WASHINGTON — The government is bringing in a power panel of witnesses to defend Medicare's competitive bidding program at a congressional hearing scheduled Sept. 15.
Called by the Subcommittee on Health of the House Energy and Commerce Committee, the hearing will "examine the conception and implementation of the competitive bidding program, the implementation of the Round 1 re-bid, and its potential effects on patients, providers, and suppliers," according to a notice.
A list of invited witnesses posted Monday includes for the government:
- Laurence Wilson, director of the Centers for Medicare and Medicaid Services' Chronic Care Policy Group;
- Inspector General Daniel Levinson from the Department of Health and Human Services' Office of Inspector General; and
- Kathleen King, director, Health Care, Government Accountability Office.
A second panel of witnesses representing various interests includes:
- Richard Lerner, president of Allcare Medical in Old Bridge, N.J., who will testify on behalf of the HME industry as a representative of the American Association for Homecare and the Jersey Association of Medical Equipment Services (see Allcare Medical to Testify at House Bid Hearing);
- Alfred Chiplin, managing attorney, Center for Medicare Advocacy;
- Nancy Schlichting, president and CEO, Henry Ford Health System; and
- William Scanlon, a health policy consultant. A commissioner on the National Commission for Quality Long-Term Care, Scanlon is a member of the Medicare Payment Advisory Commission and co-chairs the HHS Review Panel for the Medicare Trustees Reports. He has previously served as managing director of health care issues at the GAO.
An update from the Accredited Medical Equipment Providers of America calls the latter three "wild cards."
Chiplin's testimony "will probably be identical to what the witnesses from Medicare, the Government Accountability Office and the Office of the Inspector General will say," according to the group, which believes Scanlon will also side with his colleagues from CMS, OIG and GAO.
Schlichting, AMEPA said, "could discuss how the program will
make it nearly impossible to discharge patients from hospitals.
However it is anticipated that she will be pushing H.R. 6065, the
bill from Michigan Congressman John Dingell to exclude
hospital-based DME providers from the bidding program."
As background, an 11-page "briefing memo" sent to members of the subcommittee and congressional staff gives a rundown of "issues in pricing and integrity of DMEPOS," including "numerous reports over several decades" in which the GAO and OIG have documented overpayments, improper payments and instances of fraud.
The brief also includes a list of the single payment amounts recently announced as a result of the Round 1 rebid, noting that "average price savings across all product categories was 32% for both the federal payment and for beneficiary cost sharing obligations."
For oxygen concentrators, the memo gives as an example, "average monthly payment in competitive bidding areas will be reduced from $173 to $116, a reduction of $46 per month for federal Medicare payments and a reduction of $11.40 for beneficiary cost sharing. Over 3 years (the maximum payment term for oxygen equipment), the Medicare savings for an oxygen concentrator will total $1,642, and the beneficiary cost sharing savings will be $410, on average."
The hearing room could prove a tough battleground since most HME stakeholders consider competitive bidding and its "suicidal" rates the industry's overarching threat.
"It looks like the people there from the government are going to be the people who are going to talk about fraud and abuse in DME," said Dave McCausland, senior vice president of planning and government affairs for The Roho Group, Belleville, Ill. "They are not going to talk about whether the [competitive bidding] program makes sense or not." (See Save Homecare Now for more from McCausland.)
Nevertheless, industry advocates may get some help. Of the 35 subcommittee members, 19 representatives have signed on as cosponsors of H.R. 3790, the bill that would repeal the bidding program.
"I want to see beneficiaries getting quality goods and services and fair and equitable reimbursement for DME," McCausland said. "To do that, the parties need to work together. Right now, we are not even talking the same language."
The hearing will begin at 10 a.m. Wednesday in Room 2123 of the Rayburn House Office Building.
A PDF of the full briefing memo is available on the health subcommittee's hearings page.
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