The industry needs to add a tune

 - 
Saturday, November 30, 2002

While AAHomecare remains a
steadfast opponent of nationwide competitive bidding (NCB), the time has come for vigorous consideration of another message it must carry onto the Hill when Congress reconvenes in January: If you are going to require competitive bidding for products needed by Medicare beneficiaries, the legislation needs to look like this…

The 'this' is what the industry needs to start talking about, and what it needed to start talking about yesterday. Should the Federal Acquisition Regulation be part of NCB, or not? (It's not now.) Should industry serve in an advisory capacity to the development of an NCB program, or not? (The House bill says yes; the Senate bill says nothing.)

These are just two examples of who knows how many various issues are going into the development of NCB. The industry might continue to say no, no, no to competitive bidding, but if that's the only tune we're carrying come January, it may very well sound a little bit like 'Nearer, My God, to Thee' when Congress calves the iceberg that cuts the industry's hull.

So far, the industry has made very little noise (at least we've not been hearing it) about what to do if NCB does come.

"Maybe that was appropriate up until now," says Cara Bachenheimer, a healthcare attorney at Epstein Becker & Green. "The industry has been focused on lobbying against [NCB], and we can continue to lobby against it, but it's not inconsistent to say, 'Hey let's take a look at where we might be and do the best we can to prepare."'

At Invacare, Dave Williams, director of government affairs, is appraising the stark reality from a similar vantage point. Acknowledging that the effort to defeat competitive bidding must remain in force, "how will we begin to shape it" if it becomes a reality has to become part of the conversation the industry has with itself.

If the next Congress delivers NCB, we're not likely to see it for another two-three years. There will be time to sort through the impact NCB has on state Medicaid programs, for example. Since the source of Medicaid's fee schedule is Medicare's fee schedule, what will it mean for Medicaid if NCB slashes reimbursement for home oxygen therapy the way it did in Polk County? (Perhaps it will mean you'll have to pay beneficiaries for the privilege of supplying home oxygen therapy.)

Those kinds of issues can be sorted through later, but again, the industry wants to ensure that it's in the most influential position possible to help guide policy on the tricky repercussions posed by passage of NCB.

"We can't afford to change horses" in midstream, said Williams, "but we can redirect the horse. We can pull the reins tighter and really focus on developing a focused message that is understood by every provider."

Make no mistake. The industry believes competitive bidding is bad for Medicare beneficiaries. There's no need to back off that message. But it is time to acknowledge that the possibility of NCB exists, and if it will exist, that it should have the industry's hand in its development.

Unless of course your hand's otherwise busy, playing out the waning notes of Nearer, My God, to Thee. HME

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