WASHINGTON and ALEXANDRIA, Va. — As home care advocates waited to see whether U.S. Sen. Bob Graham, D-Fla., would attach a durable medical equipment competitive bidding amendment to Senate bill 812, a newly formed anti-competitive-bidding coalition released a study that predicted competitive bidding would be a bureaucratic nightmare for the federal government.

Based on the competitive bidding mandates in the Medicare Modernization and Prescription Drug Act — which passed the U.S. House in July — Medicare would have to add approximately 1,620 new staff members to implement DME competitive bidding nationwide, the study said.

“The foregoing analysis demonstrates that adoption of a competitive bidding program, as set forth in MMPDA Section 511, would be unwise,” the Coalition for Access to Medical Services, Equipment and Technology concluded.

CAMSET, which includes 19 industry and consumer advocate organizations, commissioned the report from the Washington-based firm Multinational Business Services, whose staff includes former senior officials from the U.S. Congressional Budget Office, CAMSET said.

After first identifying 50 separate congressional mandates contained in Section 511 of the House bill, MBS analyzed the “complex bureaucratic structure that would be required to accomplish all the individual mandates,” CAMSET explained.

According to MBS' analysis, the bill would require Medicare to set up approximately 260 “competitive acquisition areas” in metropolitan centers throughout the United States. Each area “would require its own bureaucracy in addition to increases in the bureaucracy in [the Centers for Medicare and Medicaid Services] regional offices and in CMS' headquarters.”

“Based on CMS' current size,” CAMSET said, “CMS would need to expand by 35 percent to carry out Section 511 mandates,” and inevitably would duplicate some of the agency's functions.

These findings prompted CAMSET to urge Congress not to adopt nationwide competitive bidding until:

• CMS completes and analyzes its two ongoing demonstration projects;
• the government conducts additional demonstrations in more-diverse areas of the country, using a broader product sample; and
• CMS solicits and considers public comments on nationwide competitive bidding.

Despite these suggestions, Senate Majority Leader Tom Daschle, D-S.D., told The New York Times that he expected the Senate to pass prescription drug legislation before the August recess.

However, even if the Senate approves S.812 and is able to reconcile the bill with the House's MMPDA, the fate of the combined bill is unclear, because the Bush administration does not support the generic drug bill in its current form.

In a statement of administration policy issued July 18, the President's executive office said “the administration opposes S.812 in its current form because it will not provide lower drug prices.”

At press time, one week before the Senate's August recess, urgency among lawmakers reached an all-time high.

With the pressure mounting to compromise on Medicare-reform legislation before the November elections, only one thing was clear: Provider issues — including competitive bidding — still were on the table.

“Everybody in Washington thinks the Senate will get to provider issues before they go home to face elections,” said Tom Connaughton, AAHomecare's president.

Consequently, AAHomecare is planning for a political battle in September, when negotiators from the Senate and the U.S. House of Representatives could meet to decide the ultimate fate of DME competitive bidding.

“We're going to have a mini legislative conference on September 18,” said Julie Phillips, AAHomecare's director of communications. “Right around the time when [lawmakers] will be making these decisions, we'll have people lobbying on the Hill.”

AAHomecare is sending registration information for the free event — which will convene at the Hyatt Regency Capitol Hill — to all association members.

For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.