Beefed up MedPAC? Industry is 'inherently suspicious'

Sunday, July 19, 2009

WASHINGTON - Industry stakeholders aren't quite sure what to make of a proposal that would give the Medicare Payment Advisory Commission (MedPAC) more power to set reimbursement rates, including those for HME.

In its current form, MedPAC merely makes recommendations to Congress on Medicare spending.

"I can't remember the last time there was a MedPAC member that actually understood home care or HME--that would be our reservation," said Cara Bachenheimer, senior vice president of government relations for Invacare. "We're always going to be inherently suspicious of a group making payment decisions, when it's highly unlikely that there'll be someone with the right expertise in there."

The White House proposal, in draft legislative form, calls for a new Medicare Advisory Council to make two reports on Medicare spending each year, one for Part A and one for Part B, according to news reports. The president would indicate to Congress his approval or disapproval of the council's recommendations. Congress could block the recommendations, only if lawmakers agree on a resolution within 30 days. The president would, of course, have veto power.

The goal, according to supporters of the proposal: To de-politicize the process.

The HME industry's exposure to the MedPAC has been limited. In a Sept. 4, 2008 meeting, the commission discussed pricing for HME. Its members echoed then-CMS Administrator Kerry Weems, who had testified before Congress on the discrepancy between Medicare and Internet pricing, and the lack of services involved in providing HME.

The MedPAC has also been an ardent supporter of national competitive bidding. In 2003, after Congress passed the Medicare Modernization Act, which required CMS to conduct competitive bidding for HME, the MedPAC endorsed the program as a way to save money without reducing patient access or quality. In March 2009, it reiterated those sentiments in a letter to CMS Acting Administrator Charlene Frizzera.

"Competitive bidding for DMEPOS appears to be a promising way to improve the accuracy of Medicare's payments for these services," the commission stated.

The HME industry wouldn't be alone in having reservations with a beefed up MedPAC.

"The Senate Finance Committee, in particular, believes it's not in the country's best interest to take the role of healthcare policy out of the hands of Congress," said Seth Johnson, vice president of government affairs for Pride Mobility Products.