Powerful commission raises eyebrow at HME

Friday, October 31, 2008

WASHINGTON--A meeting of the Medicare Payment Advisory Commission (MedPAC) on Sept. 4 made it clear that the HME industry has its work cut out for it on a number of fronts.

“I think that there were many comments made (by MedPAC) that were generalizations lobbed at HME that require intensive follow-up,” said Walt Gorksi, vice president of government affairs for AAHomecare. “MedPAC’s recommendations carry significant weight with policymakers.”

MedPAC is an independent advisory council made up of experts across the healthcare spectrum. It is tasked with ensuring beneficiaries receive the highest possible level of care and the government spends taxpayer money wisely, said Gorski.

One issue that resurfaced: Internet pricing. In particular, according to AAHomecare:

- The commission chairman indicated that, “there is a seemingly egregious problem between what Medicare is paying and the generally available prices.”

- MedPAC staff repeated a statement by CMS Administrator Kerry Weems, who testified before Congress in May that Medicare prices for DME items inaccurately compare to Internet prices, and that little in the way of services is involved in the DME benefit.

“I am not surprised that the issue of Internet pricing has not gone away,” said Michael Reinemer, AAHomecare’s vice president of communications and policy. “That is an issue we need to address very aggressively and with a lot of thought.”

With the delay of national competitive bidding and the enactment of the Medicare Improvements for Patients and Providers Act of 2008, it comes as no surprise that the HME industry is in MedPAC’s spotlight, said Gorksi.

“It’s an issue that has a lot of focus on it at the moment,” he said.

MedPAC supports NCB, said AAHomecare. Its staff said the program provides a means of arriving at “realistic pricing while weeding out providers prone to fraud—with no reduction in patient access to care.”

But the door may be open to winning them over, said Seth Johnson, vice president of government affairs for Pride Mobility Products.

“The one thing that was clear to me was that MedPAC didn’t indicate they are going to investigate NCB,” he said. “It’s imperative that we make sure MedPAC understands the role of HME providers and the level of services they provide.”