The American Association for Homecare (AAHomecare) expressed concerns about the proposed rule for competitive bidding published in the Federal Register on Monday, May 1. The Centers for Medicare and Medicaid Services (CMS) issued the notice of proposed rulemaking (NPRM) for competitive bidding for durable home medical equipment, which is mandated by the Medicare Modernization Act of 2003.
AAHomecare is concerned about patient access to quality care, the impact on small providers, and the Association disputes the claim that competitive bidding will save significant dollars for Medicare.
"Competitive bidding will limit patient choice," said Tom Ryan, AAHomecare Chair and CEO of Homecare Concepts. "Dissatisfied beneficiaries or referral sources can currently choose another provider if they are not satisfied with their service - but the number of choices will be reduced under the national competitive bidding program."
The American Association for Homecare disputes CMS's claim that a national competitive bidding program will save Medicare a significant sum of money in light of the numerous cuts to homecare reimbursement in recent years and the administrative costs of implementing the new contracting system.
Ryan stated, "Homecare providers have seen double-digit percentage cuts from the Medicare Modernization Act of 2003, a freeze on CPI increases until 2008, and institution of a new rent-to-purchase policy for oxygen under the Deficit Reduction Act of 2005. These cuts, freezes, and restrictions come at a time when skilled labor, operational, and fuel costs for delivery of homecare continue to rise at unprecedented rates."
"The reality is some durable medical equipment items have already been set by the government at a price below what the market would set. If a provider cannot bid above a mandated below-market fee ceiling, how does that accomplish the wonders that CMS advertises, which is to 'harness marketplace dynamics to create incentives for suppliers to provide quality items'? The touted cost savings and market-driven benefits of this restrictive contracting program are unrealistic."
AAHomecare believes that managing costs and promoting competition are important goals for homecare under the Medicare program, but these goals must be pursued in a way that protects patients' choice as well as access to quality care. Beneficiaries should at least have the option to opt out of the national competitive bidding program - otherwise, it will serve as a closed-panel HMO.
"It's extremely important to get this program right," Ryan said. "There are many important issues that remain. Much is at stake for Medicare beneficiaries and providers so this program should be rolled out very cautiously."
The American Association for Homecare continues to aggressively support the Hobson-Tanner bill which would amend MMA to add important protections for patients (requiring implementation of quality standards before the bid process begins), exempt rural areas, and allow small providers to continue to participate in Medicare if they meet the competitive price. The bill, introduced by Reps. David Hobson (R-Ohio) and John S. Tanner (D-Tenn.), has more than 100 cosponsors with strong bi-partisan support.
The proposed rule addresses some key aspects of competitive bidding implementation, but many issues, such as the products and metropolitan statistical areas (MSAs) that will be subject to competitive bidding will be determined by CMS at a future date. See aahomecare for AAHomecare's updated summary highlighting key elements of the proposed rule and other documents including the proposed rule itself.
American Association for Homecare
625 Slaters Lane, Suite 200
Alexandria, VA 22314-1171 703-535-1881
aahomecare
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