ATLANTA--In an effort to halt the runaway train that is competitive bidding, legislators in increasing numbers are appealing to key congressional committee members, the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to put the brakes on before proceeding to round two of the project.
On Thursday, eight Republican senators led by Sen. George Voinovich, R-Ohio, fired off a letter to HHS Secretary Michael Leavitt seeking a meeting to address what they termed “widespread issues” pertaining to DMEPOS competitive bidding.
“We hope to have a conversation with you about our outstanding concerns and a discussion about potentially delaying the program until all of the issues can be addressed,” read the letter, which was signed by Voinovich and fellow Sens. Wayne Allard, R-Colo.; Richard Burr, R-N.C.; Saxby Chambliss, R-Ga.; John Cornyn, R-Texas; Lindsey Graham, R-S.C.; Johnny Isakson, R-Ga.; and Arlen Specter, R-Pa.
The letter cited issues including bidders who appear to have been unfairly excluded from round one, program transparency and data anomalies.
Meanwhile, on Friday, eight freshman Democrats sent a letter to key House committee chairmen calling the bid program “seriously flawed” and urging a six-month delay in implementation.
Addressed to, among others, Reps. Charles Rangel, D-N.Y., chairman of the Ways and Means Committee, and Fortney “Pete” Stark, D-Calif., chairman of the Subcommittee on Health, the letter records an inventory of problems: the overlooking of small providers, a flawed certification/application process, unfair bidder exclusions and an excessively short period (10 days) for contract acceptance.
“We respectfully request that your distinguished committees or subcommittees hold hearings to review problems encountered with the roll-out of the program,” the letter said. It was signed by Reps. Jason Altmire, D-Pa.; Bruce Braley, D-Iowa; Steve Cohen, D-Tenn.; Ron Klein, D-Fla.; Betty Sutton, D-Ohio; Tim Walz, D-Minn.; and Peter Welch, D-Vt.
According to John Gallagher, vice president of government relations for Waterloo, Iowa-based VGM Group, the letters are a result of the industry's intense efforts to point out to those in positions of power the serious problems with the administration of the competitive bidding program.
“We are trying to get all members of the House to support the Altmire letter and contact [members of the Ways and Means committee],” Gallagher said.
“We are just delighted that these champions are stepping up and getting the word to leadership in Congress and also to CMS that this is a train wreck,” said Michael Reinemer, vice president, communications and policy, for the American Association for Homecare.
“There are really two 'asks,'" added Seth Johnson, vice president of government affairs for Pride Mobility, Exeter, Pa.
The first request, he said, is to delay implementation of round one at least until all disqualified providers who have filed complaints with the CBIC have received a response. The second would be a requirement that, prior to expanding to more areas, CMS must first analyze the effects of competitive bidding.
“There would have to be a variety of [impacts] they would have to analyze and report to Congress on prior to expanding the program,” Johnson said.
Reinemer is hopeful CMS staff will hear those “asks” very forcefully on Tuesday, when CMS officials are set to brief legislative aides on competitive bidding. “CMS will be talking to [congressional] staffers to tell them what a glorious success competitive bidding is,” he said wryly.
Gallagher, who encouraged providers to get on the phone and urge their legislators to send staff to the briefing, said he is hopeful that at least some of the aides will ask “very pointed questions about the incompetence of CMS and the CBIC.
“We want to make sure we don't get the same spin from CMS that they got '64 percent of the bids from small business,'” he said. “That sounds a whole lot better than the fact that less than 5 percent of small providers eligible to bid received offers. Why is CMS trying to mislead Congress?
“[The aides] need to ask CMS how they are going to get this right,” Gallagher continued. “The message has got to be the incompetence of CMS. They are incapable of administering this program. They need to scrap it and start all over.”
He said he hopes that after the briefing, CMS has “a better understanding of the concern on Capitol Hill. This is not working.”
On another legislative front, stakeholders are urging inclusion of supportive DME language in the so-called “doc fix” bill--which would delay a 10-percent Medicare reimbursement cut for physicians--being crafted by Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee.
The language calls for a 12- to 18-month study of the impacts of competitive bidding in round one prior to implementing round two. The evaluation would be based on interviews with “Medicare beneficiaries with various clinical conditions and product category requirements, small business suppliers, community retail pharmacies, representatives of minority communities, manufacturers and other interested stakeholders and affected populations.”
According to VGM, the doc-fix bill might be the only vehicle available to get such stipulations into law.
Industry advocates also continue to fight the 36-month cap on oxygen that will affect anywhere from 25 to 50 percent of Medicare oxygen beneficiaries when it hits Jan. 1, 2009, Gallagher said, and to stump for the rehab carve-out from competitive bidding. (See “NRRTS, NCART Head to the Hill” in this issue.)
As well, AAHomecare has scheduled a Washington fly-in May 21 to lobby Congress for suspension of round one and delay of round two of competitive bidding.
“The key thing is to stop and … reexamine, reassess and fix these problems,” Reinemer said. "The bottom line is that people need to be on the phone and sending emails and calling the district offices.”
Added Johnson, “I remain very optimistic that, as the noise level continues to build and the political pressure continues to mount on Secretary Leavitt and other senior officials with the Medicare program, we will be able to secure a delay in implementation. Our advocacy efforts continue to be in high gear--and they need to remain in high gear in order to make that happen.”
Gallagher said some members of Congress are telling him they are not hearing from many providers. “It's critical that over the next couple of weeks, we get the phones ringing off the hook,” he said. “We have got to stop this mess.”
To locate your members of Congress, call the U.S. Capitol switchboard at 202/224-3121.
For information on VGM's Last Chance for Patient Choice, which is supporting two lawsuits against the competitive bidding program, visit www.vgm.com.
For information on AAHomecare's May 21 fly-in, visit www.aahomecare.org.