WASHINGTON--Late Friday, Montana Democrat Max Baucus, chairman of the Senate Finance Committee, filed a Medicare bill with a “doc fix” provision that would stop a 10 percent pay cut for physicians currently set to take effect July 1. But the bill also contains reduced payments for standard power wheelchairs and home oxygen.
Senate Democrats and Republicans have each crafted their own plans for Medicare legislation to halt the physician pay cut, but a summary of the Republican bill, also released Friday by Sen. Charles Grassley, R-Iowa, contains no cuts for home care.
“Sen. Baucus' proposal contains a very harmful provision that would eliminate the first-month purchase option for standard power wheelchairs,” according to Seth Johnson, vice president of government affairs for Pride Mobility Products, Exeter, Pa. He noted the provision is different than that contained in last year's CHAMP Act, which would have eliminated the option for all PWCs.
“This provision would exempt complex rehab from that change, and would also accelerate the rental payments for standard power to the tune of 15 percent per month for months one through three,” Johnson explained. “Essentially, providers would get 45 percent of the total within 90 days, and then the remaining amount would be paid out in months four through 13.”
But even under that proposal, Johnson said, Medicare would “still pay more under this change than they would maintaining the current purchase option. It still nets out to 105 percent of the fee schedule, so we're continuing to question how Medicare would save money under this provision.
“If you look at the typical beneficiary who receives these chairs,” he continued, “they have long-term chronic conditions and … a review of historical data for Medicare claims shows that beneficiaries provided a power wheelchair 92 percent of the time use it 13 months or more, so 8 percent have a short-term need less than 13 months.”
The Baucus bill also includes a cut for home oxygen under which stationary payment rates would decrease from the current $198 per month to $144, according to Cara Bachenheimer, senior vice president of government relations for Invacare, Elyria, Ohio.
But "the legislative language is very unclear," Bachenheimer said, so the following summary of oxygen provisions is based on conversations with Capitol Hill staff:
--For patients receiving stationary and traditional (e.g., delivered tanks) systems, providers would be paid a total of $122 per month compared to the current $132 payment rate. New oxygen technology, defined as transfilling systems and portable oxygen concentrators, would stay at the current payment rate of about $250 per month. Bachenheimer added that these are the rates for the first 36 months of payment.
--In addition, the Democrats' proposal would also repeal the mandatory title transfer provisions of the 2005 Deficit Reduction Act, which automatically transferred ownership of oxygen equipment to the beneficiary after the rental period expired. Under the proposal, equipment provided under competitive bidding contracts entered into prior to Sept. 1, 2008, would not be subject to this payment change.
--Finally, the proposal would require the Institute of Medicine to do a study within 18 months on the current payment system based on classes of equipment, and the adequacy of payment for equipment and services.
Bachehheimer said she expects "further clarification in the coming days" on the full proposal.
Johnson added the Senate's Medicare package is still a “fluid process.
”Largely what we are seeing right now is a lot of political grandstanding, and at some point, Sens. Baucus and Grassley will have to come together and work on a package that can pass the Senate and be signed by the president. The Senate will have to work on a bill that they can get through to address the looming cut in physician payments, which continues to drive this Medicare legislation.”
Baucus said he expects to move the bill to the Senate floor this month.