Inside Health Policy, a Washington newsletter, reported on September 14 that, “Independent experts on competitive bidding say CMS’ durable medical equipment bidding program is uniquely designed to set prices below a level at which many winning bidders can afford to participate, which likely will lead to product shortages.”
The article describes three “fatal” flaws with CMS’ program outlined Peter Crampton, a professor of economics at the University of Maryland: “bids are not binding, CMS sets reimbursement at the median price among winning bidders and only CMS knows how the winners were chosen…. CMS will not disclose how it determines the amount of product that each bidder is expected to supply. It’s unclear who the winning bidders are, even though bidding took place more than 10 months ago.”
Crampton along with Brett Katzman, an economics professor at Kennesaw State University in Georgia, plan to meet with the Congressional Budget Office to urge the CBO to re-estimate the potential savings from the bidding program, which Katzman describes as “drastically overstated.”
The article notes, “Apart from being professors, [Crampton and Katzman] are paid to set up competitive bidding programs. No other competitive bidding program, for any product in either the private or public sector, uses the design that CMS came up with, they said.”
Thursday, September 16, 2010
New Jersey’s Allcare Medical Delivers Homecare Message at House Hearing
At a packed Energy and Commerce Committee hearing room on Capitol Hill on September 15, Karen A. Lerner, a registered nurse and wound care specialist at Allcare Medical, in Sayreville, NJ, was the lone voice opposing the “competitive” bidding program at the health subcommittee’s hearing on the program. She told the committee members the bidding program “will not achieve its desired outcomes and will in fact reduce access to care for Medicare beneficiaries, lower the quality of that care, increase costs and kill jobs.”
Lerner is a member of the American Association for Homecare and the Jersey Association of Medical Equipment Services. See her statement in the Newsroom and full testimony under What’s New at www.aahomecare.org.
Pictured left to right, Wendy Russalesi (JAMES executive director), Richard Lerner (Allcare), Rep. Frank Pallone, Karen Lerner (Allcare), Dr. Kevin Saluck (Allcare) at the Energy and Commerce subcommittee hearing on September 15, 2010.
Drawing on Allcare’s experience serving users of wheelchairs and respiratory services in New Jersey and Pennsylvania, Lerner provided several compelling examples about the likely negative impact on patients that would result from the bidding program.
The other witnesses who testified this morning were either in favor of the bidding program or neutral. While some of the dozen-plus members of Congress at the hearing favored the bidding program, many were highly skeptical.
HME advocates who packed the hearing room burst into applause after Texas Congressman Ralph Hall (R-Texas) delivered a scathing review of all the shortcomings of the CMS bidding program during the initial Round One and the re-bid. He noted that CMS used “abandoned rates to set the fee schedule” in the re-bidding of Round One and that in its refusal to release data about Round One bidding, “CMS seems to be hiding many flaws.”
Congressman Bruce Braley (D-Iowa) described the recent University of Northern Iowa study that predicts a steep decline in HME providers in rural states due to Round One bidding. Several others, including Betty Sutton (D-Ohio), Michael Burgess (R-Texas), and Diana DeGette (D-Colo.) raised serious concerns about the bidding program.
Henry Waxman (D-Calif.), who chairs the full Energy and Commerce Committee, defended the bidding program and brushed off concerns about access to care as “speculative threats.”
In his testimony before the subcommittee, Laurence Wilson, CMS director of the chronic care policy group, opened his remarks by repeating two extensively discredited arguments: that the bidding program will reduce Medicare beneficiaries’ out of pocket costs and that the program will reduce fraud. The first statement is only true for a small number of beneficiaries (who will suffer from the decimation of the HME sector), and the second statement is simply a red herring designed to draw attention away from CMS’ embarrassing record for fraud prevention.
Dan Levinson, of the Office of the Inspector General, Department of Health and Human Services, made the eyebrow-raising claim that HME reimbursement rates encourage fraud. By that logic, fraud would have declined dramatically over the past 10 years, mirroring the sharp reductions in HME reimbursement rates. At least one member of Congress questioned the link between reimbursement rates and fraud.
A third government witness was Kathleen King, director, health care, Government Accountability Office. In the second panel, witnesses included Alfred Chiplin, managing attorney, Center for Medicare Advocacy, Nancy Schlichting, president and CEO, Henry Ford Health System, and William Scanlon, a policy consultant, in addition to Karen Lerner of Allcare.
AAHomecare encourages HME stakeholders to continue to enlist support for the elimination program and share with your members of Congress the Dobson | DaVanzo & Associates study.
Lerner is a member of the American Association for Homecare and the Jersey Association of Medical Equipment Services. See her statement in the Newsroom and full testimony under What’s New at www.aahomecare.org.
Pictured left to right, Wendy Russalesi (JAMES executive director), Richard Lerner (Allcare), Rep. Frank Pallone, Karen Lerner (Allcare), Dr. Kevin Saluck (Allcare) at the Energy and Commerce subcommittee hearing on September 15, 2010.
Drawing on Allcare’s experience serving users of wheelchairs and respiratory services in New Jersey and Pennsylvania, Lerner provided several compelling examples about the likely negative impact on patients that would result from the bidding program.
The other witnesses who testified this morning were either in favor of the bidding program or neutral. While some of the dozen-plus members of Congress at the hearing favored the bidding program, many were highly skeptical.
HME advocates who packed the hearing room burst into applause after Texas Congressman Ralph Hall (R-Texas) delivered a scathing review of all the shortcomings of the CMS bidding program during the initial Round One and the re-bid. He noted that CMS used “abandoned rates to set the fee schedule” in the re-bidding of Round One and that in its refusal to release data about Round One bidding, “CMS seems to be hiding many flaws.”
Congressman Bruce Braley (D-Iowa) described the recent University of Northern Iowa study that predicts a steep decline in HME providers in rural states due to Round One bidding. Several others, including Betty Sutton (D-Ohio), Michael Burgess (R-Texas), and Diana DeGette (D-Colo.) raised serious concerns about the bidding program.
Henry Waxman (D-Calif.), who chairs the full Energy and Commerce Committee, defended the bidding program and brushed off concerns about access to care as “speculative threats.”
In his testimony before the subcommittee, Laurence Wilson, CMS director of the chronic care policy group, opened his remarks by repeating two extensively discredited arguments: that the bidding program will reduce Medicare beneficiaries’ out of pocket costs and that the program will reduce fraud. The first statement is only true for a small number of beneficiaries (who will suffer from the decimation of the HME sector), and the second statement is simply a red herring designed to draw attention away from CMS’ embarrassing record for fraud prevention.
Dan Levinson, of the Office of the Inspector General, Department of Health and Human Services, made the eyebrow-raising claim that HME reimbursement rates encourage fraud. By that logic, fraud would have declined dramatically over the past 10 years, mirroring the sharp reductions in HME reimbursement rates. At least one member of Congress questioned the link between reimbursement rates and fraud.
A third government witness was Kathleen King, director, health care, Government Accountability Office. In the second panel, witnesses included Alfred Chiplin, managing attorney, Center for Medicare Advocacy, Nancy Schlichting, president and CEO, Henry Ford Health System, and William Scanlon, a policy consultant, in addition to Karen Lerner of Allcare.
AAHomecare encourages HME stakeholders to continue to enlist support for the elimination program and share with your members of Congress the Dobson | DaVanzo & Associates study.
Friday, September 10, 2010
House Energy and Commerce Committee Plans September 15 Hearing on Bidding Program
The health subcommittee of the House Energy and Commerce Committee has issued a formal notice that it will hold a hearing on the Medicare “competitive” bidding program for HME on Wednesday, September 15, 2010. The hearing is titled, “Medicare’s Competitive Bidding Program for Durable Medical Equipment: Implications for Quality, Cost and Access.” The subcommittee notice stated, “This hearing will examine the conception and implementation of the competitive bidding program, the implementation of the Round One Re-Bid, and its potential effects on patients, providers, and physicians.”
A representative from Allcare Medical, in Old Bridge, New Jersey, has been asked by Subcommittee Chairman Frank Pallone (D-NJ) to testify on behalf of The American Association for Homecare and the Jersey Association of Medical Equipment Services.
The American Association for Homecare encourages HME providers and patients to attend the hearing in person to demonstrate concern about the bidding program.
The Association especially encourages HME stakeholders who are constituents of members of the health subcommittee (list below) to let committee members know about the effects competitive bidding will have on your patients and your business. Advocates can use the AAHomecare Take Action Center to find contact information, or call the Capitol switchboard at 202-224-3121 to be connected to the appropriate congressional office.
Current co-sponsors of H.R. 3970, the bill to replace the competitive program, have an * next to their name – be sure to thank those offices for their support! Members are listed by party, and in order of committee seniority.
Democratic members of the health subcommittee:
Frank Pallone, NJ - Chairman
John Dingell, MI
Bart Gordon, TN*
Anna Eshoo, CA
Eliot Engel, NY
Gene Green, TX
Diana DeGette, CO*
Lois Capps, CA - vice chair
Jan Schakowsky, IL
Tammy Baldwin, WI*
Mike Ross, AR*
Anthony Weiner, NY*
Jim Matheson, UT*
Jane Harman, CA
Charles Gonzalez, TX*
John Barrow, GA*
Kathy Castor, FL*
John Sarbanes, MD
Christopher Murphy, CT
Zachary Space, OH*
Betty Sutton, OH*
Bruce Braley, IA*
Republican members of the health subcommittee
John Shimkus, IL – Ranking Republican member
Ralph Hall, TX*
Ed Whitfield, KY*
John Shadegg, AZ
Roy Blunt, MO*
Steve Buyer, IN
Joseph Pitts, PA
Sue Wilkins Myrick, NC*
John Sullivan, OK
Tim Murphy, PA*
Michael Burgess, TX
Marsha Blackburn, TN*
Phil Gingrey, GA*
The hearing is slated to begin at 10:00 a.m. in Room 2123 of the Rayburn House Office Building. AAHomecare will provide online and/or C-SPAN viewing information when/if it becomes available.
A representative from Allcare Medical, in Old Bridge, New Jersey, has been asked by Subcommittee Chairman Frank Pallone (D-NJ) to testify on behalf of The American Association for Homecare and the Jersey Association of Medical Equipment Services.
The American Association for Homecare encourages HME providers and patients to attend the hearing in person to demonstrate concern about the bidding program.
The Association especially encourages HME stakeholders who are constituents of members of the health subcommittee (list below) to let committee members know about the effects competitive bidding will have on your patients and your business. Advocates can use the AAHomecare Take Action Center to find contact information, or call the Capitol switchboard at 202-224-3121 to be connected to the appropriate congressional office.
Current co-sponsors of H.R. 3970, the bill to replace the competitive program, have an * next to their name – be sure to thank those offices for their support! Members are listed by party, and in order of committee seniority.
Democratic members of the health subcommittee:
Frank Pallone, NJ - Chairman
John Dingell, MI
Bart Gordon, TN*
Anna Eshoo, CA
Eliot Engel, NY
Gene Green, TX
Diana DeGette, CO*
Lois Capps, CA - vice chair
Jan Schakowsky, IL
Tammy Baldwin, WI*
Mike Ross, AR*
Anthony Weiner, NY*
Jim Matheson, UT*
Jane Harman, CA
Charles Gonzalez, TX*
John Barrow, GA*
Kathy Castor, FL*
John Sarbanes, MD
Christopher Murphy, CT
Zachary Space, OH*
Betty Sutton, OH*
Bruce Braley, IA*
Republican members of the health subcommittee
John Shimkus, IL – Ranking Republican member
Ralph Hall, TX*
Ed Whitfield, KY*
John Shadegg, AZ
Roy Blunt, MO*
Steve Buyer, IN
Joseph Pitts, PA
Sue Wilkins Myrick, NC*
John Sullivan, OK
Tim Murphy, PA*
Michael Burgess, TX
Marsha Blackburn, TN*
Phil Gingrey, GA*
The hearing is slated to begin at 10:00 a.m. in Room 2123 of the Rayburn House Office Building. AAHomecare will provide online and/or C-SPAN viewing information when/if it becomes available.
Thursday, September 2, 2010
Mobility Matters: End of First-Month Option Threatens Access to Power Mobility
The American Association for Homecare released the eighth in a series of “Mobility Matters” bulletins focused on the threats to power mobility. The article states:
“Clearly Congress did not consider the economic consequences of putting additional financial stress on these homecare businesses at a time when banks and other lenders have a tight rein on credit. The problem for these businesses is that many providers cannot secure the capital or credit necessary to cover the overhead and upfront costs of acquiring power wheelchairs while waiting 13 months for full payment. In fact, most banks cite the unpredictability of the Medicare program and the risk associated with the 13-month billing period as reasons for not backing the providers. In addition, Medicare receivables cannot be assigned to securitize lines of credit.
So in short, the government is telling providers to find upfront cash to pay for power wheelchairs, deliver those chairs to Medicare patients, and then wait to be reimbursed over a 13-month rental period. This would force the homecare providers to do what the nation’s banks are refusing to do – provide the credit for Medicare patients to receive power mobility. This scenario is totally unreasonable in the current economic climate.”
Tyler Wilson, president of AAHomecare, commented, “Congress and CMS should heed these warnings from the homecare community and advocates for people living with disabilities. Medicare beneficiaries are about to become victims of very bad public policy. Lawmakers should not be adding to the burdens of some of the most vulnerable people in our society. Taking away access to mobility is wrong. And this can be averted by Congress acting to delay implementation of this policy.”
Click here to read the full Mobility Matters article.
“Clearly Congress did not consider the economic consequences of putting additional financial stress on these homecare businesses at a time when banks and other lenders have a tight rein on credit. The problem for these businesses is that many providers cannot secure the capital or credit necessary to cover the overhead and upfront costs of acquiring power wheelchairs while waiting 13 months for full payment. In fact, most banks cite the unpredictability of the Medicare program and the risk associated with the 13-month billing period as reasons for not backing the providers. In addition, Medicare receivables cannot be assigned to securitize lines of credit.
So in short, the government is telling providers to find upfront cash to pay for power wheelchairs, deliver those chairs to Medicare patients, and then wait to be reimbursed over a 13-month rental period. This would force the homecare providers to do what the nation’s banks are refusing to do – provide the credit for Medicare patients to receive power mobility. This scenario is totally unreasonable in the current economic climate.”
Tyler Wilson, president of AAHomecare, commented, “Congress and CMS should heed these warnings from the homecare community and advocates for people living with disabilities. Medicare beneficiaries are about to become victims of very bad public policy. Lawmakers should not be adding to the burdens of some of the most vulnerable people in our society. Taking away access to mobility is wrong. And this can be averted by Congress acting to delay implementation of this policy.”
Click here to read the full Mobility Matters article.
Urge Congress to Sign Letter to Delay End to the First-month Purchase Option
ACTION: Please ask your member of Congress to sign an important letter that requests a one-year delay of the elimination of the option to purchase a standard power wheelchair during the first month of use. Representatives Jim Langevin (D-R.I.), co-chair of the Bipartisan Disabilities Caucus, and Glenn Thompson (R-Pa.) are co-leads of a “dear colleague” letter requesting a one-year delay to eliminate the option. The dear colleague and sign-on letter were circulated to all House offices yesterday afternoon.
It is vital that you contact your member of the House of Representatives and urge him or her to contact Representatives Langevin or Thompson’s office and agree to sign this important letter. You can reach your Representative by calling the Capitol Hill switchboard at 202-224-3121.
Section 3136 of the Affordable Care Act (ACA), a provision in the health care reform law, will eliminate the first-month purchase option for standard power wheelchairs beginning January 1, 2011.
Many providers are unable to secure the capital and credit necessary to cover the up-front cost of acquiring the power wheelchair and then wait 13 months to receive full payment. Additional guidance and implementation time is needed to transition to this significant change in a manner that will not jeopardize access to care. Without access to power wheelchairs, beneficiaries will face increased hospitalizations, home health visits, and other clinical services for falls or other injuries suffered by those with compromised mobility.
The Association, along with consumer advocacy groups, is strongly urging Congress to delay implementation of the mandatory standard power wheelchair rental provision for one year. This will provide time for the homecare sector to secure financing and make the necessary business and system changes in a manner that will limit the negative impact on their businesses and Medicare beneficiaries with a medical need for a power wheelchair.
It is critical to have bipartisan support on delaying the elimination of the first-month option provision to enable power wheelchair providers’ much-needed time to secure additional financing and adjust their business models so that consumers will not see interruptions or reductions in access to equipment and services.
Supportive organizations listed at the bottom of the sign-on letter include:
• American Association for Homecare
• American Association of People with Disabilities (AAPD)
• Association of Programs for Rural Independent Living (APRIL)
• National Council on Independent Living (NCIL)
• National Spinal Cord Injury Association (NSCIA)
• United Spinal Association
In addition, Paralyzed Veterans of America added their support of this delay today. The deadline to sign on to this letter is Friday, September 17, 2010.
To view the full letter, click here.
It is vital that you contact your member of the House of Representatives and urge him or her to contact Representatives Langevin or Thompson’s office and agree to sign this important letter. You can reach your Representative by calling the Capitol Hill switchboard at 202-224-3121.
Section 3136 of the Affordable Care Act (ACA), a provision in the health care reform law, will eliminate the first-month purchase option for standard power wheelchairs beginning January 1, 2011.
Many providers are unable to secure the capital and credit necessary to cover the up-front cost of acquiring the power wheelchair and then wait 13 months to receive full payment. Additional guidance and implementation time is needed to transition to this significant change in a manner that will not jeopardize access to care. Without access to power wheelchairs, beneficiaries will face increased hospitalizations, home health visits, and other clinical services for falls or other injuries suffered by those with compromised mobility.
The Association, along with consumer advocacy groups, is strongly urging Congress to delay implementation of the mandatory standard power wheelchair rental provision for one year. This will provide time for the homecare sector to secure financing and make the necessary business and system changes in a manner that will limit the negative impact on their businesses and Medicare beneficiaries with a medical need for a power wheelchair.
It is critical to have bipartisan support on delaying the elimination of the first-month option provision to enable power wheelchair providers’ much-needed time to secure additional financing and adjust their business models so that consumers will not see interruptions or reductions in access to equipment and services.
Supportive organizations listed at the bottom of the sign-on letter include:
• American Association for Homecare
• American Association of People with Disabilities (AAPD)
• Association of Programs for Rural Independent Living (APRIL)
• National Council on Independent Living (NCIL)
• National Spinal Cord Injury Association (NSCIA)
• United Spinal Association
In addition, Paralyzed Veterans of America added their support of this delay today. The deadline to sign on to this letter is Friday, September 17, 2010.
To view the full letter, click here.
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