Rep. Thomas goes to bat for HME industry

Sunday, May 23, 2004

May 24, 2004

WASHINGTON -  Providers received some support last week from an unlikely source: Rep. Bill Thomas, R-Calif., the lead architect for many of the DME reimbursement cuts included in the Medicare Modernization Act.
In a May 13 letter to industry supporter Rep. David Hobson, R-Ohio, Thomas agreed that any DME reimbursement cuts based on the Federal Employees Health Benefits Program should be made on solid data.
“(Thomas’ letter) acknowledges that Hobson has some valid points,” said Cara Bachenheimer, Invacare’s vice president of government affairs. “If I was CMS, I would be looking and thinking a little harder perhaps before just blindly implementing the reductions. I’d do something to cover myself.”
The MMA calls for reimbursement cuts as high as 20% in 2005 for five key HME products: nebulizers, diabetic supplies, power wheelchairs, oxygen and hospital beds/air mattresses. Hobson has drafted legislation that if passed would repeal the FEHBP cuts.
In his letter, which he sent in reponse to a letter Hobson sent him, Thomas addressed industry concerns that basing DME cuts on  FEHBP pricing is like comparing apples to oranges.
“During the rulemaking to implement this provision, the Secretary should also evaluate whether there are significant clinical differences between the two populations - FEHBP and Medicare - which may affect the price of DME,” Thomas wrote.
He also stated that CMS should gather additional pricing data before making any cuts and make sure that data already gathered was “a representative set upon which Medicare reimbursement should be based.”
He concluded by saying: “I look forward to working with you and the Bush Administration to ensure the most appropriate payments for durable medical equipment.”
The MMA legislation doesn’t require CMS to gather additional data before implementing the FEHBP cuts. Thomas’s letter, however, indicates that CMS is responsible for using reliable data, Bachenheimer said.
It also provides the industry with additional ammunition in its fight to stave off the cuts, she said.
“It puts the responsibility on the industry to show the (FEHBP) data is skimpy and not representatives of Medicare products and the package of service provided to beneficiaries,” Bachenheimer said.