The U.S. Congress is back in town to finish up its last few priorities before returning home for November elections. One piece of unfinished Congressional business will be Medicare competitive bidding for durable medical equipment. In June, the U.S. House of Representatives passed the Medicare Modernization and Prescription Drug Act of 2002 (H.R. 4954) which contains a provision that would require the Centers for Medicare and Medicaid Services to implement nationwide competitive bidding for DME and inhalation drugs used in conjunction with DME. While the U.S. Senate did not approve a competitive bidding mandate this year, the House and Senate will have to reach a compromise this month on a final Medicare package — and proponents of DME competitive bidding from both parts of Congress will make every effort to include a competitive bidding provision in the final Medicare legislation.

Unless you and your business take an active role in calling and writing your senators and representatives today, Congress likely will pass legislation that includes DME competitive bidding. The industry must engage in a grassroots effort as never before. Every senator and representative needs to hear from you, your coworkers, and, if possible, the beneficiaries you serve, about the ill effects of competitive bidding.

How? It's not difficult. Write a letter to your representatives and senators explaining why your business and the beneficiaries you serve would be harmed by competitive bidding. The letter should be short and in your own words. Use the following as talking points:

• Competitive bidding will limit access to medically necessary products and services
• Competitive bidding imposes significant restrictions on choice of providers/suppliers
• Competitive bidding will retard medical innovation
• Competitive bidding is anti-competitive and will wipe out many small businesses
• Competitive bidding is administratively costly and complex

You also should refer in your letters to two studies released by the Alexandria, Va.-based American Association for Homecare that show the folly of competitive bidding for DME. The first, conducted by Multinational Business Services in Washington, projects that CMS will have to increase its staff by 36 percent, or 1,627 employees, in order to manage a nationwide DME competitive bidding program. The second study, conducted by PricewaterhouseCoopers, questions the Congressional Budget Office's claim that competitive bidding will save $7.9 billion over eight years. PwC says the savings could be as little as $1 billion during that period.

If you do the math, competitive bidding is projected to save the government $125 million per year — but the 1,627 employees required to do the work will cost the government almost $100 million per year. This is important information to share with your representatives and senators: Congress must be informed that irreparable harm can be done to the DME industry for minimal savings. You can download copies of the studies from AAHomecare's Web site at www.aahomecare.org.

You also should encourage as many consumers and beneficiaries as possible to write to their representatives and senators to express concern that competitive bidding will result in decreased access to and quality of health care. An example of a compelling beneficiary letter follows:

By supporting competitive bidding for DME, you would be sending the following messages to senior citizens and people with disabilities who rely on Medicare, Medicaid and some private insurers:

1. I believe that all you need and deserve are the cheapest products available on the market.
2. I believe that cost reduction is more important than providing the services necessary for positive clinical outcomes.
3. I believe that consumers should have no choice in selecting who will provide this component of your health care needs.

If you were to vote in support of legislation establishing or expanding competitive bidding in any way, I would have no choice but to make the above assumptions.

To borrow Nike's slogan, just do it! If you've already written, visited or called, that's great — but do it again. The home care industry can prevail over competitive bidding legislation this year if two things happen. First, every provider must write a personal letter and/or visit the local offices of his or her representatives and senators. Second, we can overwhelm the proponents of competitive bidding if every provider gets at least four additional business associates or customers to send letters to their representatives in Congress.

Otherwise, our industry will have to learn to live with nationwide competitive bidding. We can only prevail if everyone gets involved.

---

You can also find this article on our Web site, www.homecaremag.com.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is an attorney with the law firm of Epstein, Becker & Green in Washington. Bachenheimer previously worked at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 202/861-1825 or e-mail at cbachenheimer@ebglaw.com.