AAHomecare Asks Obama to Review “Patchwork” of Ineffective HME Regulations

Yesterday, the American Association for Homecare asked President Obama to review “onerous and outdated regulations that hamper job creation and threaten access to quality home medical equipment (HME) and services under the Medicare program.” AAHomecare sent Obama a letter in response to the President’s January 18 executive order, “Improving Regulation and Regulatory Review,” which solicits examples of problematic regulations. View the executive order here.

The Association asked specifically that the President examine “policies related to competitive bidding for durable medical equipment, respiratory therapy…, power mobility devices, diabetes testing equipment and supplies, Medicare audits and anti-fraud and abuse initiatives.”

The full text of the letter follows.

The President
The White House
Washington, D.C. 20500

Dear Mr. President:

I am writing on behalf of the American Association for Homecare (AAHomecare) to express our keen interest in working with your Administration to review onerous and outdated regulations that hamper job creation and threaten access to quality home medical equipment (HME) and services under the Medicare program. We believe that in complying with your Executive Order, Improving Regulation and Regulatory Review, we should take a holistic approach to the Medicare HME benefit and specifically look at issues such as policies related to competitive bidding for durable medical equipment, respiratory therapy (including home oxygen and sleep devices), power mobility devices, diabetes testing equipment and supplies, Medicare audits and anti-fraud and abuse initiatives.

AAHomecare is the only national trade association representing every line of medical equipment and services within the homecare community. The Association represents health care providers and manufacturers who serve the medical needs of millions of Americans who require durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) such as home oxygen therapy, mobility assistive technologies, diabetes therapy and other supplies, sleep therapy technologies, inhalation drug therapy, home infusion, and other home medical equipment, therapies, services, and supplies in their homes. Our membership reflects a cross-section of the homecare community, including national, regional and local providers.

The Association believes that there are a number of regulations that relate to the HME sector that need close scrutiny. These regulations, created over a 25-year period, have created a patchwork of rules that could be better designed to improve the quality of care furnished by HME providers with the goal of caring for individuals in their homes rather than in more costly institutional settings like nursing homes and hospitals.

AAHomecare looks forward to working with you and your Administration to address ineffective and outdated rules and the hassle factor these regulations create on HME providers that inhibit job growth and quality of care. The Association will provide you with more detailed comments in the near future and I am available to meet with you or your staff to discuss these concerns further.

If you have questions about the Association’s concerns, please contact Jay Witter at (703) 535-1884 or jayw@aahomecare.org.

Sincerely,

Tyler J. Wilson
President

Download the letter here.

Outreach Materials for Reporting Competitive Bidding Problems

Our competitive bidding feedback toll-free hotline is now active – 1-888-990-0499 – joining our reporting forms at www.biddingfeedback.com.

AAHomecare asks that HME providers and other stakeholders in the homecare sector help publicize these feedback resources.

Here are links to three flyers, in PDF format, that individuals and organizations in Round One regions can use or adapt as they see fit. Each flyer has been slightly modified for a particular target audience:

• Consumers
• HME Providers
• Physician/Referral Sources

If you are interested in adapting the language from any of these flyers for your own publications or outreach materials, you can request text versions from gordonb@aahomecare.org.

Contact Your Representatives to Tell Them About the Problems Being Caused by Competitive Bidding!

CMS is moving forward with Medicare’s Competitive Bidding Program despite problems in implementation. More than 160 leading economic experts predicted that this bidding program will fail, and patients and providers in the initial nine metropolitan areas are seeing these economists’ predications come to life.

In recent weeks, the following red flags have been reported:

• Some companies that were awarded bidding contracts that are bankrupt;
• Errors on the Medicare.gov website providing misinformation to beneficiaries;
• Incorrect materials sent to beneficiaries outside of bidding areas instructing them to switch to contract providers;
• Lack of required state licensure among some bid winners; and
• Credit problems among a significant percentage of the bid winners.

The government cannot allow these mishaps and errors to jeopardize the health and well-being of those who rely on home medical equipment. Write your Representative and ask them to stop this badly design system. We need to Save Homecare Now!

Please forward this message to your friends and colleagues, and ask that they sign up to receive updates from the campaign to Save Homecare.

Medicare Policy Changes Will Make it More Difficult for Nevada Beneficiaries to Obtain Power Wheelchairs

Will power wheelchairs continue to be available to Nevada’s Medicare patients following a series of federal regulatory and policy changes?

There are grave concerns among consumer groups, Medicare beneficiaries and homecare equipment providers in Nevada that the changes in Medicare policies may severely hamper the ability of providers to supply quality products and services to beneficiaries.

One of the biggest threats is a new law establishing that the Medicare program will pay rental payments over a 13 month period to homecare equipment providers after they supply power wheelchairs to Medicare beneficiaries. The change will create significant cash flow problems for providers, who will be forced to purchase the equipment from manufacturers, and then receive reimbursement payments stretching over 13 months. Previously, Medicare beneficiaries could request that the government purchase the equipment for them in the first month of use.

“We fear that the Medicare mobility benefit won’t be available for the people who need it because there won’t be providers around to fill the power wheelchair prescriptions once doctors order them for their patients,” said Corrie Herrera, rural director for the Northern Nevada Center for Independent Living in Elko, Nevada. “Our organization, as well as others across the state who represent people living with disabilities, feel that the Washington policymakers don’t understand how much a power wheelchair means to the people who need them. We must ensure that Medicare patients continue to have access to this equipment.”

Herrera said physicians prescribe power wheelchairs to patients needing assistance with critical daily activities, such as grooming, getting to the bathroom and preparing food. By continuing to perform these tasks in their homes with power wheelchairs, Herrera said it often delays the necessity of placing beneficiaries in expensive nursing homes. Mobility assistance also reduces emergency room visits for Medicare patients, who are less likely to suffer injuries from falls.

Jason Turner, 43, of Las Vegas, said his power wheelchair has made a dramatic difference in his life. Turner, who has multiple sclerosis, said he has used a power chair for a dozen years. “It is like getting my legs back,” said Turner. “I can help my daughters with their homework; and I have the freedom and independence to go wherever I need to go.”

Moreover, Turner said that he is relieved not to be a “burden” on anyone because he can do so many things for himself. “I hope that power wheelchairs remain available for other Medicare beneficiaries,” he said. “Being mobile changes your life.”

But in recent years, changes in Medicare policies have significantly impacted providers, hampering their ability to supply quality home medical equipment and services to Medicare beneficiaries. Over the last five years, the Medicare program has cut reimbursements for power wheelchairs by more than 35 percent. At the same time, the providers are experiencing excessive government audits and extended delays in reimbursement payments.

The new rental reimbursement policy will slash providers’ cash-on-hand by 40 percent in the first year. Because of the struggling economy, providers are unable to obtain loans or credit lines that would allow them to purchase power wheelchairs from manufacturers and do the necessary servicing so that Medicare beneficiaries have properly-adjusted equipment. Many Medicare patients would receive chairs stored in warehouses that haven’t been specially fitted to address the individual needs of the patients.

To read the full story, click here or visit www.aahomecare.org/mobility for more information about this issue.

Round One Bid “Winners” Finally Announced as New Questions Arise about Flawed Program

The Centers for Medicare and Medicaid Services announced winners of Round One of the “competitive” bidding program. The overdue announcement leaves little time to make the required administrative and operational changes before the January 1 implementation. Those changes relate to regulations including “grandfathering” notifications to patients, subcontracting arrangements, and changes in company ownership. Medicare beneficiaries have received little information to date about the coming changes.

Click here to see the full list of bid winners.

Meanwhile, another study, by Cal Tech economics professor Charles R. Plott, outlines the severe design flaws in the bidding system. The new study concludes that the fundamental flaws in the Medicare bidding system will prevent any “quick fix.” A draft report of the study dated October 2010 concludes that:

• Good auction architectures for procurement applications do exist.
• The proposed Medicare supplies auction is not a good procurement auction. It is based on an inappropriate architecture that cannot deliver services at competitive rates and qualities.
• The Medicare supplies auction architecture cannot be adjusted in some simple way. There is no “quick fix”. The two central pillars of the auction are flawed. First, the price determination by the median accepted bid is not an appropriate method for determining price. Second, the ability of bidders to cancel bids is an inappropriate guide for competitive bidding strategies.

See the full study here.

This adds to the argument made by 166 economists and auction experts, including two Nobel laureates, who have urged key congressional leaders and committees in Congress to scrap the system and start over. Click here to view letters.