WASHINGTON — For home medical equipment industry long-timers, it was, as the venerable Yogi Berra said, déjà vu all over again when President Obama tapped Nancy-Ann Min DeParle, former HCFA admnistrator, to lead the White House Office of Health Reform.
Obama also nominated Gov. Kathleen Sebelius, D-Kan., as Health and Human Services secretary. If Sebelius is confirmed, together the two women will oversee the crafting and implementation of the nation's health reform effort.
The announcement came a month after former Sen. Tom Daschle, D-S.D., withdrew his nomination to head HHS following an admission he had failed to pay $128,000 in back taxes. Daschle also stepped away from the newly created White House office, which would have given him a dual role in directing the push for reform.
The president's health team got another setback when CNN's Dr. Sanjay Gupta, a neurosurgeon, recently withdrew as Obama's nominee for surgeon general.
In announcing his new health care duo last week, Obama said health reform will require a commitment that focuses "on ideas that work to rein in costs, expand access and improve the quality of health care for the American people."
The announcement labeled DeParle "one of the nation's leading experts on health care and regulatory issues." In her new role, DeParle will act as a counselor to the president and is expected to coordinate White House reform efforts with Congress.
DeParle was the administrator of the Health Care Financing Administration, precursor to the current Centers for Medicare and Medicaid Services, when the first competitive bidding demonstration projects were implemented in October 1999. A year later to the day, she resigned her position, which she had held since 1997.
She had previously been associate director for health and personnel in the White House Office of Management and Budget and was commissioner of the Department of Human Services in Tennessee. In addition, she served on the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare reimbursement issues.
During DeParle's term at HCFA, the agency established new codes for oxygen concentrators, added supplier standards and began an effort to deal with Medicare fraud and abuse in its original proposal for a provider surety bond and additional site visits.
DeParle supported the DMEPOS competitive bidding initiative, saying the first demonstration in Polk County, Fla., achieved Medicare savings without compromising patient access to quality care. "Competition helps Medicare beneficiaries receive quality medical supplies at fair market prices," she said at the time. "Old laws have forced Medicare to spend more for equipment than market prices or common sense should allow."
In announcing the winners of the Polk County project, which resulted in reimbursement reductions of 13 to 31 percent in five product categories, DeParle said the results "show that competition can work for Medicare beneficiaries."
DeParle's background as a proponent of competitive bidding could be a concern to the home medical equipment sector, said Don Clayback, vice president of government relations for The MED Group in Lubbock, Texas. But, he added, "we have to see what her current view is on that once she gets into office and assimilates what's been going on the last few years relative to competitive bidding. Certainly things have changed, and there are new facts."
Since DeParle was at HCFA, CMS has carved signficant savings out of the HME industry, he noted.
Seth Johnson, vice president of government affairs for Pride Mobility, Exeter, Pa., agreed. "I'm not that concerned with Nancy-Ann DeParle having this elevated role as counselor to the president for health policy because there have been so many changes to the health care spectrum, especially when you look at the DME industry within that, since she was administrator of HCFA," Johnson said.
"One of the challenges we've always had with competitive bidding is that it sounds like motherhood and apple pie," he continued, "but I think once we have an opportunity to go in there and bring [DeParle] up to speed on all these changes — which I'm confident she may be largely aware of — I think we will be able to make a very compelling case to her that will hopefully lead to some type of change as far as the future of competitive bidding."
But Joan Cross, co-owner with her husband Alan of C&C Homecare in Bradenton, Fla., said she remembered DeParle during the implementaton of the competitive bidding demonstration project in Polk County and had hoped to see a non-bureaucrat in the new White House position. "I would have loved to have seen them give it to somebody with a nursing background [or] a physician ... I would like to have seen somebody [who was not a bureaucrat]. At least Sebelius has some experience in the field."
Sebelius, who has served as Kansas governor since 2003, has championed universal health care in the state during her tenure but has not been able to achieve it. She also served as the state's Insurance Commissioner from 1994 to 2002, successfully blocking the Anthem-Blue Cross of Kansas merger on the theory — correct, it turned out — that premiums would rise under Anthem.
Her nomination was greeted with some optimism by many in the HME sector. Clayback said it was promising that Sebelius "has a pretty good relationship with Sen. Pat Roberts [R-Kan.], and he is attuned to some of the issues relative to the HME industry. I assume they have a working relationship, and that is a good thing going forward."
AAHomecare reported in its Wednesday newsletter that many HME stakeholders in Kansas support Sebelius' nomination. "They personally think she will be great because she really understands the issues that we have in the Midwest — especially the rural communities," Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services, told AAHomecare.
However, Sandra London-Leib, CEO of Advanced Homecare in Lawrence, Kan., was more cautious. "Do not look for any sweeping changes from her," she said. "She will definitely be in agreement with the president. After hearing the president … talk about the bidding process for all government contracts and payments, it is very clear that competitive bidding will be the standard course of action for her department."
On Thursday, the White House held a health care summit that brought together members of Congress and stakeholders from the health care and insurance industries — including DeParle — to discuss the reform effort. Participants ticked off various health care difficulties that require reformative action: the vagaries of health care costs around the country, out-of-control maplpractice costs, inflated health insurance costs, bloated prices for prescription drugs, a shortage of medical professionals, divergent standards of care.
While those at the summit might not have agreed on how to fix the health care woes, they did agree on one thing: Health care reform must be achieved.
On Friday, President Obama announced that a series of public health care reform forums would be held in California, Iowa, Michigan, North Carolina and Vermont as a follow-up to the White House summit. The forums will provide "an opportunity for Americans from all over the country to voice their concerns and ideas about reforming our health care system," according to a White House press release.
"The time for reform is now and these regional forums are some of the key first steps toward breaking the stalemate we have been stuck in for far too long," Obama said in the release. "The forums will bring together diverse groups of people all over the country who have a stake in reforming our health care system and ask them to put forward their best ideas about how we can bring down costs and expand coverage for American families."
The president has said he wants to achieve health care reform by the end of this year.