Tanner-Hobson Lite in the Works?

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?”