WASHINGTON — In an enormous leap forward in the home medical equipment industry's intense efforts to halt DMEPOS competitive bidding, Reps. Fortney "Pete" Stark, D-Calif., and David Camp, R-Mich., introduced bipartisan legislation Thursday calling for an 18-month delay in implementation of the troubled program.
H.R. 6252--the Medicare DMEPOS Competitive Acquisition Reform Act of 2008--would delay the first round of bidding for at least 18 months; round two would be delayed for up to three years.
In addition, Sens. Max Baucus, D-Mont., and Charles Grassley, R-Iowa, are expected to introduce a Senate companion bill to H.R. 6252 this week, industry insiders said.
“This is huge, huge!” emphasized Cara Bachenheimer, senior vice president of government relations for Elyria, Ohio-based Invacare. “Just a month ago, nobody would have put any money on this happening.”
As expected, however, the legislation comes with a price tag. Stark’s bill calls for a nationwide 9.5 percent payment reduction on products subject to the bidding program to cover its projected savings.
In working with Stark, Camp and other members of the House Ways and Means health subcommittee, which Stark chairs, the industry had been looking for a lesser across-the-board cut to offset savings that Medicare would see from the bidding program, said John Gallagher, vice president of government relations for Waterloo, Iowa-based VGM, “but the only thing offered was 9.5 percent.”
That has upset some providers who are not currently included in either round one or round two of bidding, according to Gallagher. But if the industry hadn’t accepted the offer, “it’s doubtful we would ever get a hearing again,” he said. “In an ideal world, we’d want no cuts at all, but the ‘pay-as-you-go’ environment is the political reality, and we had to agree to a cut.”
“The payment cut is a little higher than we had anticipated,” acknowledged Bachenheimer, “but by and large, the choice is between the 9.5 percent cut this year compared to a 26 percent cut next year. It’s a no-brainer.”
CMS, she reminded, has the power to institute the rates set through competitive bidding in all areas of the country, whether or not those areas are included in competitive bidding. CMS has said the round one rates average a 26 percent reduction, and those cuts could be applied to all providers as early as next year. “Some people forget that CMS has that authority,” Bachenheimer said.
There is another plus to the proposed legislation, she added. Under the Stark-Camp bill, the CPI update, which the industry lost years ago, would be reinstated for all items in 2010 and continue through 2013. “Then we would get a two percent increase in 2014,” Bachenheimer said, referring to the items that would have been subject to the 9.5 percent reduction.
Seth Johnson, vice president of government affairs for Pride Mobility Products, Exeter, Pa., said the bill also contains another victory for the industry and Medicare beneficiaries. “The Stark bill would carve out complex rehab [from competitive bidding],” he said. “It would, however, be subject to the 9.5 percent reduction.”
Bachenheimer said the bill has been placed on an expedited track and could be voted on Tuesday. The bill’s sponsors only do that, she said, if they are confident they have the votes to get it passed.
“This is the best package that we can possibly get,” said Bachenheimer. “We certainly need industry consensus on this issue. We have a lot of people on Capitol Hill doing a lot of hard work and they need to hear that the industry is 150 percent behind them.”
AAHomecare endorses H.R. 6252
In a statement issued Friday, the American Association for Homecare
urged passasge of the Stark-Camp measure.
“The American Association for Homecare sought an across-the-board reduction to all DME items and not just the bidding product categories selected by CMS,” said Tyler Wilson, president. “An across-the-board cut would have resulted in a smaller percentage reduction in reimbursement. However, the association was unsuccessful in getting its position included in the final legislation and AAHomecare elected, after careful consideration, to accept the Ways and Means Committee package rather than risk implementation of round one of bidding.”
Added Wilson, “This bill is critical to making important improvements to Medicare policy that will protect America’s seniors and people with disabilities who depend on home medical equipment and services in their homes. If allowed to go forward, the bidding program will put thousands of qualified home care providers out of business and reduce patients’ access to quality home medical equipment and services.”
Earlier this month, 132 House members--nearly a third of its membership--signed a letter asking Stark, Camp and other members of the Ways and Means Committee to support a delay of competitive bidding. And last week, 40 members of the Senate signed on to a letter calling for legislation to delay the program.
In a press release on H.R. 6252 issued by Stark, he said he would work with colleagues “for its swift passage so that the program can be redesigned to meet the needs of patients, providers and taxpayers.”
In addition to AAHomecare, Stark’s release listed a number of organizations supporting H.R. 6252, including:
- American Academy of Physical Medicine and Rehabilitation
- American Podiatric Medical Association
- American Society of Transplantation
- Consortium for Citizens with Disabilities Health Task Force
- Health Industry Distributors of America
- Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition
- National Coalition for Assistive and Rehab Technology
- National Community Pharmacists Association
- Orthotic and Prosthetic Alliance
- Pedorthic Footwear Association
- The Endocrine Society
- Vision Council of America
- Wound Ostomy Continence Nurses Society
Medicare ‘doc fix’ package also in the
works
Stark’s bill isn’t the only one needing support. In the
Senate, as Baucus and Grassley work toward a compromise Medicare
“doc fix” bill--which would stop a 10.6 percent
physician pay cut set to take effect July 1--the industry needs to
back Grassley’s version, said Pride’s Johnson.
The goal is for the final Medicare package to include language that would delay competitive bidding, repeal the oxygen cap and transfer of ownership, carve out complex rehab and retain the first-month purchase option for power wheelchairs. If a bipartisan Medicare package can make it through Congress, Johnson and others said, the president is unlikely to veto it.
Grassley’s current bill does not include any cuts to home care, and it eliminates the 36-month cap on oxygen and the transfer of equipment ownership to the beneficiary mandated under the Deficit Reduction Act. Baucus' version includes cuts both to oxygen and standard PWCs.
“From the industry’s perspective, we need to support Grassley,” Johnson said.
Gallagher called on all providers to contact their legislators and voice support for the Stark-Camp bill in the House and also for the provisions in Grassley’s bill in the Senate.
“We as providers need to be contacting our House of Representatives and saying we approve Stark’s amendments and section 142 of Grassley’s bill, which would repeal the oxygen cap, and talk to the senators and say the same thing,” said Gallagher. “If it’s the same language in all three bills, we’ve got a chance.”
He pointed out that winning a delay in competitive bidding could be a huge boon to the industry in another way. “It gives us the opportunity with a new administration … to right the ship and look at fee-based service components,” he said. “There’s a lot to like about this.”
After several years of pouring efforts into fighting competitive bidding, the HME industry is closer now to winning the battle than it’s ever been, stakeholders said.
“We’re close, but we’re not there yet,” cautioned Bachenheimer, “so it’s still important at a grassroots level for providers to communicate with their legislators.”
If providers don’t get behind the legislation, warned Gallagher, “the alternative is losing thousands of providers in both rounds one and two. We can hang together, or we can surely hang separately.”
It could all be over in a couple of weeks, he said. “Time is of the essence.”
