In the Trenches

The industry's fight to fix or prevent competitive bidding has been a hard-fought political and policy battle waged in the trenches. It seems as though every inch of progress has required an intense struggle.

A few recent developments are worth reciting.

• In a letter delivered to Health and Human Services Secretary Michael Leavitt in June, the American Association for Homecare strongly recommended that standard and complex rehab be removed from at least the first round of the competitive acquisition program. The letter, drafted by AAHomecare's Rehab and Assistive Technology Council, stated:

  “Power wheelchairs are provided to individuals with disabilities such as spinal cord injuries, cerebral palsy, amyotrophic lateral sclerosis, multiple sclerosis and other diseases or disabilities that are progressive in nature. Because of the profound and progressive nature of these diseases and disabilities, many power wheelchair products and services are highly individualized. The products must be assembled, fitted, serviced and monitored to accommodate each person's individual medical needs …

  Clearly these are not the types of products or beneficiaries intended for competitive bidding.”

• In mid-July, 14 U.S. senators and 65 representatives signed letters to CMS urging Medicare to extend the deadline for competitive bidding until quality and patient access issues are resolved. The bipartisan group asked CMS to take specific steps to ensure that implementation of the bidding program does not harm quality or beneficiary access to home care.

  The signatories to the letter listed concerns about how CMS will assess the effectiveness of the bidding program with respect to clinical outcomes for patients; the compressed timeline for implementation of the bidding process; and Medicare codes that in many cases are overly broad, inconsistent and confusing.

  State home care associations, other national provider associations, buying groups and AAHomecare joined forces in this effort.

• Throughout June and July, AAHomecare fielded numerous calls from providers who encountered severe problems submitting bids through the online bidding program. We, in turn, conveyed these problems to key contacts at CMS.

  In some cases, our calls and e-mails helped to resolve the problems quickly. In other cases, the calls helped to highlight the ongoing problems with the bidding system.

• On July 20, we convened a call with CMS officials and with other national provider associations to review specific problems.