Bid legislation to provide breathing room

WASHINGTON - With legislation to modify the national rollout of competitive bidding in the works, industry stakeholders are setting the stage for a full court press.

But there's only so much they can do until they have a “score” from the Congressional Budget Office, they say.

“We'll begin a full grassroots push, which we've lined up,” said Tom Ryan, president and CEO of AAHomecare. “We can work the committees and we can work the grassroots angle, but we've got to get a score.”

The legislation, drafted by industry champion Tom Price, R-Ga., would provide a 30% increase in reimbursement over the bidding-derived prices and a four-year phase-in period, and include a provision that would reinstate the bid cap at the unadjusted fee schedule.

As the current plan stands, CMS wants to apply bid pricing in two phases: 50% of the cut Jan. 1 and the full cut on July 1.

“It's not as dramatic a cut so quickly, so it gives providers the ability to make plans and to adjust over a longer period of time, which is really critical for business,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Asked whether a 30% reimbursement adjustment could be too big of an ask, Bachenheimer says stakeholders have their work cut out for them, but she says it is “a reasonable and proper request.”

“It's understood in health care that the cost to serve is higher in rural areas,” she said. “There are plenty of reasons to have a bump-up in pricing. CMS is blindly applying bid prices, which makes no sense.”

It certainly makes no sense to Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services, which represents seven states, including the “100% rural” Dakotas. MAMES will host a virtual fly-in on Wednesday to start greasing the wheels for the legislation.

“Providers, if they even survive, say there will be a vast difference of what they are going to be capable of doing (compared to what they do now),” she said. “We have some members who are the only provider within a 150-mile radius. They are not going to be able to cover that any more.”