Thomas/Hobson pressure HHS on FEHBP cuts

Sunday, August 29, 2004

August 30, 2004

WASHINGTON -   The questions that initially frustrated HME suppliers when Congress called for a round of FEHBP-based reimbursement cuts Jan. 1 have re-surfaced in a letter that carries plenty of political clout.     
Last week, Rep. Bill Thomas, R-Calif. and Rep David L. Hobson, R-Ohio, penned a letter to Secretary Tommy Thompson at DHHS, asking the following:
- How many enrollees were covered by the 30 [FEHBP] plans that responded to the OIG survey, and is that data set a representative sample of Medicare patients that use DME?
-  Are there significant clinical differences between the two patient populations (i.e. Federal Employee Health Benefit Plan and Medicare) that use these DME products that may affect the price of DME, such as utilization?
-  Are there other sources of information from other government agencies, such as the Government Accountability Office and CMS surveys, that agree with or contradict the survey found in the OIG report? Are the data comparable?
Using data from a 2002 OIG report, the Medicare Modernization Act calls for reimbursement cuts Jan. 1 of up to 20% in several, key DME product categories, including nebulizers, power wheelchairs, diabetic supplies, and hospital beds/pressure mattresses. The MMA also calls for a cut to oxygen based on the findings of an OIG report scheduled for release in late August.
“That OIG report is based on extremely limited and bad data,” said Cara Bacheneheimer. “No more than 30 plans responded and not all of them provided price points for each of the HCPCS codes that are identified in that chart.”
Bachenheimer and other critics of the plan argue as well that the costs of doing business are significantly lower for FEHPB plan members, who are typically younger and healthier than Medicare beneficiaries.
Thomas signaled  his willingness to intervene on the industry’s behalf on May 13 when he responded to a March 3 letter from Hobson, agreeing that the Jan. 1 FEHBP-based DME cuts should be based on solid data.
While Hobson, and now Thomas, call for CMS to examine its data before making any cuts, a bill introduced June 2 by Hobson and Rep. Harold Ford, Jr., D-Tenn. is garnering support from additional members of Congress. At last count, 28 members of Congress had signed on to legislation that would repeal the FEHPB cuts.
“We need CMS to know that there is significant congressional support behind both the notion that the data was bad -  bad data makes bad policy, and if necessary, that Congress will do something [about this provision of the MMA],” said Bachenheimer.