Between a rock and a hard place

WASHINGTON — Industry insiders are encouraged by reports that Sen. Bob Graham (D - Fla.) may be less inclined to advocate for nationwide competitive bidding in the next Congress. If Graham does change his tune on NCB, it would mark a major victory for the industry. On Oct. 10, Graham and Phil Gramm (R-Texas) introduced a bill that would impose national competitive bidding on DME. The reports are being very quietly peddled by Graham's staff, say insiders, and could go some way toward defeating competitive bidding if it rears its head as stand-alone legislation next year. Graham's office denies the rumors. "We haven't even done our planning session for next year, so that would be an inference that people are making," said one staffer. "The administration is driving this train with how much money they need. They're in trouble with their budget. It's up to them. They have been supportive of [competitive bidding] in the past." That outright denial hasn't discouraged sources who believe that Graham may begin to insist that the demonstration project be completed before Congress considers rolling out NCB. "He does not want to be the lead dog on [NCB] next year," said one source. As the industry continues the fight immediate against competitive bidding, it's also planning for the future. At the AAHomecare Leadership Conference in February, the keynote presentation and panel will discuss "potential payment mechanisms for the future that recognize homecare's value-added services." The conference dovetails with AAHomecare's Future of Reimbursement Committee, which formed early last year with the goal of doing some long-term planning. "We're just tossing around ideas at the moment," said committee chair Tom Ryan. "I don't want everyone to sit back and say, 'Let's look at the future and forget about the immediate fight.' As the competitive bidding battle goes on, we also have our sites on the horizon of what may be the future of reimbursement. We need to weigh in on that." Whatever the future holds, competitive bidding is still bad policy that will put many HMEs out of business, according to Ryan. Providers must continue to impress that fact upon their senators and representatives, he said. Les DeFelice sits on the Future of Reimbursement Committee and called the industry's lobbying against national competitive bidding unified and accurate, but acknowledged "we've got some big political winds that are tough to deal with." Those political winds include possible givebacks for doctors and other provider groups and a prescription drug bill. Lawmakers view cuts in the Medicare DME budget as a way to help pay for those expenses. Despite that, up to this point there's reason to be cautiously optimistic with the industry's strategy, said AAHomecare Chairman Steve Knoll. That strategy included, among other things, an all out blitz to educate lawmakers about the DME industry and how NCB could drive many providers out of business, hurt beneficiary access and not save nearly as much money as projected. "I don't think Congress has ever been as well informed about the DME industry and what it does," Knoll said. "And I think the industry was effective in creating enough concern about national competitive bidding that it didn't pass. It may be only half time, but we are ahead." HME