Rep. Thomas goes to bat for HMEs

Wednesday, June 30, 2004

WASHINGTON - Providers received some support in May 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’s 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 was 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.”

Seth Johnson, director of government affairs at Pride Mobility Products and a former AAHomecare staffer, said the association appreciates Thomas’s support. The MMA legislation, however, doesn’t appear to require CMS to gather additional data before implementing the FEHBP cuts, he said.

Thomas’ letter is “better than a kick in the head, and you don’t want to look a gift horse in the mouth,” added John Gallagher, VGM’s vice president of government affairs. “But to insure that something is done, it will have to be done through the legislative process.”

Thomas’s letter, however, indicates that there may be some uneasiness among lawmakers regarding FEHBP data. By gathering additional data that proves the current FEHBP numbers don’t add up, the industry strengthens its argument that the cuts should not be implemented, say industry sources.

“And we’d better do it right, or it will be looked at with a jaundiced eye,” Gallagher said.