DALLAS — Just a few weeks after being introduced, the bill that would eliminate DMEPOS competitive bidding is gaining traction among legislators.
As of Friday, H.R. 3790, introduced on Oct. 13 by Rep. Kendrick Meek, D-Fla., had garnered 53 cosponsors.
"This places us over halfway to our goal of 100 cosponsors within only three weeks," said Barry Johnson, president of the Texas Alliance for Home Care Services and one of the bill's originators. "We expect more congressional support as members fully understand the tremendous cost savings of our budget-neutral legislation."
The goal, Johnson said, is to see the bill "signed and enacted on Jan. 1" — or the first business day after Jan. 1. "In the words of Larry the Cable Guy," he said, "we need to get 'er done."
With the Meek bill, providers are finally armed to fight the battle against competitive bidding, according to Johnson, who stressed that more providers are needed on the front lines. "We need more providers to step up to the plate and tell the story," he said. "It's an education process."
He knows it's tough for providers who have never been politically active before. Johnson said when he visits a legislator's office, "I say, 'I'm not here to bother you; I'm here to tell you something that is going to make everyone's life better.'"
A respiratory therapist for 40 years, Johnson is a salesman when it comes to the Meek bill because he believes it gives CMS just what it wants and protects patients and providers at the same time. "The point of competitive bidding was to reduce the number of providers out there. Competition reduction. Well, OK," said Johnson. "Reduce fraud and abuse — absolutely. Get more for your money. I'm a taxpayer and I'm all for that.
"But what if I could do all that stuff better, faster, quicker and give you back $25 million? Would you go for that? Well, welcome to H.R. 3790."
Johnson ticked off the bill's selling points:
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Significant savings. "First off, we have a bill with a number on it. It's pretty tough to see the light when no one turns the light bulb on," Johnson said. Up to this point, industry representatives could only provide legislators with information and particulars about the devastating problems competitive bidding would create for small business providers and Medicare beneficiaries, he said.
"But how can they really properly evaluate what you are telling them? Now they have the legislation and they can see the legislation," Johnson said. "We have had it scored by an independent actuary, and it's coming in about 10 percent [savings for Medicare]. We've had a 9.5 percent cut already. That's 19.5 percent, a half percent greater than the [savings from the] first round of demonstrations in Polk County, Fla."
Combined with the 25 percent savings on oxygen from the 36-month oxygen cap implemented in January, Medicare is already seeing a substantial savings that is far beyond the average 26 percent savings on DMEPOS items in the aborted Round 1 of competitive bidding last year.
"We're rolling back the prices to 1998. We're better than Walmart," Johnson said.
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Access to care. The Meek bill would preserve patients' access to care because it would not eliminate thousands of providers, Johnson pointed out. "When you're reducing the number of providers by 90 percent, you are asking 10 percent of the providers to take care of 100 percent of the population. That's a tough deal," he said.
His own Dallas County is 9,000 square miles and, under competitive bidding, would have only about 40 providers, he estimates. "It's going to be difficult to get from one corner to another in a timely manner … Now we have a patient risk issue here because we are limiting access to care."
Medicare is very likely to see more trips to the emergency room and more hospitalizations because there will be too few providers to attend to them quickly, a problem that would worsen dramatically in cases of thunderstorms, hurricanes, snow and heavy winds, Johnson said.
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Elimination of the Competitive Bidding Implementation Contractor. "The CBIC can go away, and the cost of the CBIC is $25 million annually," Johnson said. "We truly have a bipartisan bill which will achieve the same results as competitive bidding while returning $25 million to the taxpayer annually. These administrative funds are simply being wasted to administer the severely flawed competitive bidding program."
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Curb fraud and abuse. "We want to start a fraud-and-abuse program that works with the $25 million," Johnson said. Because of mandatory accreditation, surety bonds, onsite visits, stiffer standards and post-payment audits, inroads are already being made into the fraud-and-abuse arena, he said.
"There was a reduction of providers, on average, of about 40 percent," he said. "We think what has happened is that those people who were less than responsible, those people have dropped out.
"Congress is seeing that," he continued, noting that despite the derogatory stories popping up all over the media — the most recent being a "60 Minutes" piece on Oct. 25 (see '60 Minutes' Points TV Finger at Medicare Fraud) — legislators are beginning to understand that most of the fraud that is surfacing is being perpetrated by "Nigerian scam artists and the Russian mob, not the majority of the independent mom-and-pop, dedicated providers" serving local areas.
"This is good news for our industry," he said. "They know it's not us."
Johnson is hopeful that other organizations such as the AMA will get on board and help champion H.R. 3790 with legislators. Last week, the 5,000-member National Association for Support of Long Term Care threw its support behind the bill. The group is encouraging a grassroots effort and is sending an "advocacy message" to legislators through the NASL Advocacy Center.
Such support could help to make H.R. 3790 a standalone bill rather than one that would need to piggyback on another measure such as health reform legislation. "I personally would like to see it as an independent-status bill," Johnson said. "There are too many problems associated with the health reform package."
He's proud of the Meek bill, which he noted was forged over seven months with important input from industry stakeholders and help from the American Association for Homecare. There's much good in it, he believes. But in the end, the biggest reason to eliminate the DME bid program is "to save the beneficiary" because competitive bidding is unsafe for patients, Johnson said.
"Rather than go through this gyration with competitive bidding and all the problems associated with it, let's just go with 3790 and make everybody happy," he said. "It's a way to save for the Medicare program. This is a bipartisan bill that does something for everybody.
"We've kept access, lowered the patients' copay by reducing the fee schedules and, Grandma, we are not throwing you out with the bathwater … We do all that independently, with one swoop of the pen and without asking for any assistance from any government agency and no new taxes for any taxpayer."
Johnson has a personal interest in all this that goes beyond his business. His father is 86 and needs oxygen. He does not want to see what happens to his dad if competitive bidding goes through.
Elimination of the program is "just something that has to happen," he said. "We owe this to the American taxpayer, we certainly owe it to the beneficiary and we owe it to Congress to come up with a bill where we can continue to provide the services, protect the elderly and prevent fraud.
"If they can pass this bill, they will definitely be a Medicare beneficiary's hero."
View more competitive bidding stories.
To contact your representative in support of H.R. 3790, call the U.S. Capitol switchboard at 202/224-3121. The operator will connect you directly to your congressman's office using your ZIP code.
View background and talking points for H.R. 3790 from AAHomecare.
View the full text of H.R. 3790 also on AAHomecare's Web site.
CMS has scheduled its eighth and final Special Open Door Forum on the Round 1 rebid Wednesday, Nov. 4, from 2 to 3 p.m. ET. To participate in the call, which will be devoted to questions about bidding, dial 800/837-1935 and reference Conference ID 23045924. As a reminder, Nov. 4 marks the close of bidding registration.
