H.R. 1041 Gains Ground, but There’s More Work to Do

WASHINGTON — Key industry stakeholders applauded the
growing numbers of legislators signing on as cosponsors to H.R.
1041, but said last week there is much more work to be done if
competitive bidding is
to be repealed.

The bill to halt the bidding program has so far gained 113
cosponsors, with one of the latest signers Rep. Carolyn McCarthy,
D-N.Y. That gives the state 10 of 29 representatives signed on,
according to Michael Reinemer, vice president, communications and
policy, for the American Association for Homecare.

Representatives in other large states are signing on in
significant numbers, too: Pennsylvania, 12 out of 19; Ohio, 10 out
of 18; and Florida, 11 of 25. In some states — Iowa, Maine,
Vermont and West Virginia — all of the representatives have
signed on.

“There are still some big holes,” Reinemer acknowledged. “About
17 states have zero cosponsors including California, which has 53
House seats. So there is plenty more work to do in the House
— and in terms of getting a sponsor for a Senate companion
bill.”

Two Pennsylvania legislators, Rep. Jason Altmire, a Democrat,
and Rep. Glenn “GT” Thompson, a Republican, are responsible for
H.R. 1041, and the Pennsylvania Association of Medical Suppliers is
working diligently to get the rest of the state’s representatives
on board, said John Shirvinsky, executive director of PAMS.

“Of the seven remaining, one includes the chairman of the Energy
& Commerce Health Subcommittee,” Shirvinsky said. “While
Chairman [Joe Pitts, R-Pa.], is unlikely to sign on to a measure
that is within the purview of his subcommittee’s jurisdiction, he
has been very sympathetic on this issue, and the eastern half of
his district includes the Philadelphia MSA. We continue to work
with the two sole holdouts in the Pittsburgh MSA and we are
establishing ties with the remaining four non-sponsors, all of whom
represent the Philadelphia area.”

Rob Brant, president of the Accredited Medical Equipment
Providers of America, said he is urging more Florida legislators to
sign on to the bill. “In the state of Florida, we have 10 new
legislators, so we had to do a lot of work to educate them,” he
said. “We hope to get some more from Florida. I think that the
message is getting out.”

Five months into the program, he said, patients are now calling
for services and equipment that they are accustomed to receiving
the same day. That is not happening, he said, largely because
providers working under the competitive bidding reimbursement rates
cannot afford it.

“If they don’t like it, they need to contact their legislator,”
said Brant.

Reinemer seconded that.

“Bottom line, we need to have multiple, credible advocates
— providers and patients — in each of the 435
congressional districts making frequent calls and holding regular
meetings with their representatives and senators,” he said. “In
this environment especially, there’s no way we can achieve our
goals without much deeper and broader action in every corner of the
U.S. And that’s exactly what we’re working on with our grassroots
program. Providers and other advocates can visit capwiz.com/aahomecare/home or www.aahomecare.org
to get started.”

It isn’t the same as the drive last year to get support for a
similar repeal bill, H.R. 3790, Shirvinsky said.

“The dynamics of H.R. 1041 are very different than what we saw
last session. We have strong, bipartisan cosponsors who really
understand this issue and our industry,” he said. “We have nine
MSAs that are already impacted and 91 others that will find out the
exact borders of their bidding areas within the next two
months.”

There’s also the ongoing national debate on health care and the
budget, which leaves the industry with either an opportunity
— that in framing Medicare reform there could be a
legislative vehicle to stop competitive bidding — or that, as
usual in Washington budget negotiations involving Medicare, could
put HME cuts on the table once again. (See “Debt Ceiling Debate
Puts HME in Perilous Spot“.)

And then there is Peter Cramton, a University of Maryland
professor who has alerted both Congress and CMS to the fatal flaws
of the competitive bidding design. Cramton thinks a bidding program
for DME could work — just not the current one — and he
is now advocating a “repeal and replace” strategy that includes his
plan for an “efficient” auction design. (See “Cramton
Floats ‘Repeal and Replace’ Option for Competitive
Bidding“.)

While most in the industry oppose any sort of bidding program no
matter how well it is designed, they’re grateful Cramton is beating
the drum.

“We have a very motivated economist and auction expert who is
virtually carrying on a one-man campaign against the Medicare
bidding scheme because it is so atrociously flawed,” Shirvinsky
said, “not to mention that those who are in a position to do
something about it have been outright dismissive of his
considerable professional opinion.

“And we have a new House leadership that seems to understand the
inherent problems with the program and the bipartisan support that
exists for its repeal,” he continued. “All in all,” he said of H.R.
1041, “we are off to a very strong start, and we have the potential
for committee discussion in the near future.”

Will that result in a Senate champion to carry the repeal bill?
The jury is still out on that one. In any case, the onus is on
providers to move their legislators to fight the current CMS
program, stakeholders said.

Wayne Stanfield, president of the National Association of
Independent Medical Equipment Suppliers, said “there is a vast
corps of providers out there that think this thing is going to go
away, and they have to get over it.” He told NAIMES members in a
commentary last week that providers watching from the sidelines
essentially could be allowing the demise of the industry.

“I have told every supplier for years now that ‘all politics are
local,’” he wrote. “Every supplier reading this has had the power
to change the course of this bidding disaster for years. For every
one of you that have not made that call, or e-mail, or visit, or
sent the letter to Congress, when Round Two starts, go look in the
mirror. You will see one of the thousands of faces who didn’t see
the need to get involved.”

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