ATLANTA — AAHomecare officials at Medtrade acknowledged that's it's not easy to bring down an 800-pound gorilla. The beast in question is national competitive bidding, and without a legislative Hail Mary, the program will go into effect on Jan. 1, 2011, in nine cities across the United States.
According to Walt Gorski, vice president of government affairs for AAHomecare, unprecedented budgetary pressures and a competitive bidding Congressional Budget Office (CBO) score of $20 billion combine to make a miracle unlikely. "Unless we can find $20 billion, legislatively it is going to be very difficult or virtually impossible to stop competitive bidding," said Gorski to a packed house at the association's Legislative Update session Nov. 17 during Medtrade. "We are going to fight these next 45 days, and if we can't stop it, we are going to fight next year."
Elimination of the first-month purchase option for power wheelchairs also looms, and Gorski warned that if the provision goes forward next year, it would result in a 40 percent cash flow shortage the day it kicks in. AAHomecare is advocating for a one-year delay to give cash-stricken mobility providers a reprieve.
The problem for providers, said Tyler Wilson, president of AAHomecare, is that sweeping election changes, health care reform and a soon-to-be released deficit commission report combine to lower the chances for compromise.
"You have must-pass pieces of legislation poised in front of the House and Senate," said Wilson. "What are they going to do with tax cuts? What are they going to do with the doc fix? And what are they going to do with a continuing resolution to fund the government?"
Factor in the Thanksgiving break with lawmakers still sorting out crucial leadership positions, and the chance for substantive work, let alone compromise, remains unlikely.
"We have a time of ultimate gridlock where compromise is capitulation," said Gorski.
Also on the horizon, AAHomecare is anticipating that a GAO report next year will likely advocate cutting oxygen payments that are still deemed too high. All of it, said Gorski, serves as a call for membership gains in AAHomecare. "Currently there are 500 members with 3,000 locations across the country," he said. "There are about 15,000 true HME companies across the country. Imagine if we had 1,000 or 2,000 [members]. Think about what we could do."
Washington insider Stan Collender, partner in Qorvis Communications, confirmed the no-compromise sentiment in a 45-minute talk that sought to prepare providers for what could be a tough road ahead. "Nothing anybody here has ever seen in American politics has prepared you for what is about to happen over the next two years," said Collender. "Governing is no longer the goal in Washington. The goal these days is you get elected to get re-elected."
Despite the seeming disconnect in Washington, Collender said that all bets are off, and hope should not be lost. "Your efforts are not a waste of time," said Collender. "Nothing is really ever final. Anything that happens can be changed. The fact that it [competitive bidding] is happening does not mean that it can't unhappen. However, it will not unhappen if you think the fight is over and you stop."
"If you do nothing, then you are defenseless, and Congress and regulators can do what they want," added Gorski. "If you don't raise the volume on an issue, consider yourself dead before you get out of the starting blocks."
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