AAH pushes unity on bid alternative

Thursday, October 27, 2011

ATLANTA – The HME industry needs to resist the urge to pick apart a new market pricing program (MPP) for HME, said Walt Gorski during the AAHomecare Washington update at Medtrade last week.

So far, MPP, an alternative to the current competitive bidding program, has been “well received” on Capitol Hill, said Gorkski, vice president of government affairs for AAHomecare.

“This is head and shoulders above where we are right now,” he said. “There’s not going to be a lot of room for negotiation, If there’s disunity, it’s going to be set aside.”

Provisions of MPP include using a clearing price instead of a median price as the single payment amount; making contracts binding; and restricting bid areas to smaller areas.

One provision that stakeholders, including AAHomecare, predict will be the toughest pill to swallow: maintaining Round 1 until the MPP is implemented, but allowing unsuccessful bidders to enter similar contracts to supply bid products at bid rates.

“(Round 1) is the reason we’re having this conversation,” said John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers (PAMS), who was involved in developing MPP. “The program is flawed. It put in place unsustainable bid rates.”

Gorski said he doesn’t disagree, but that scrapping Round 1 and redoing it using the MPP was a proposal that resulted in a “resounding thud” with lawmakers.

“We didn’t take (the provision) lightly,” he said. “It was the hardest provision.”

Stakeholders, including Shirvinsky and the Florida Alliance of Home Care Services, have since offered alternatives to maintaining Round 1, such as adjusting the single payment amounts based on clearing prices.

The industry’s best bet at moving MPP forward is the deficit reduction bill that the so-called super committee is currently working on, says Stacey Rampy, a principal at Mehlman Vogel Castagnetti, a Washington. D.C.-based lobbying firm, who spoke alongside Gorski.

“What the super committee is working on is the legislative vehicle,” she said.

During the update, Gorski said the industry’s also making progress advancing an alternative to a proposal to require prepayment reviews for all power wheelchairs. The crux of the alternative: using 7-day pre-authorizations instead of prepayment reviews, and implementing a clinical medical necessity template.