Congress Gets Busy on Competitive Bidding
WASHINGTON — In an enormous leap forward in the home
medical equipment industry’s intense efforts to halt DMEPOS competitive bidding,
Reps. Fortney “Pete” Stark, D-Calif., and David Camp, R-Mich.,
introduced bipartisan legislation Thursday calling for an 18-month
delay in implementation of the troubled program.
H.R. 6252–the Medicare DMEPOS Competitive Acquisition Reform
Act of 2008–would delay the first round of bidding for at least 18
months; round two would be delayed for up to three years.
In addition, Sens. Max Baucus, D-Mont., and Charles Grassley,
R-Iowa, are expected to introduce a Senate companion bill to H.R.
6252 this week, industry insiders said.
“This is huge, huge!” emphasized Cara Bachenheimer,
senior vice president of government relations for Elyria,
Ohio-based Invacare. “Just a month ago, nobody would have put
any money on this happening.”
As expected, however, the legislation comes with a price tag.
Stark’s bill calls for a nationwide 9.5 percent payment
reduction on products subject to the bidding program to cover its
projected savings.
In working with Stark, Camp and other members of the House Ways
and Means health subcommittee, which Stark chairs, the industry had
been looking for a lesser across-the-board cut to offset savings
that Medicare would see from the bidding program, said John
Gallagher, vice president of government relations for Waterloo,
Iowa-based VGM, “but the only thing offered was 9.5
percent.”
That has upset some providers who are not currently included in
either round one or round two of bidding, according to Gallagher.
But if the industry hadn’t accepted the offer,
“it’s doubtful we would ever get a hearing
again,” he said. “In an ideal world, we’d want no
cuts at all, but the ‘pay-as-you-go’ environment is the
political reality, and we had to agree to a cut.”
“The payment cut is a little higher than we had
anticipated,” acknowledged Bachenheimer, “but by and
large, the choice is between the 9.5 percent cut this year compared
to a 26 percent cut next year. It’s a no-brainer.”
CMS, she reminded, has the power to institute the rates set
through competitive bidding in all areas of the country, whether or
not those areas are included in competitive bidding. CMS has said
the round one rates average a 26 percent reduction, and those cuts
could be applied to all providers as early as next year.
“Some people forget that CMS has that authority,”
Bachenheimer said.
There is another plus to the proposed legislation, she added.
Under the Stark-Camp bill, the CPI update, which the industry lost
years ago, would be reinstated for all items in 2010 and continue
through 2013. “Then we would get a two percent increase in
2014,” Bachenheimer said, referring to the items that would
have been subject to the 9.5 percent reduction.
Seth Johnson, vice president of government affairs for Pride
Mobility Products, Exeter, Pa., said the bill also contains another
victory for the industry and Medicare beneficiaries. “The
Stark bill would carve out complex rehab [from competitive
bidding],” he said. “It would, however, be subject to
the 9.5 percent reduction.”
Bachenheimer said the bill has been placed on an expedited track
and could be voted on Tuesday. The bill’s sponsors only do
that, she said, if they are confident they have the votes to get it
passed.
“This is the best package that we can possibly get,”
said Bachenheimer. “We certainly need industry consensus on
this issue. We have a lot of people on Capitol Hill doing a lot of
hard work and they need to hear that the industry is 150 percent
behind them.”
AAHomecare endorses H.R. 6252
In a statement issued Friday, the American Association for Homecare
urged passasge of the Stark-Camp measure.
“The American Association for Homecare sought an
across-the-board reduction to all DME items and not just the
bidding product categories selected by CMS,” said Tyler
Wilson, president. “An across-the-board cut would have
resulted in a smaller percentage reduction in reimbursement.
However, the association was unsuccessful in getting its position
included in the final legislation and AAHomecare elected, after
careful consideration, to accept the Ways and Means Committee
package rather than risk implementation of round one of
bidding.”
Added Wilson, “This bill is critical to making important
improvements to Medicare policy that will protect America’s
seniors and people with disabilities who depend on home medical
equipment and services in their homes. If allowed to go forward,
the bidding program will put thousands of qualified home care
providers out of business and reduce patients’ access to
quality home medical equipment and services.”
Earlier this month, 132 House members–nearly a third of its
membership–signed a letter asking Stark, Camp and other members of
the Ways and Means Committee to support a delay of competitive
bidding. And last week, 40 members of the Senate signed on to a
letter calling for legislation to delay the program.
In a press release on H.R. 6252 issued by Stark, he said he
would work with colleagues “for its swift passage so that the
program can be redesigned to meet the needs of patients, providers
and taxpayers.”
In addition to AAHomecare, Stark’s release listed a number
of organizations supporting H.R. 6252, including:
- American Academy of Physical Medicine and Rehabilitation
- American Podiatric Medical Association
- American Society of Transplantation
- Consortium for Citizens with Disabilities Health Task
Force - Health Industry Distributors of America
- Independence Through Enhancement of Medicare and Medicaid
(ITEM) Coalition - National Coalition for Assistive and Rehab Technology
- National Community Pharmacists Association
- Orthotic and Prosthetic Alliance
- Pedorthic Footwear Association
- The Endocrine Society
- Vision Council of America
- Wound Ostomy Continence Nurses Society
Medicare ‘doc fix’ package also in the
works
Stark’s bill isn’t the only one needing support. In the
Senate, as Baucus and Grassley work toward a compromise Medicare
“doc fix” bill–which would stop a 10.6 percent
physician pay cut set to take effect July 1–the industry needs to
back Grassley’s version, said Pride’s Johnson.
The goal is for the final Medicare package to include language
that would delay competitive bidding, repeal the oxygen cap and
transfer of ownership, carve out complex rehab and retain the
first-month purchase option for power wheelchairs. If a bipartisan
Medicare package can make it through Congress, Johnson and others
said, the president is unlikely to veto it.
Grassley’s current bill does not include any cuts to home
care, and it eliminates the 36-month cap on oxygen and the transfer
of equipment ownership to the beneficiary mandated under the
Deficit Reduction Act. Baucus’ version includes cuts both to oxygen
and standard PWCs.
“From the industry’s perspective, we need to support
Grassley,” Johnson said.
Gallagher called on all providers to contact their legislators
and voice support for the Stark-Camp bill in the House and also for
the provisions in Grassley’s bill in the Senate.
“We as providers need to be contacting our House of
Representatives and saying we approve Stark’s amendments and
section 142 of Grassley’s bill, which would repeal the oxygen
cap, and talk to the senators and say the same thing,” said
Gallagher. “If it’s the same language in all three
bills, we’ve got a chance.”
He pointed out that winning a delay in competitive bidding could
be a huge boon to the industry in another way. “It gives us
the opportunity with a new administration … to right the ship
and look at fee-based service components,” he said.
“There’s a lot to like about this.”
After several years of pouring efforts into fighting competitive
bidding, the HME industry is closer now to winning the battle than
it’s ever been, stakeholders said.
“We’re close, but we’re not there yet,”
cautioned Bachenheimer, “so it’s still important at a
grassroots level for providers to communicate with their
legislators.”
If providers don’t get behind the legislation, warned
Gallagher, “the alternative is losing thousands of providers
in both rounds one and two. We can hang together, or we can surely
hang separately.”
It could all be over in a couple of weeks, he said. “Time
is of the essence.”
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