Competitive bidding update: New allies, old tricks

Friday, August 10, 2012

WASHINGTON – HME stakeholders are close to “locking down a commitment” from a lawmaker to sponsor their market-pricing program (MPP), according to Seth Johnson.

Johnson, vice president of government affairs for Pride Mobility Products, says stakeholders believe they have found a way to move forward with a bill for MPP in September, with or without a score from the Congressional Budget Office (CBO).

“We’ve talked to a few offices and it does appear as though we can get the bill introduced without a score,” he said. “But it will likely require some type of agreement—whether it’s written in the bill or it’s a commitment from the industry—that MPP will be budget neutral.”

The lack of a score has being the biggest obstacle stakeholders have faced in getting a bill for MPP, the industry’s alternative to competitive bidding, introduced.

There were two other developments last week that boosted the industry’s efforts. First, Al Lewis, a Brandeis University professor who’s an expert in health management measurement, sent a letter to top administration officials on Aug. 6 that shoots holes in CMS’s methodology for tracking the impact of competitive bidding. By analyzing claims within only a 120-day period, Lewis says CMS leaves out beneficiaries who become non-compliant and who may be at risk for worse outcomes, creating “inaccurate and unreliable data.”

“Every piece of evidence like this adds to the pile and stacks up, and at some point it’s going to break,” said Wayne Stanfield, president and CEO of NAIMES.

Second, stakeholders were baffled last week when providers who submitted bids for Round 2 of competitive bidding reported receiving emails from CMS asking them to confirm their licensure status. Providers say they received the requests even though they have already provided the required documentation or they submitted bids in states, like California, that they believe don’t require licensure. Just the same, stakeholders recommend providers follow-up.

“This same thing happened in Round 1—providers who had submitted hard copies of their documentation were being asked to resubmit it like CMS never got it,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “I’m not surprised, but I’m a little disappointed.”

Stakeholders say these developments give the industry momentum going into what will likely be a busy fall and winter on Capitol Hill.

“The goal is to have a sponsor for the bill lined up in the House by September so we can build up co-sponsors and we can get the bill advanced in the lame-duck session,” Johnson said. “We’re hopeful.”