the bidding process will
jeopardize beneficiary access to the specific product they need,
and bidding such items may actually result in increased health care
costs for beneficiaries and the Medicare program.”

In other words, said Dave McCausland, senior vice president of
planning and government affairs for The Roho Group, Belleville, Ill., with “broad,
under-defined codes that may include hundreds of items with a range
of features and benefits, what you’ll end up with is patients in
the competitive bidding areas restricted to having access only to
the lowest-cost items in the code as opposed to the products that
are most appropriate.”

According to McCausland, the Medicare Modernization Act gives
the HHS secretary “the discretion — and the responsibility
— to exclude products when there aren’t really any savings to
be had, or those things that could negatively impact patient care
and access.”

Costello and Shimkus agree, requesting Sebelius to complete a
“reassessment and revision” of the codes in the program before
bidding for the new Round One begins.

While CMS has said privately it would consider such a request
before Round Two, officials believe under the Medicare Improvements
for Patients and Providers Act, they are prohibited from changing
the codes that are to be rebid in Round One. “So now we need to get
Congress to chime in and tell them they have that authority,”
McCausland said.

“The ITEM Coalition letter and the RESNA letter [show] this is a
concern to beneficiaries and clinicians — it’s not just an
industry issue,” he said, adding that “it’s not just about
cushions. CMS needs to eliminate all the codes where logic tells
you it’s not appropriate to bid them.”

Another example that fails the litmus test is the complex
wheelchair category, McCausland noted, “which has somewhere in the
neighborhood of 150 codes in one bid category. Yet 10 of those
codes represent 90 percent of the total dollar value of that whole
category. How much savings will you derive from those other 140
codes, especially when you offset that with the additional costs to
deal with that?

“It really comes back to why would you want to bid things that
will complicate the bidding process, not give return on investment
and diminish patient care and access.”

The deadline for representatives to sign on to the
Costello-Shimkus letter is noon today.