Message No. 1: Stop Competitive Bidding

WASHINGTON — HME stakeholders went to Washington last week
with a message. Lots of messages, in fact.

In 300 Capitol Hill visits, more than 250 providers and others
attached to the industry asked senators and representatives to stop
competitive bidding, reform Medicare’s oxygen payment system,
repeal the 36-month cap, restore the 9.5 percent cut to complex
rehab and adopt the American Association for Homecare’s 13-point
anti-fraud plan.

“Nobody’s here because times are good,” said AAHomecare President and CEO
Tyler Wilson. “Most of us think HME is under assault. People feel
their backs are against the wall. Everyone is fighting mad, and all
of us are looking to change the direction Medicare is heading.”

On the list of asks, however, competitive bidding was the
headliner for most participating in AAHomecare’s lobby day, held in
conjunction with the association’s Legislative Conference June
1-3.

“Our mission from Florida was really to talk about competitive
bidding,” said Rob Brant of City Medical Services in North
Miami Beach, Fla. “What is happening with oxygen affects us, but if
we don’t get some help on competitive bidding, we’re dead.”

John Shirvinsky, executive director of the Pennsylvania Association of
Medical Suppliers, agreed. “Nine out of 10 DME providers are
targeted for elimination,” he said during a bidding discussion
panel. “Everyone likes to think, ‘Maybe I can be that one guy.’ But
you know what? You can’t all be that one guy. Companies are going
to fall.”

The industry got some sympathy from Rep. Betty Sutton,
D-Ohio.

“The way in which the [competitive bidding] program was carried
out left a lot to be desired,” she told the conference. “The
application process was exclusive and muddled. The bidding process
… disenfranchised qualified providers while reducing access to
needed devices and therapy.”

Although the program was eventually delayed, Sutton noted, “to
many of us in Congress it seems that CMS took the letter of the
2008 delay but not the intent, which is the most important
part.”

Earlier this year, Sutton spearheaded a sign-on letter
asking CMS to halt the bidding program before the Interim Final
Rule took effect April 18. The letter, which garnered signatures
from 84 members in the House, pointed out that of thousands of
providers in the initial bidding areas, only 376 were deemed to
have met the bidding program requirements.

“That seems absurd,” Sutton said. “As a growing number of
seniors enters the Medicare program, it’s important that we take
care to maintain an adequate number of qualified providers to
address demand for care in the home.”

A June 2 letter from Sen. Sherrod Brown, D-Ohio, urging HHS
Secretary Kathleen Sebelius to rescind the IFR should give the
industry another boost. (See Pull the IFR,
Says HELP Committee’s Brown.)

Brant lamented, however, that the legislators from his state
were not all as supportive. While some said they didn’t want
bidding to go forward, others said they thought changes to the
program could make it work. “And some said if you want it to stop,
you’re going to have to pay for it,” Brant said.

Providers did get a bit of good news at a June 4 meeting of the
Program Advisory and Oversight Committee when CMS announced it
wouldn’t implement the new Round One until January 2011. That gives
the industry some “stall” time to continue efforts to get the
program stopped, Brant said.

But even if CMS tweaks the program, he added, “the bottom line
is if you lose a contract, you’re out of Medicare.”

Summed up AAHomecare’s Wilson, “It’s critical that we hold
Congress’ feet to the fire and talk about killing the program and
driving a stake through its heart.”

At Odds over Oxygen

Wilson was equally adamant on the subject of oxygen reform,
urging conference attendees to push the New
Oxygen Coalition’s long-term reform plan versus the Home Oxygen
Patient Protection Act (H.R. 2373).

Introduced last month by Reps. Tom Price, R-Ga., and Heath
Shuler, D-N.C., the HOPP Act would repeal
the 36-month cap and restore oxygen payments for the period of
medical need.

While he applauded Price’s efforts — this is the third
time the Georgia physician has introduced the bill — Wilson
said AAHomecare believes the best strategy to protect both oxygen
patients and providers is to enact the reform, which is the measure
that’s “got legs.”

Expected to be introduced in the next few weeks by Rep. Mike
Ross, D-Ark., a former pharmacy and HME owner, the reform bill
— currently being written into legislative language —
is budget-neutral, meaning it wouldn’t cost more than the current
benefit. The legislation would repeal the cap, exempt oxygen from
competitive bidding and recognize home oxygen services.

According to Mike Reinemer, AAHomecare vice president,
communications and policy, “The under-appreciation of the
service-intensive nature of oxygen therapy [has] given policymakers
ammunition to cut oxygen in Medicare, time after time. That has to
end.

“The HOPP Act, which AAHomecare has supported for many years
now, cannot by itself achieve all the changes that need to be
made.”

Many providers at the conference felt differently. “Im feeling
the hurt [from the cap] now,” said one HOPP Act supporter who asked
to remain anonymous, “and I need the cap repealed now.”

Another in favor of the HOPP Act, Andy Simmons Jr. of
Cornerstone Medical, Atlanta, questioned the association’s
strategy. Health care reform is moving fast, he said, and with no
oxygen reform bill in hand, “Congress already thinks the benefit is
overpaid and they want to cut us some more.

“We have a message and we have a bill,” Simmons said of H.R.
2373. “Wouldn’t it be best to go in on two fronts?” he asked,
adding that providers could lobby for the HOPP Act now while
continuing to work for long-term reform.

But past AAHomecare Chair Tom Ryan of Homecare Concepts,
Farmingdale, N.Y., responded, saying the “political reality” is
that with the HOPP Act, which would restore payments to pre-Deficit
Reduction Act levels, “you’re adding more money into the system
when there’s no more money to be had … I don’t think going back
to the way it was is a horse that’s going to run.”

It was provider Tammy Johnson, owner of Ablecare in Georgetown, Ky., who got
the last word on the matter. “I agree with the gentleman from
Georgia,” she said, referring to Simmons. “I’d rather have two
bullets in my gun.”

HOPP Act supporters came away from the lobbying effort with more
than 30 cosponsors for the bill. View the list on the
congressional Web portal.

See the AAHomecare Web site for a summary
of the oxygen reform proposal.