Competitive bidding: Industry awaits score, prepares to rally

Thursday, July 22, 2010

WASHINGTON - With CMS projecting competitive bidding will save $17 billion over 10 years, the industry may have to open its wallet a little wider than it expected--wider than it can afford, some stakeholders fear--to repeal the program.

Earlier this year, officials at the Congressional Budget Office (CBO) said it would cost the industry $9.6 billion over 10 years to repeal the program. But that was based on an average reimbursement cut of 26% for Round 1, stakeholders say. In July, CMS officials announced an average reimbursement cut of 32% for Round 1.2.

Now CBO officials are taking another look at H.R. 3790, the industry's bill to repeal competitive bidding, and stakeholders suspect its score will come in higher than $9.6 billion.

"I expect it to be closer to $11 billion, but if it's $17 billion, I don't think the industry can afford it," said Wayne Stanfield, president and CEO of NAIMES. "Analysts estimate that would be a 20% cut. It would be unreasonable to ask the industry to pay that."

The CBO's re-score of H.R. 3790 could happen in "the next few weeks," stakeholders say.

As an independent agency, the CBO won't necessarily go along with CMS's projections, stakeholders pointed out.

"A lot of times, they don't necessarily agree," said Jay Witter, AAHomecare's senior director of government affairs.

Even so, the possibility of a more costly score, coupled with the industry's difficulty getting a companion bill introduced in the Senate, have providers "dismayed." But there's no time for that, stakeholders say.

"This issue is not over by any means," said Cara Bachenheimer, senior vice president of government relations for Invacare. "We have a whole bunch of things in play, and we're going to have to really build momentum in the next few months."

Those things include CMS announcing the winning bidders in September (which could give the industry fodder for its anti-competitive bidding message); Congress holding two hearings on competitive bidding that same month (which could give the industry an opportunity to tell its side of the story); and Congress taking up two Medicare-related bills before the end of the year (which could serve as vehicles for H.R. 3790).

"Once we have a score and a Senate companion bill, we'll be in a strong position to advance a plea in September or a lame duck session after the election," said Seth Johnson, vice president of government affairs for Pride Mobility Products.