On pins and needles: Industry awaits amendments to healthcare reform bill

Sunday, December 6, 2009

WASHINGTON - The Senate last week began the tedious debate process for its healthcare reform bill, and it could be weeks before the plan is voted on, industry stakeholders warn.

"It's like watching paint dry," said Cara Bachenheimer, senior vice president of government relations for Invacare.

While industry stakeholders have seen nothing in writing yet, there may be a few amendments introduced during the debate that would affect HME.

For example, Sen. Arlen Specter, D-Pa. has drafted an amendment that would preserve the first-month purchase option for standard power wheelchairs, said Seth Johnson, vice president of government relations for Pride Mobility. The amendment is based on the "clawback" alternative proposed by the HME industry a few months ago.

"If there is a break in service prior to the 13th month, the supplier would be responsible for repaying Medicare the unused portion of what would have been paid under the rental period," he said. "Specter is in the process of gathering support for it."

The amendment is in the scoring process at the Congressional Budget Office (CBO), Johnson said.

The industry continues to press its case with lawmakers on other issues, including oxygen and national competitive bidding.

"The Senate is very keen on competitive bidding, which presents challenges for us," said Walt Gorski, vice president of government affairs for AAHomecare. "There's no word on oxygen, though we are watching very closely on that issue."

Also still in play: a provision that would tax medical device manufacturers based on market share. The tax would be levied retroactively to Jan. 1, 2009. A similar measure in the House bill wouldn't go into effect until 2013.

Providers are being squeezed from all angles, said Gorski.

"Manufacturers would have to pass along the tax to providers--in essence raising the cost of the items," he said. "Provider payments are being ratcheted down; and competitive bidding is coming at them from the side. We don't see the benefit of healthcare reform accruing to providers the same as it will to doctors and hospitals."

The 2,000-plus page document contains several HME-related provisions, including:

*    Expand Round 2 of national competitive bidding by 21 cities (from 79 to 100). Apply bid rates nationwide by 2016.

*    Eliminate the first-month purchase option for standard power wheelchairs beginning Jan. 1, 2011. Pay providers 15% of the purchase price in months one through three, and 6% of the purchase price in months four through 13. Exempt complex power wheelchairs.

*    Implement fee schedule updates each year by a "productivity adjustment," an estimated -1%.

*    Exempt pharmacies that have less than 5% of their revenues coming from Medicare's DMEPOS accreditation requirement.