Our work never stops

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Monday, September 30, 2019

The bids are in for Round 2021. Now the HME community will wait until sometime next summer to see the prices set through the bidding process and a final announcement of contracted suppliers in the fall of 2020. The uncertainty as to how Medicare reimbursement rates will shake out presents business planning challenges for every segment of the HME sector, whether a company is in a bidding area or in a non-bid/rural area using bidding-derived pricing. The results will also impact rates from the spectrum of MCOs, Medicaid authorities, Tricare, and private payers who peg or negotiate their fee schedules off of Medicare rates.

How the rates will compare to those currently in effect is impossible to predict. There’s cause for optimism that bid-bond requirements will keep less-serious bidders and those simply looking to subcontract winning bids out of the mix. A raise in the bid ceiling, bona-fide bid requirements and analyses, and a change in the bid methodology to use maximum winning bids to determine lead-item prices should also have a positive impact on the final rates.

Collaboration is key

Even before CMS finalized details for Round 2021, HME stakeholders began work to develop resources to make sure suppliers understood changes to the program and were prepared to bid in the next round.  AAHomecare, VGM, the Council on Quality Respiratory Care and the Healthcare Nutrition Council partnered to develop the DMECBPEducation.com website, a comprehensive resource pulling together details and deadlines for Round 2021 in one simple-to-navigate location. In addition to sections explaining everything from financial documentation requirements to business ownership rules, the site featured video tutorials on key subjects from HME experts.

The site also included calculators designed to show how the bids using CMS’s new lead-item bidding approach will also impact prices for other products in 16 bidding categories. These calculators employed calculations based on ratios from calculators developed by the Competitive Bidding Implementation Contractor, with additional features allowing users to compare results to 2019 rates and factor in their own costs.

The popularity of these calculators, with more than 12,000 user downloads as of this writing, is perhaps the strongest testament to the value of the multi-stakeholder investment in making sure suppliers had access to a host of resources to help them bid smart in Round 2021. I’m especially proud that AAHomecare staff and members of our Regulatory Council played a leading role in developing the calculators, and I’m very appreciative of the contributions of our partner organizations and the dozens of individuals who collaborated on the site. It’s a great reminder of what this industry can accomplish when we pull together.

Keep ventilators out

While the bidding for Round 2021 closed in mid-September, that doesn’t mean that AAHomecare is done working to change the shape of the program before the new rates take effect 14 months from now. Specifically, we’re continuing to work with respiratory stakeholders in our industry to build support on Capitol Hill for legislation to remove non-invasive ventilators from the bidding program. 

Thanks to the active support of major patient advocacy organizations and clinician groups who understand the potential consequences of subjecting highly specialized life-support systems to a reimbursement methodology designed to determine the lowest-cost supplier, we made a strong impression on Capitol Hill.  In the space of just a few weeks, the HME community and these advocacy groups convinced more than 40% of the House of Representatives and Senate to join congressional sign-on letters asking CMS to keep non-invasive ventilators out of the bidding program.

CMS has made it clear that they would like to continue to expand the bidding program to cover as much of the HME product spectrum as possible, so the scope of the bidding program is going to remain a battlefront for our industry in the years ahead. AAHomecare has been a part of past successes in keeping several product categories out of the bidding program, including complex rehab wheelchairs, urologicals, orthotics, prosthetics, inhalation, and ostomy supplies.  We need to add non-invasive ventilators to that list.

I hope that you’ll add your voice to efforts to keep non-invasive ventilators out of the bidding program as we work to advance a legislative fix in the coming months. Even if you’re not involved in the respiratory sector, we need your support. The bids may be in, but we can still make Round 2021 better for respiratory specialists and the patients and family caregivers who critically depend on these products.

Tom Ryan is president & CEO of the American Association for Homecare. Find him on twitter at @TomRyanHME.