Competitive bidding expansion serves as wake-up call

Thursday, March 25, 2010

WASHINGTON - For providers who have remained on the sidelines while the industry battles to stop competitive bidding, the expansion of the program should make one thing clear: It's time to get in the game.

"This thing is going to impact everybody no matter where you are or how rural of an area you serve," said Cara Bachenheimer, senior vice president of government relations for Invacare.

The healthcare reform bill, signed into law last week, expands competitive bidding to an additional 21 metropolitan statistical areas (MSAs) and applies prices nationwide in 2016.

Providers everywhere can get in the game by helping to increase the number of co-sponsors for H.R. 3790, a bill to repeal the competitive bidding, industry stakeholders say. It currently has 184 co-sponsors.

"I am looking at numbers of 250 or 260 co-sponsors," said Rob Brant, president of the Accredited Medical Equipment Providers of America (AMEPA). "Providers who are in the areas that weren't touched before--people who weren't worried--we hope now they'll get energized."

That goes for lawmakers, too. While it's still unclear which additional MSAs will be included in Round 2, certain areas, like Portland, Ore., are likely targets. So far, no lawmakers from that state have co-sponsored the bill.

"That's been my argument all along to my representative--yeah, it's not here yet, but it's still going to affect us. It's a matter of time," said Bob McLellan, president elect of the Pacific Association for Medical Equipment Services (PAMES).

The push for H.R. 3790 should continue despite the fact that the bill could require some fixes to remain budget neutral, industry stakeholders say. H.R. 3790 proposes paying for a repeal of competitive bidding by eliminating a 2% payment increase for HME in 2014, along with various CPI adjustments in 2010, 2011 and 2012. Unfortunately, the reform bill already takes away that payment increase, and it calls for an undefined "productivity adjustment" that will lower CPI updates to HME.

"We are going to have to figure something else out," said Bachenheimer. "We lost some of our pay-fors and our CPI reductions were essentially stolen from us."

With a 9.5% reimbursement cut in 2009 to delay competitive bidding, industry stakeholders aren't sure how much more providers can afford to do without.

"That's the $8 billion question," Bachenheimer said.

AAHomecare is already working with the lead sponsor of the bill, Rep. Kendrick Meek, D-Fla.

"Once the bill starts moving forward, it may need some minor changes," said Jay Witter, senior director of government affairs for the association. "But we continue to build support and seek a Senate sponsor in preparation for any legislative opportunity that comes along."