Competitive bidding's $20 billion question

WASHINGTON - If not competitive bidding, then what?

That is the question that HME stakeholders must answer eventually to get the unpopular program repealed, say stakeholders.

"We've heard that asked from industry supporters in Congress," said Seth Johnson, vice president of government affairs for Pride Mobility. "I don't think the industry is prepared to answer that question at this point."

The challenge is finding an alternative that saves the $20 billion CMS estimates competitive bidding will save over 10 years.

To delay competitive bidding in 2008--never mind repeal the program--it cost stakeholders a 9.5% reimbursement cut for all included product categories. Additional cuts aren't a good alternative because with the 9.5% cut, on top of others over the years, there's not a lot left to give, says AAHomecare's Walt Gorski.

"No other healthcare provider has had their payments adjusted as much since the inception of the fee schedule," said Gorski, vice president of government affairs. "Our long-term goal needs to be to look at how to account for services within the bundled HCPCS payment. There's a real disconnect between what the homecare community and CMS think is a reasonable amount for services."

Stakeholders have indicated that there are behind-the-scenes discussions taking place on alternatives to competitive bidding, but they say it's a complicated process.

"Medicare has set the marker so there is no other precedent for what we are doing," said Cara Bachenheimer, senior vice president of government relations for Invacare. "We have to come up with something that assures the government they are paying appropriately."

Getting there is the tough part. Discussions like these can take years, often using an academic "think tank" model. The problem: The industry doesn't have the luxury of time, Bachenheimer said.

"This is something we've got to get our arms around sooner rather than later," she said. "If this were easy, we would have figured it out years ago."