“AAHomecare will be working with the PAOC co-chairs to develop agenda items for future discussions,” Gorski said. “We’ll also be following up with CMS on the key issues that were raised during the meeting.”

Meeting attendee Tim Binkley of Valentine’s Diabetic Supplies in Roswell, Ga., said he also would be keeping up with future meetings. He’s very concerned, he said, about patient accessibility to quality products under the bidding program.

“Our concern is that we wouldn’t be able to provide the most widely used and popular [diabetic] meters on the market that many patients use,” he said.

Reimbursement for diabetic supplies was cut by a massive 43 percent under 2008’s aborted Round One. “You would not be able to provide the major brands under a 43 percent reduction,” said Binkley, whose company serves patients in 30 states. “Most of us couldn’t be in business with a 43 percent cut.”

The only way even to come up with a bid that low would be to supply “products that are not used by most diabetics,” he said.

Binkley also said he is worried that, as in the first Round One, CMS will once again allow bidders to win who have no experience in the product category, let alone in the bidding area.

Binkley isn’t the only one concerned about the quality of both products and services.

During a public comment period, one provider said numerous business suitors surfaced after the contracts were awarded last year and sought to purchase her company because they thought she had been a winning bidder. None was qualified to be a Medicare provider, she said, noting that this smacked of “selling the beneficiary.”

Seth Johnson, vice president of government affairs for Exeter, Pa.-based Pride Mobility Products, said the issue of selling a business and a contract is a competitive bidding loophole that must be closed.

“Many winning bidders last year tried to sell their companies once they secured a [contract],” Johnson explained. “The issue raised at the PAOC was that CMS should prohibit the sale or transfer of a winning bid, essentially to force winners to provide products and services at the agreed-upon price, and also hopefully prevent bottom-feeder bids that are simply submitted to secure a bid only to turn around and sell it.”

Johnson said CMS did not state a position on the matter. The issue will be tackled at future PAOC meetings, stakeholders said.

Even as efforts continue to get CMS to make significant changes to the competitive bidding project, attempts are also afoot to eliminate it altogether.

“AAHomecare is working with congressional offices and other HME stakeholders on several fronts, including a bill to repeal competitive bidding [and] legislative reforms of the competitive bidding program,” said Michael Reinemer, vice president, communications and policy. Reinemer said he would have more information “when those efforts start to gel.”

Review the Codes before Rebid, Representatives Say
WASHINGTON--In April, the Rehabilitation Engineering and Assistive Technology Society of North America wrote CMS Acting Administrator Charlene Frizzera asking that specialized wheelchair seating cushions be exempted from competitive bidding. In May, the ITEM Coalition, a 70-group-strong disability advocacy, wrote HHS Secretary Kathleen Sebelius about the matter. Now Reps. Jerry Costello, D-Ill., and John Shimkus, R-Ill., are circulating a sign-on letter that will be sent to Sebelius about exempting the cushions--plus some.

In fact, the representatives’ letter urges the HHS secretary to exclude any HCPCS codes from the DMEPOS bidding program “that would negatively impact the health of Medicare beneficiaries or would not produce significant savings to the program.”

The litmus test for whether codes should be excluded, the letter states, is based on any of three conditions:

1) The code does not represent a unique, distinguishable and easily replicated group of items and/or services;
2) The inclusion of the code would jeopardize beneficiary access to quality items and/or services; or
3) The code is not likely to produce significant savings to the Medicare program.

“To illustrate our point,” the congressmen wrote, “specialized wheelchair seating is a vital component to managing skin integrity and avoiding costly hospital stays resulting from the occurrence of wounds for wheelchair-bound individuals.

“The HCPCS codes that specialized seating products are assigned to are not specific enough to represent unique, distinguishable groups of items; including such items in the bidding process will jeopardize beneficiary access to the specific product they need, and bidding such items may actually result in increased health care costs for beneficiaries and the Medicare program.”

In other words, said Dave McCausland, senior vice president of planning and government affairs for The Roho Group, Belleville, Ill., with “broad, under-defined codes that may include hundreds of items with a range of features and benefits, what you’ll end up with is patients in the competitive bidding areas restricted to having access only to the lowest-cost items in the code as opposed to the products that are most appropriate.”

According to McCausland, the Medicare Modernization Act gives the HHS secretary “the discretion--and the responsibility--to exclude products when there aren’t really any savings to be had, or those things that could negatively impact patient care and access.”

Costello and Shimkus agree, requesting Sebelius to complete a “reassessment and revision” of the codes in the program before bidding for the new Round One begins.

While CMS has said privately it would consider such a request before Round Two, officials believe under the Medicare Improvements for Patients and Providers Act, they are prohibited from changing the codes that are to be rebid in Round One. "So now we need to get Congress to chime in and tell them they have that authority,” McCausland said.

“The ITEM Coalition letter and the RESNA letter [show] this is a concern to beneficiaries and clinicians--it’s not just an industry issue,” he said, adding that “it’s not just about cushions. CMS needs to eliminate all the codes where logic tells you it’s not appropriate to bid them.”

Another example that fails the litmus test is the complex wheelchair category, McCausland noted, “which has somewhere in the neighborhood of 150 codes in one bid category. Yet 10 of those codes represent 90 percent of the total dollar value of that whole category. How much savings will you derive from those other 140 codes, especially when you offset that with the additional costs to deal with that?

“It really comes back to why would you want to bid things that will complicate the bidding process, not give return on investment and diminish patient care and access.”

The deadline for representatives to sign on to the Costello-Shimkus letter is noon today.

Stakeholders Scramble for Relief on Oxygen Reimbursement
ATLANTA--In a race against a swiftly ticking clock, HME stakeholders were lobbying on two fronts last week to generate congressional support for some sort of oxygen reimbursement relief.

Reps. Mike Ross, D-Ark., and Kendrick Meek, D-Fla., circulated a sign-on letter among their colleagues calling for reform of the oxygen benefit to be included in the national health care reform package. The Ross-Meek letter also urges elimination of the oxygen cap and the exemption of oxygen from competitive bidding.

Both the American Association for Homecare and the Accredited Medical Equipment Providers of America called on providers to encourage lawmakers to sign the letter.

“I encourage all providers to contact your legislators and have your oxygen patients contact them as well and ask them to … sign on to the letter,” said Rob Brant, AMEPA president, in a message to members. “This is a budget-neutral plan, which will remove the oxygen cap and reimburse providers based on actual patient usage, not just on the equipment in their home. Therefore, it is a win for both patients and the Medicare program.”

As of Friday, nearly 50 legislators had agreed to sign on, said Michael Reinemer, AAHomecare vice president, communications and policy.

The letter will be sent to the key House committees overseeing Medicare issues and health reform, Reinemer said, and will serve as a “placeholder” for an oxygen overhaul bill that Ross and Meek are expected to introduce shortly. AAHomecare had hoped to have the legislation in hand sooner, but drafting the oxygen reform plan has been slowed by an influx of health care proposals to the House Office of Legislative Counsel, which must write all bills into legislative language.

Advocates are hoping to get the bill attached to the health care reform package, which is already on the move. AAHomecare said the deadline for the sign-on--today--is being driven by Ross, "who wants to make sure the oxygen message is delivered before the health reform legislation is finalized."

According to a tentative schedule, a draft of the health reform language in the House could be released this week, then the bill will be referred to three committees: Ways and Means, Education and Labor and Energy and Commerce. Those committees could hold subcommittee hearings as early as next week, followed by full committee hearings the week of July 6 and floor consideration the week of July 27.

House leaders have said they want to have a health care reform bill passed by August.

On a parallel track, supporters continue a push for cosponsors on the Home Oxygen Patient Protection (HOPP) Act.

“Keep contacting your representative to get more support [for H.R. 2373]," urged VGM, the Waterloo, Iowa-based HME services group. That bill, introduced last month by Reps. Tom Price, R-Ga., and Heath Shuler, D-N.C., would repeal Medicare’s 36-month oxygen rental cap.

“It is important that we get at least 218 supporters of the bill,” VGM said on its Web site, a point echoed by the National Association of Independent Medical Equipment Suppliers in an email. “This would allow legislation to move past the committees to which the bill was referred and onto the House floor.”

As of Friday, the bill had garnered 49 cosponsors.

For the text of H.R. 2373, go to thomas.loc.gov and search by bill number.

To view the Ross-Meek letter, go to www.aahomecare.org.

From HomeCareMag.com: News You Can Use
Having trouble keeping up? To catch up on the latest headlines, visit www.homecaremag.com or click below:

Next Stop Obama: Tobacco Regulation Act Passes

Cornyn Wants Anti-Fraud Measures in Health Reform Bill

H1N1 Flu Now a Pandemic

Virginia Hackers Still at Large; Will EHRs Be Secure?

Ross, Meek Send Oxygen Reform Sign-On Letter

PWC Documentation Under the Microscope

HME Company Newswire
Bluegrass Makes a Move; Invacare Named to Fortune 1000
LEXINGTON, Ky.--Bluegrass Oxygen consolidated its billing and administration offices into a newly renovated 18,000-sq. ft. building as of June 1. The new facility, which also serves as a central warehouse and an intake center, now functions as the “nerve center” for the company’s six locations, according to President/CEO Mike Marnhout. Bluegrass funded the move with an SBA loan that came through in four days, allowing the company to install a new communication system, a new software system, redo the parking lot and “spruce up” the entire building, he said. "With all the changes that are coming, this gives us an opportunity to grow," Marnhout said.

Invacare Named to Fortune 1000
ELYRIA, Ohio--Invacare Corp. has been named to Fortune magazine's 2009 Fortune 1000, ranking 983. The list is an annual ranking of America's 1,000 largest corporations based on revenue. "We have come a long way in 30 years, from $19 million to $1.75 billion in sales, and we look forward to moving up in the rankings in future years," said the company's Mal Mixon, chairman and CEO. "Today, home health care is becoming a reality for more and more patients, and Invacare has taken a position of strong advocacy for the home care industry. Home care is a trifecta in the health care system--it is patient preferred, has better clinical outcomes and is significantly more cost effective than institutional care."

Perot Snags Apria IT Contract
PLANO, Texas--Under a 10-year contract announced last week, Perot Systems will manage data center operations, deliver application solutions and provide other health care information technology consulting for Lake Forest, Calif.-based Apria Healthcare. “Our alliance with Perot Systems will provide greater flexibility, quality and efficiency in our IT operations," Apria CEO Norman Payson, MD, said in a release.

In Brief
CMS Sets NPWT Meet; Watch Arthritis Kits, TriCenturion Warns
CMS' recent coding decision on negative pressure wound therapy will be the subject of a public meeting set for July 9, the agency announced last week. The Medicare Improvements for Patients and Providers Act required an evaluation of existing HCPCS codes for NPWT devices "to ensure accurate reporting and billing for the items and services under such codes," according to CMS, which partnered with the Agency of Healthcare Research and Quality on a review. At issue, whether to go with a single code or multiple codes for NPWT.

Results of the study found no significant differences between NPWT devices, however, and CMS has issued a preliminary decision stating there is no need for multiple codes. The July 9 meeting will allow stakeholders "an opportunity to provide input" on the decision, CMS said.

For the AHRQ's final report, go to www.ahrq.gov/clinic/techix.htm.

Earlier this year, the Office of Inspector General recommended that reimbursement for NPWT be reduced. (See "OIG Recommends Reimbursement Reduction for NPWT," March 23.)

Watch Arthritis Kits, TriCenturion Warns
TriCenturion, the Jurisdiction B DME Program Safeguard Contractor, said it has has identified a number of suppliers who are marketing what are often described as "arthritis kits." According to a June 5 notice, the PSC said advertisements for these kits--which can include multiple upper limb, lower limb and spinal "orthotics" and/or heat lamps--"entice beneficiaries and obtain physician orders by stating that the items are 'Medicare approved' and that there will be no cost to the beneficiary (if he/she has a Medicare aupplement plan)."

But the PSC pointed to several problems with the kits in cases it has investigated: Many of the items are billed using incorrect HCPCS codes; many are statutorily noncovered by Medicare; and "in almost all cases," documentation does not support the medical necessity for the items.

"A simple diagnosis of arthritis or other general statement is not sufficient," the PSC said. "The history and physical examination must document the severity of the condition and the need for each item. Since it would rarely be medically necessary to order multiple orthoses at the same time, the greater the number of items provided, the more detailed is the documentation that would be required."

Washington Post Reporter Comments on Competitive Bidding
On C-SPAN’s June 5 “Washington Journal,” HME provider David Heaton called in to ask Washington Post reporter Ceci Connolly her view of competitive bidding. “With respect to competitive bidding and using more of that in the Medicare program, yes, I do expect that there will be more of an effort to have competitive bidding,” Connolly responded. The Post health care reporter told C-SPAN’s audience that competitive bidding is “all about the free enterprise system” and “letting the marketplace really flourish. The idea is that Medicare ought to be able to get the best price available. They ought to be able to do some good shopping for their customers,” she said.

According to Heaton, who owns First Class Medical Equipment and Supply in Houston, “This should be a wake up call to durable medical equipment companies and lobbying organizations that wish to have competitive bidding repealed. The efforts currently being made by the durable medical equipment industry to go it alone have me believe that their comments will fall on deaf ears based upon Congress’ view that competitive bidding is the beginning of the process in the evolving health care reform plan for Medicare, or any other national health plan for that matter.” In a press release after the program aired, Heaton said related entities such as hospitals, home health, skilled nursing and physician representatives need to “unify in their opposition to competitive bidding as a whole.”

View the segment on the C-SPAN site. (It’s 12 minutes and 33 seconds in.)

To revisit this news any time during the week, go to www.homecaremonday.com.

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