WASHINGTON--In a race against time, key industry stakeholders are seeking to salvage the best of the Tanner-Hobson bill, which sought to lessen the effects of competitive bidding, and fashion it into legislation that would have a strong chance of passing this year.
The industry learned in February that the bill, H.R. 1845, would not move forward because an unofficial ranking, or "score," from the Congressional Budget Office gave it a price tag of $12 billion over 10 years. The current "pay-as-you-go" congressional mandate means that $12 billion would have to come from somewhere else in the HME industry--an undoable proposition since that figure represents half of the entire industry.
"We haven't given up on the provisions of the Tanner-Hobson Act. We have taken the provisions and are hoping to shop those around, and we are hoping that they will wind up in another bill," said Michael Reinemer, vice president, communications and policy, for the American Association for Homecare.
While the bill had nearly 160 cosponsors, the sticking point was its "any willing provider" provision, which would have allowed any eligible provider who had submitted a bid and lost to continue doing Medicare business under the new competitive bidding rates.
That provision was touted as a major issue for small HME companies, and many were upset when they heard it was not likely to be part of a new bill.
"The demise of Tanner-Hobson has taken the wind out of our sails," said Rob Brant of City Medical Services in North Miami Beach, Fla., who last year made a fruitless appeal to the Small Business Administration to help fight competitive bidding.
"The Tanner-Hobson bill was our only hope," said Terry Luft, owner/president of Central Medical Equipment in Harrisburg, Pa. "[With] the 'any willing provider' provision, the government was going to let us have the opportunity to lose money. It was all that we had to hang on to, because no one was going to say, 'We're going to stop this."
Luft said his new hope was in the power of two recent studies that call into serious question not only the results of competitive bidding but also the very process itself. (See related story in this issue.)
Brant said he will attend the AAHomecare Legislative Conference this week as planned before the news about Tanner-Hobson. But his goal, which had been to stump for more cosponsors for the bill, has changed.
"I want to meet with the providers in the first 10 metropolitan statistical areas and come up with a game plan so we are not the sacrificial lambs," he said. "We want to get [competitive bidding] stopped."
Reinemer said AAHomecare is still "hoping to advocate for 'any willing provider.'
"We haven't thrown in the towel yet," he said. "There may be sort of a Tanner-Hobson lite. But at the same time, we want to hold out the possibility that [enough] members of Congress hear the message of 'any willing provider.' It's funny how Congress is able to find money for something if they think it is important."
Don Clayback, vice president of government relations for Lubbock, Texas-based The MED Group, said he sympathized with those who are upset about the bill's fate. "I understand people's feelings that Tanner-Hobson is not going to happen, but the message is changing because that horse doesn't have any legs," he said. "We have to find a different horse."
Because of a short legislative year due to the presidential election, the industry must find that horse quickly. "If we are going to make something happen, it's going to be over the next 60 days," said Clayback.
Top industry players are attempting to come up with something to present to HME supporters on Capitol Hill as early as this week, even if it is not yet a fully crafted bill.
"We do have draft legislative language," said Cara Bachenheimer, senior vice president of government relations for Invacare, Elyria, Ohio, "and we are working with the same offices on the Hill willing to work with us."
"What we've got to do is take part of that bill that we have support for and get them to take it the rest of the way. We've got a whole bunch of folks [behind us]," said John Gallagher, vice president of government relations for Waterloo, Iowa-based VGM Group.
Gallagher emphasized there was more to the Tanner-Hobson bill than the "any willing provider" condition. "The main portion of [H.R.] 1845 is the language that dictates [competitive bidding should] cease and desist until you have done a full analysis of round one and what the impact is on smaller business, on beneficiaries and on quality of care," he noted. "Until you can respond with an analysis to the affirmative, you do not have the ability to go nationwide."
Another important facet of the bill, he said, stipulated the reimbursement fee schedule could not be changed nationwide "based on ridiculous low bids [in such places as Miami and Dallas]."
Such protections will likely be present in whatever version of Tanner-Hobson comes next, stakeholders said.
Meanwhile, Gallagher and Bachenheimer stressed that the effort made to rally support for the Tanner-Hobson bill was not in vain. "I would strongly dispute that it was a waste of time," Bachenheimer said. "It was a considerable accomplishment, and we educated lots of folks."
"The message can't be 'We failed, 1845 is dead,'" said Gallagher. "We got this much carried to the middle of the mountain; what can we get carried to the top?"