COLUMBUS, Ohio--Medicare competitive bidding is on hold nationally, but a similar Medicaid program called “value purchasing” is on the table in Ohio, and members of the Ohio Association of Medical Equipment Services are prepared for a fight.
Last week, OAMES Executive Director Kam Yuricich testified at a public hearing on the matter before the Ohio Department of Job & Family Services. Yuricich told officials the restrictive nature of value purchasing for incontinence supplies would create "inefficiencies and breakdowns in the continuity of care and the myriad of health care professionals serving Medicaid customers.”
Yuricich pointed to flaws in Medicare's national competitive bidding program and its recent delay by Congress. Ironically, she noted, the day after the House of Representatives voted to stop competitive bidding was the day the ODJFS filed rules to proceed with value purchasing in the state.
“ODJFS has frequently pointed to the Medicare program as one of the motives for implementing selective contracting in Ohio. They've reported that 'Ohio received an affirmative response to its selective contracting Request for Proposal (RFP) for incontinence garments from CMS on Nov. 2, 2007.' In light of CMS' own failure to launch its program successfully, having the federal agency's approval offers no reassurance that Ohio should move forward. In fact, for Ohio Medicaid to proceed with these rules and implement a contracting program when CMS' national model was just halted by Congress is irresponsible and completely unfair to our state's Medicaid beneficiaries,” Yuricich said.
Yuricich said that while value purchasing currently only affects incontinence supplies, OAMES is sure that additional DME will be added to the program.
“While today's proposed rule change only affects incontinence supplies, we expect ODJFS will proceed with other medical products as indicated by the blanket selective contracting rule earlier this year. Thus, we wholeheartedly believe that the careful coordination of a patient's care by HME providers today will unravel as more products are subject to competitive bidding and more providers are eliminated by value purchasing,” she said.
In 2005, a commission charged with drafting recommendations to reform Ohio's ailing Medicaid program recommended that the state implement selective contracting for DME. But according to OAMES, Medicaid programs in Pennsylvania, Idaho and Minnesota have all abandoned efforts to implement such contracting for DME products.
If Ohio chooses to go forward with its program, Yuricich said, the state could see disastrous results. Instead, she asked the ODJFS to pursue "true reform.”
“True reform can be achieved in an objective exercise between the industry and ODJFS without dismantling the HME community by auctioning selected health care services in a move that threatens Ohio jobs, disrupts continuity of care and wipes out personal and professional relationships between patients and health care providers in their local communities,” she said.
“If home-based DME services are reviewed in isolation to other Medicaid benefits, unintended consequences such as increases in medical transportation or emergency room visits or poorer health outcomes caused by decreasing patient compliance or delays in timely hospital discharges, are likely to occur. This is not 'reform' but simply reducing costs in one benefit by shifting it to another. We call it the 'silo effect' and it is a dangerous, short-sighted logic for developing public policy.”
Yuricich told the ODJFS that if the state decides to proceed with implementation of a selective contracting program, OAMES will prepare "to make a case to invalidate the rule ... We firmly believe a government-run contracting scheme is not in the best interest of the Medicaid program and its beneficiaries, the taxpayers, health care professionals nor Ohio’s small business community."
OAMES reported that after the Aug. 12 hearing, ODJFS changed the Medicaid incontinence supplies rule to 'To Be Refiled' status.
While this is a positive development, it does not mean the program has been removed permanently, OAMES cautioned. The organization said it would continue to fight the value purchasing program for Ohio Medicaid and “will reach out to ODJFS officials and request a meeting to openly discuss options to help the department achieve its objectives without the implementation of a controversial and anti-competitive contracting program.”
Written testimony was also submitted by the American Association for Homecare, The MED Group, the Ohio Pharmacists Association, the Ohio Provider Resource Association and the United Ostomy Associations of America.
To view OAMES' full presentation at the hearing, click here.
