Healthcare reform: 'A lot is in flux'

WASHINGTON - Members of the Senate last week were expected to work into the weekend to meld two healthcare reform bills, but industry stakeholders didn't expect them to make any major changes to the HME provisions in play.

"None of our provisions are under negotiation," said Cara Bachenheimer, vice president of government relations for Invacare.

The Senate's goal was to have its proposal on the Senate floor this week, but that appears unlikely, say industry stakeholders.

"They still have some significant issues to work out," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "It could go into the third week of November because they are not in session the second week."

Once the Senate agrees on a bill, it will seek a new score from the Congressional Budget Office.

One surprise on the Hill last week: the Senate voted 53 to 47 against a permanent fix to Medicare reimbursement for physicians. The plan would have cost $247 billion over 10 years. While that takes a little pressure off HME providers, who could have been targeted to pay for the so-called "doc fix" through reimbursement cuts, it could further slow healthcare reform, said John Gallagher, vice president of government affairs for The VGM Group.

"They will need to (find a way) to bring doctors on board," he said. "The White House said, 'Help us get reform; we'll get you the doc fix.' There's a quid pro quo that's not developing now. I think that's all part and parcel for why it's being pushed back."

Some of the HME provisions included in the Senate Finance Committee's bill: a provision to expand competitive bidding from 79 to 100 cities in the first two rounds and apply competitive bid rates to remaining areas by 2016. It also includes provisions to tax manufacturers of medical devices and exempt certain pharmacies from accreditation requirements.

A provision to eliminate the first-month purchase option for power wheelchairs in 2011 has been tweaked again, for the better, said Johnson.

"They would frontload the payments," he said. "Providers would receive 15% of the total for the first three months upfront, a total of 45% within 90 days and the remainder in 6% installments rather than 7.5%. Providers would get $546 more in 90 days."

One big question: Will oxygen reform be included in the final package?

"There is some desire by the Senate Finance Committee to get rid of the 36-month cap," said Bachenheimer. "But I don't think that's going to happen this year. It still has the same CBO and other issues."

The House is still working on getting its three bills combined into one package, but it will likely wait until after the Senate bill hits the floor, said Bachenheimer.

"A lot is still in flux," she said. "The leadership of both chambers is trying to put together packages that will get enough votes."