Rehab leaders still split over how to tackle NCB

Monday, January 31, 2005

WASHINGTON - With the industry preparing to take up the fight this year against national competitive bidding for DME, rehab leaders still disagree over how to play their cards.

Do they take a stance that competitive bidding is inevitable and lobby that custom rehab be excluded? Or do they stand with providers of other product lines and try to torpedo the entire thing?

It’s a schism that concerns Jim Greatorex, vice president of the New England Medical Equipment Dealers Association.

“I worry about the effectiveness of splitting the message,” said Greatorex, a rehab provider and co-owner of Black Bear Medical in Portland, Maine. “I’m personally in total agreement that rehab should be cut out of the competitive bidding process, but being vice president of a state association, I have a hard time leaving the rest of the industry to fight it alone.”

The Medicare Modernization Act mandates that CMS implement competitive bidding in 2007. The agency began discussions on how to do that last fall. Those discussions will intensify this year, and the industry has begun to ramp up lobbying efforts against the cut accordingly.

In this high stakes fight, AAHomecare and the National Coalition for Assistive and Rehab Technology have chosen different strategies.

NCART has thrown its weight behind a lobbying effort to exclude or carve-out high-end rehab. The group sponsored a rehab fair and Washington fly-in last month to drive home its point to lawmakers. High-end rehab is complex, labor intensive and requires a high degree of customization. Those variables make it almost impossible to competitively bid rehab services, NCART argues.

“I find it hard to believe that national competitive bidding will work for DME, but I find it more difficult to see how it can be extended to the specialized rehab products that NCART people do,” said NCART member Bruce Bayes, president of Custom Mobility in Largo, Fla. “How do you compare apples to apples when you are dealing with an individual with specific and unique needs?”

AAHomecare officials argue that competitive bidding would be bad for all providers, not just rehab professionals. Likewise, as a national organization, AAHomecare is obligated to lobby for the interests of all its members, not a particular market segment, said Matthew Burke, chairman of the association’s Rehab and Assistive Technology Council.

Any carve out should represent a segment of providers - rural HMEs for example - and not specific HCPCS, Burke said.

“You could say you want a carve out for rehab providers, but there is no definition for that,” he said. “You can’t open a book and say, ‘I’m a rehab provider.’”