WASHINGTON — In April, the Rehabilitation Engineering and Assistive Technology Society of North America wrote CMS Acting Administrator Charlene Frizzera asking that specialized wheelchair seating cushions be exempted from competitive bidding. In May, the ITEM Coalition, a 70-group-strong disability advocacy, wrote HHS Secretary Kathleen Sebelius about the matter. Now Reps. Jerry Costello, D-Ill., and John Shimkus, R-Ill., are circulating a sign-on letter that will be sent to Sebelius about exempting the cushions — plus some.
In fact, the representatives' letter urges the HHS secretary to exclude any HCPCS codes from the DMEPOS bidding program "that would negatively impact the health of Medicare beneficiaries or would not produce significant savings to the program."
The litmus test for whether codes should be excluded, the letter states, is based on any of three conditions:
- The code does not represent a unique, distinguishable and easily replicated group of items and/or services;
- The inclusion of the code would jeopardize beneficiary access to quality items and/or services; or
- The code is not likely to produce significant savings to the Medicare program.
"To illustrate our point," the congressmen wrote, "specialized wheelchair seating is a vital component to managing skin integrity and avoiding costly hospital stays resulting from the occurrence of wounds for wheelchair-bound individuals.
"The HCPCS codes that specialized seating products are assigned to are not specific enough to represent unique, distinguishable groups of items; including such items in the bidding process will jeopardize beneficiary access to the specific product they need, and bidding such items may actually result in increased health care costs for beneficiaries and the Medicare program."
In other words, said Dave McCausland, senior vice president of planning and government affairs for The Roho Group, Belleville, Ill., with "broad, under-defined codes that may include hundreds of items with a range of features and benefits, what you'll end up with is patients in the competitive bidding areas restricted to having access only to the lowest-cost items in the code as opposed to the products that are most appropriate."
According to McCausland, the Medicare Modernization Act gives the HHS secretary "the discretion — and the responsibility — to exclude products when there aren't really any savings to be had, or those things that could negatively impact patient care and access."
Costello and Shimkus agree, requesting Sebelius to complete a "reassessment and revision" of the codes in the program before bidding for the new Round One begins.
While CMS has said privately it would consider such a request before Round Two, officials believe under the Medicare Improvements for Patients and Providers Act, they are prohibited from changing the codes that are to be rebid in Round One. "So now we need to get Congress to chime in and tell them they have that authority," McCausland said.
"The ITEM Coalition letter and the RESNA letter [show] this is a concern to beneficiaries and clinicians — it's not just an industry issue," he said, adding that "it's not just about cushions. CMS needs to eliminate all the codes where logic tells you it's not appropriate to bid them."
Another example that fails the litmus test is the complex wheelchair category, McCausland noted, "which has somewhere in the neighborhood of 150 codes in one bid category. Yet 10 of those codes represent 90 percent of the total dollar value of that whole category. How much savings will you derive from those other 140 codes, especially when you offset that with the additional costs to deal with that?
"It really comes back to why would you want to bid things that will complicate the bidding process, not give return on investment and diminish patient care and access."
The deadline for representatives to sign on to the Costello-Shimkus letter is noon today.