Stakeholders Scramble to Muster Support for HME Issues

WASHINGTON — Stakeholders in the home medical equipment
industry are pushing on multiple fronts to ensure the sector’s
voice is heard as Congress begins crafting a comprehensive health
care reform package, they said last week.

“There are four issues in the hopper: competitive bidding,
oxygen reform and the oxygen rental cap, the 9.5 percent cut for
complex rehab and fraud and abuse legislation,” said Don Clayback,
vice president of government relations for Lubbock, Texas-based
The MED
Group. “Discussions are going on in all four of those
camps.”

Beleaguered by a new round of nationwide competitive bidding, a
9.5 percent reimbursement cut — specifically in the
narrow-margin complex rehab sector — and a 36-month oxygen
rental cap, the industry is seeking relief and reform.

But how and where all those issues should be addressed is a
question.

“We need immediate relief,” Clayback said, referring especially
to the oxygen rental cap and the 9.5 reimbursement cut for complex
rehab, which have created financial difficulties for providers and
access problems for beneficiaries. “Unfortunately, although there
might be some regulatory answers, we haven’t been able to shake
them loose.”

Any sort of regulatory movement has been hampered by the fact
that the Department
for Health and Human Services was rudderless until last week
when former Kansas Gov. Kathleen Sebelius was finally confirmed as
secretary. But the top post at the Centers for Medicare and
Medicaid Services is vacant and isn’t likely to be filled
overnight, since any nominee for that position also must be
confirmed by Congress.

Stakeholders have focused much of their attention on lawmakers
in hopes that the various issues could be handled through
legislation. In all likelihood, however, any legislation would need
to be part of a larger bill.

“The thinking is that we are such a small piece that it isn’t
like we can just introduce a free-standing bill. We really have to
be attached to something,” Clayback said, adding that the two
possibilities are the health care reform package and a Medicare
overhaul bill.

Stakeholders have been encouraged by legislators such as
Rep. Jason
Altmire, D-Pa., who told HomeCare Monday he believes
home health care could be a critical part of health care reform
legislation.

“Research shows that home health care can be more cost effective
than nursing homes,” Altmire said. “Currently, the Medicare
reimbursement process does not incentivize home care, even though
it can be cost effective. As part of comprehensive health care
reform, I believe we should change the Medicare reimbursement
process so that it is easier for those who wish to receive home
care services to do so.”

By making quality home health care accessible, he said, “I
believe that home medical equipment can help to lower our country’s
health care costs in the long run.”

It’s that message that stakeholders are attempting to get across
on all four fronts. Clayback said the industry hopes to have its
approach on the four issues crystallized by June 1.

“When I say crystallized, I mean we need at least a clear
direction so we can ask Congress for their support,” Clayback said,
adding that discussions are ongoing about what the industry will
ask for specifically and what any legislative language will look
like.

Competitive bidding

Numerous “Dear Colleague” and other letters have been sent to
congressional leaders and key regulatory officials calling for
rescission of the interim final rule reimplementing DMEPOS
competitive bidding, which went into effect April 18.

“Our message on the Hill is that the IFR needs to be repealed
because the fundamental flaws that were in last year are embedded
in the one this year,” said Seth Johnson, vice president of
government affairs for Exeter, Pa.-based Pride Mobility
Products. “We’re continuing to make the case that the program
needs to be stopped.

“If they want to move forward,” he continued, “they need to move
in a much more transparent way and differently from the program
that was rolled out last year.”

Some stakeholders are also hopeful that a regulatory stay could
still occur. Sebelius said during her confirmation hearing that she
would carefully review the program to ensure that the same problems
did not remain that derailed the project when it was first
instituted last July.

“I don’t think she is going to do that unless she gets enough
support from Congress,” Clayback said bluntly, adding that the
industry must continue to build congressional and regulatory
support for halting the bid program.

Toward that end, the American Association for Homecare on Friday
called for providers to contact their legislators with the
following message: “Congress must stop the deeply flawed
competitive bidding program for home care.” The association
detailed several talking points to get the message across.

Oxygen reform and oxygen rental cap

AAHomecare is finalizing legislative language for its oxygen
reform plan, which includes elimination of the oxygen rental cap.
(See Oxygen
Reform Plan Moves Ahead, April 13.)

As well, separate legislation that would focus specifically on
eliminating the oxygen cap is expected to be introduced “any day,”
sources said.

“The feeling of most folks is that the best way to get the cap
fixed is [for it] to be part of an oxygen reform bill,” Clayback
said. He added that discussions with members of Congress have been
encouraging. “I think there has been some good interest, but
basically they’ve said, ‘Let’s see what the legislation would look
like.’”

Complex rehab carve-out from the 9.5 percent cut

With a margin as small as two percent, complex rehab providers
are suffering under the 9.5 percent reimbursement cut, stakeholders
said, and there is no relief in sight.

“We’re still continuing to build support from a consumer
perspective and on Capitol Hill some language has been developed
[to carve out complex rehab from the cut],” Johnson said. “The real
problem is that the obvious vehicle [to attach legislation to] is
the comprehensive Medicare bill, and none of us expect that to be
finalized until the end of the year,” he said.

The Medicare reform issue does have a sense of urgency since
physicians will be hit with a 21 percent cut on Jan. 1 unless
legislation is passed to stop it.

Fraud and abuse

Last week Sens. Mel Martinez, R-Fla., and John Cornyn, R-Texas,
introduced the Seniors and Taxpayers Obligation Protection Act
(see Senators Get STOP Act Started Again, May
11). Martinez, as ranking member of the Senate Special Committee on
Aging, also held a hearing to discuss ways to clamp down on
Medicare fraud and abuse.

With so much activity on every issue, there are many details to
sift through and decisions to make, Clayback noted.

“The complexity of the issues [means] there’s an awful lot of
work that is going to have to be done before some bill is
introduced,” he said. “But we don’t have months to strategize.”

For his part, Johnson said he was celebratingafter getting a
look at President Barack Obama’s 2010 budget last week. “I’m
celebrating specifically because for the first time in recent
memory, there were no cuts in the budget to DME,” Johnson said.

Obama’s $3.6 trillion budget budget proposal calls for $309
billion in Medicare and Medicaid cuts over 10 years, proposes $17
billion in cuts in various departments and eliminates 121 programs.
But no HHS health programs were proposed for cuts.

However, Johnson added, “I think the celebration will be
short-lived because Congress has made it very clear that all the
pay-fors that were not used for [the Medicare Improvements for
Patients and Providers Act] are on the table this year. That
includes elimination of the power wheelchair purchase option and
further reductions to oxygen.”