WASHINGTON — Stakeholders in the home medical equipment industry are pushing on multiple fronts to ensure the sector's voice is heard as Congress begins crafting a comprehensive health care reform package, they said last week.
"There are four issues in the hopper: competitive bidding, oxygen reform and the oxygen rental cap, the 9.5 percent cut for complex rehab and fraud and abuse legislation," said Don Clayback, vice president of government relations for Lubbock, Texas-based The MED Group. "Discussions are going on in all four of those camps."
Beleaguered by a new round of nationwide competitive bidding, a 9.5 percent reimbursement cut — specifically in the narrow-margin complex rehab sector — and a 36-month oxygen rental cap, the industry is seeking relief and reform.
But how and where all those issues should be addressed is a question.
"We need immediate relief," Clayback said, referring especially to the oxygen rental cap and the 9.5 reimbursement cut for complex rehab, which have created financial difficulties for providers and access problems for beneficiaries. "Unfortunately, although there might be some regulatory answers, we haven't been able to shake them loose."
Any sort of regulatory movement has been hampered by the fact that the Department for Health and Human Services was rudderless until last week when former Kansas Gov. Kathleen Sebelius was finally confirmed as secretary. But the top post at the Centers for Medicare and Medicaid Services is vacant and isn't likely to be filled overnight, since any nominee for that position also must be confirmed by Congress.
Stakeholders have focused much of their attention on lawmakers in hopes that the various issues could be handled through legislation. In all likelihood, however, any legislation would need to be part of a larger bill.
"The thinking is that we are such a small piece that it isn't like we can just introduce a free-standing bill. We really have to be attached to something," Clayback said, adding that the two possibilities are the health care reform package and a Medicare overhaul bill.
Stakeholders have been encouraged by legislators such as Rep. Jason Altmire, D-Pa., who told HomeCare Monday he believes home health care could be a critical part of health care reform legislation.
"Research shows that home health care can be more cost effective than nursing homes," Altmire said. "Currently, the Medicare reimbursement process does not incentivize home care, even though it can be cost effective. As part of comprehensive health care reform, I believe we should change the Medicare reimbursement process so that it is easier for those who wish to receive home care services to do so."
By making quality home health care accessible, he said, "I believe that home medical equipment can help to lower our country's health care costs in the long run."
It's that message that stakeholders are attempting to get across on all four fronts. Clayback said the industry hopes to have its approach on the four issues crystallized by June 1.
"When I say crystallized, I mean we need at least a clear direction so we can ask Congress for their support," Clayback said, adding that discussions are ongoing about what the industry will ask for specifically and what any legislative language will look like.
Competitive bidding
Numerous "Dear Colleague" and other letters have been sent to congressional leaders and key regulatory officials calling for rescission of the interim final rule reimplementing DMEPOS competitive bidding, which went into effect April 18.
"Our message on the Hill is that the IFR needs to be repealed because the fundamental flaws that were in last year are embedded in the one this year," said Seth Johnson, vice president of government affairs for Exeter, Pa.-based Pride Mobility Products. "We're continuing to make the case that the program needs to be stopped.
"If they want to move forward," he continued, "they need to move in a much more transparent way and differently from the program that was rolled out last year."
Some stakeholders are also hopeful that a regulatory stay could still occur. Sebelius said during her confirmation hearing that she would carefully review the program to ensure that the same problems did not remain that derailed the project when it was first instituted last July.
"I don't think she is going to do that unless she gets enough support from Congress," Clayback said bluntly, adding that the industry must continue to build congressional and regulatory support for halting the bid program.
Toward that end, the American Association for Homecare on Friday called for providers to contact their legislators with the following message: "Congress must stop the deeply flawed competitive bidding program for home care." The association detailed several talking points to get the message across.
Oxygen reform and oxygen rental cap
AAHomecare is finalizing legislative language for its oxygen reform plan, which includes elimination of the oxygen rental cap. (See Oxygen Reform Plan Moves Ahead, April 13.)
As well, separate legislation that would focus specifically on eliminating the oxygen cap is expected to be introduced "any day," sources said.
"The feeling of most folks is that the best way to get the cap fixed is [for it] to be part of an oxygen reform bill," Clayback said. He added that discussions with members of Congress have been encouraging. "I think there has been some good interest, but basically they've said, 'Let's see what the legislation would look like.'"
Complex rehab carve-out from the 9.5 percent cut
With a margin as small as two percent, complex rehab providers are suffering under the 9.5 percent reimbursement cut, stakeholders said, and there is no relief in sight.
"We're still continuing to build support from a consumer perspective and on Capitol Hill some language has been developed [to carve out complex rehab from the cut]," Johnson said. "The real problem is that the obvious vehicle [to attach legislation to] is the comprehensive Medicare bill, and none of us expect that to be finalized until the end of the year," he said.
The Medicare reform issue does have a sense of urgency since physicians will be hit with a 21 percent cut on Jan. 1 unless legislation is passed to stop it.
Fraud and abuse
Last week Sens. Mel Martinez, R-Fla., and John Cornyn, R-Texas, introduced the Seniors and Taxpayers Obligation Protection Act (see Senators Get STOP Act Started Again, May 11). Martinez, as ranking member of the Senate Special Committee on Aging, also held a hearing to discuss ways to clamp down on Medicare fraud and abuse.
With so much activity on every issue, there are many details to sift through and decisions to make, Clayback noted.
"The complexity of the issues [means] there's an awful lot of work that is going to have to be done before some bill is introduced," he said. "But we don't have months to strategize."
For his part, Johnson said he was celebratingafter getting a look at President Barack Obama's 2010 budget last week. "I'm celebrating specifically because for the first time in recent memory, there were no cuts in the budget to DME," Johnson said.
Obama's $3.6 trillion budget budget proposal calls for $309 billion in Medicare and Medicaid cuts over 10 years, proposes $17 billion in cuts in various departments and eliminates 121 programs. But no HHS health programs were proposed for cuts.
However, Johnson added, "I think the celebration will be short-lived because Congress has made it very clear that all the pay-fors that were not used for [the Medicare Improvements for Patients and Providers Act] are on the table this year. That includes elimination of the power wheelchair purchase option and further reductions to oxygen."