BELLEVILLE, Ill. - It may too late for Round 1 of national competitive bidding, which kicks off Jan. 1, but The ROHO Group is trying to get adjustable seat cushions carved out of Round 2.
"We're just hoping to find someone to support this position and say, 'Since we're still in the planning stages for Round 2, we think ROHO and these consumers are right,'" said Tom Borcherding, ROHO's president. "These products shouldn't be competitively bid and, therefore, they should be pulled out of the program."
Four codes for seat cushions are included in competitive bidding, under the standard and complex power wheelchairs and accessories product categories: K0734, K0735, K0736 and K0737.
ROHO argues that seat cushions shouldn't be competitively bid because, like Group 3 complex power wheelchairs, which were successfully carved out of the program, they're specialized products.
"They're called adjustable seat cushions because they're individually prescribed and individually set up for individual users," Borcherding said. "There may be only four codes, but there are well over 3,500 cushions assigned to those codes. You just can't bid the category; it's not specific enough."
ROHO has taken the lead on carving out seat cushions from competitive bidding, because it realizes that other stakeholders in the complex rehab industry at large are focused on creating a separate benefit for complex rehab.
"We're 100% behind those efforts and, hopefully, we'll be involved at every step," Borcherding said. "But because seat cushions were included in competitive bidding, this is an immediate challenge for our business and everyone who provides and uses the technology."
ROHO has enlisted consumers, most recently The ITEM Coalition, to write letters to Kathleen Sebelius, secretary of the Department of Health and Human Services, and members of Congress, asking them to carve out seat cushions from competitive bidding.
"We're just hoping to crack through all the rest of the messages out there," Borcherding said.
Because carving out seat cushions from competitive bidding would reduce the program's savings by an estimated $5.5 million, ROHO is trying to position its campaign this way: If cushions remain in the program, access will be reduced; beneficiaries will develop more wounds and other complications, and, in some cases, require hospitalization; and Medicare will end up paying more than it did pre-competitive bidding.
"You're looking at, potentially, an enormous cost increase," Borcherding said.