WASHINGTON — HME stakeholders went to Washington last week with a message. Lots of messages, in fact.
In 300 Capitol Hill visits, more than 250 providers and others attached to the industry asked senators and representatives to stop competitive bidding, reform Medicare's oxygen payment system, repeal the 36-month cap, restore the 9.5 percent cut to complex rehab and adopt the American Association for Homecare's 13-point anti-fraud plan.
"Nobody's here because times are good," said AAHomecare President and CEO Tyler Wilson. "Most of us think HME is under assault. People feel their backs are against the wall. Everyone is fighting mad, and all of us are looking to change the direction Medicare is heading."
On the list of asks, however, competitive bidding was the headliner for most participating in AAHomecare's lobby day, held in conjunction with the association's Legislative Conference June 1-3.
"Our mission from Florida was really to talk about competitive bidding," said Rob Brant of City Medical Services in North Miami Beach, Fla. "What is happening with oxygen affects us, but if we don't get some help on competitive bidding, we're dead."
John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, agreed. "Nine out of 10 DME providers are targeted for elimination," he said during a bidding discussion panel. "Everyone likes to think, 'Maybe I can be that one guy.' But you know what? You can't all be that one guy. Companies are going to fall."
The industry got some sympathy from Rep. Betty Sutton, D-Ohio.
"The way in which the [competitive bidding] program was carried out left a lot to be desired," she told the conference. "The application process was exclusive and muddled. The bidding process ... disenfranchised qualified providers while reducing access to needed devices and therapy."
Although the program was eventually delayed, Sutton noted, "to many of us in Congress it seems that CMS took the letter of the 2008 delay but not the intent, which is the most important part."
Earlier this year, Sutton spearheaded a sign-on letter asking CMS to halt the bidding program before the Interim Final Rule took effect April 18. The letter, which garnered signatures from 84 members in the House, pointed out that of thousands of providers in the initial bidding areas, only 376 were deemed to have met the bidding program requirements.
"That seems absurd," Sutton said. "As a growing number of seniors enters the Medicare program, it's important that we take care to maintain an adequate number of qualified providers to address demand for care in the home."
A June 2 letter from Sen. Sherrod Brown, D-Ohio, urging HHS Secretary Kathleen Sebelius to rescind the IFR should give the industry another boost. (See Pull the IFR, Says HELP Committee's Brown.)
Brant lamented, however, that the legislators from his state were not all as supportive. While some said they didn't want bidding to go forward, others said they thought changes to the program could make it work. "And some said if you want it to stop, you're going to have to pay for it," Brant said.
Providers did get a bit of good news at a June 4 meeting of the Program Advisory and Oversight Committee when CMS announced it wouldn't implement the new Round One until January 2011. That gives the industry some "stall" time to continue efforts to get the program stopped, Brant said.
But even if CMS tweaks the program, he added, "the bottom line is if you lose a contract, you're out of Medicare."
Summed up AAHomecare's Wilson, "It's critical that we hold Congress' feet to the fire and talk about killing the program and driving a stake through its heart."
At Odds over Oxygen
Wilson was equally adamant on the subject of oxygen reform, urging conference attendees to push the New Oxygen Coalition's long-term reform plan versus the Home Oxygen Patient Protection Act (H.R. 2373).
Introduced last month by Reps. Tom Price, R-Ga., and Heath Shuler, D-N.C., the HOPP Act would repeal the 36-month cap and restore oxygen payments for the period of medical need.
While he applauded Price's efforts — this is the third time the Georgia physician has introduced the bill — Wilson said AAHomecare believes the best strategy to protect both oxygen patients and providers is to enact the reform, which is the measure that's "got legs."
Expected to be introduced in the next few weeks by Rep. Mike Ross, D-Ark., a former pharmacy and HME owner, the reform bill — currently being written into legislative language — is budget-neutral, meaning it wouldn't cost more than the current benefit. The legislation would repeal the cap, exempt oxygen from competitive bidding and recognize home oxygen services.
According to Mike Reinemer, AAHomecare vice president, communications and policy, "The under-appreciation of the service-intensive nature of oxygen therapy [has] given policymakers ammunition to cut oxygen in Medicare, time after time. That has to end.
"The HOPP Act, which AAHomecare has supported for many years now, cannot by itself achieve all the changes that need to be made."
Many providers at the conference felt differently. "Im feeling the hurt [from the cap] now," said one HOPP Act supporter who asked to remain anonymous, "and I need the cap repealed now."
Another in favor of the HOPP Act, Andy Simmons Jr. of Cornerstone Medical, Atlanta, questioned the association's strategy. Health care reform is moving fast, he said, and with no oxygen reform bill in hand, "Congress already thinks the benefit is overpaid and they want to cut us some more.
"We have a message and we have a bill," Simmons said of H.R. 2373. "Wouldn't it be best to go in on two fronts?" he asked, adding that providers could lobby for the HOPP Act now while continuing to work for long-term reform.
But past AAHomecare Chair Tom Ryan of Homecare Concepts, Farmingdale, N.Y., responded, saying the "political reality" is that with the HOPP Act, which would restore payments to pre-Deficit Reduction Act levels, "you're adding more money into the system when there's no more money to be had ... I don't think going back to the way it was is a horse that's going to run."
It was provider Tammy Johnson, owner of Ablecare in Georgetown, Ky., who got the last word on the matter. "I agree with the gentleman from Georgia," she said, referring to Simmons. "I'd rather have two bullets in my gun."
HOPP Act supporters came away from the lobbying effort with more than 30 cosponsors for the bill. View the list on the congressional Web portal.
See the AAHomecare Web site for a summary of the oxygen reform proposal.