How will they cut Medicare?

WASHINGTON - The waiting game continues for an HME industry already reeling from competitive bidding and other reimbursement cuts this year.

As part of a debt deal passed by Congress Aug. 2, a 12-member "super committee" will be charged with shaving $1.5 trillion from the deficit by November. If the committee fails, spending will be cut by $1.2 trillion automatically. That includes a 2% across-the-board cut to all Medicare providers.

"It's going to be a crazy fall," said Cara Bachenheimer, senior vice president of government relations for Invacare.

HME providers in nine cities are already stinging from a 32% cut, on average, as part of Round 1 of competitive bidding. Providers are also stinging from the elimination of the first-month purchase option for standard power wheelchairs. Both went into effect Jan. 1.

Still, industry stakeholders expect HME-related cuts to be on the table when the committee meets to write its report. These three proposals made the rounds in discussions leading up to the debt deal: apply Medicare competitive bidding rates to Medicaid payments in those states where the program has been implemented; require prepayment review for power wheelchairs; and reduce diabetic strip pharmacy payments.

"I think the same things that were on the table before will be on the table again," said Wayne Stanfield, executive director of NAIMES.

Complicating matters further: The one-year, temporary "doc fix" to avoid cuts to physician payments expires in December. Industry stakeholders suspect lawmakers will seek another short-term fix, but that will require making further cuts.

"The big question right now is will the committee include the doc fix in their report or will lawmakers move on that separately," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "If they move separately, a doc fix bill could provide an additional vehicle for a competitive bidding alternative, but it could also provide a significant threat for more cuts to DME as they look to pay for the doc fix."

During the August recess, stakeholders are encouraging providers to reach out to lawmakers to promote the cost-effective role that HME providers play in the continuum of care. Providers should also point out that reimbursement for HME has been cut repeatedly and disproportionately in the past few years.

"We're on everybody's list, but we know what we have to do," said Michael Reinemer, vice president of communications and policy for AAHomecare. "We know what the message points are."