Stakeholders switch gears at Legislative Conference

Thursday, February 16, 2012

WASHINGTON - HME stakeholders last week were thrown a curve ball when, on the eve of the AAHomecare Washington Legislative Conference, lawmakers announced they were close to a compromise package on the payroll tax cut extension.

Stakeholders had planned to ask lawmakers to include the market-pricing program (MPP), an alternative to competitive bidding, in the package during more than 300 meetings on Capitol Hill Thursday.

"The game's not over," Walt Gorski, vice president of government relations for AAHomecare told attendees on Wednesday. "Ask lawmakers, 'This needs to get done. How do we do it?'"

The compromise package, approved by both the House of Representatives and the Senate on Friday, includes a delay to a 27% cut in Medicare payments to physicians.

Switching gears, providers spent Thursday asking lawmakers to press the Congressional Budget Office (CBO) for a score for MPP. At a breakfast on Thursday morning, Sen. Charles Schumer, D-N.Y., indicated he would do just that. Throughout the day, others, like Sen. Scott Brown, R-Mass., also said they would contact the CBO.

Lawmakers appear more favorable toward MPP than H.R. 1041, a bill that would repeal the program. Nowhere was that more evident than during a meeting between members of the New England Medical Equipment Dealers Association (NEMED) and an assistant to Sen. John Kerry, D-Mass. During last year's visit, Kerry's office indicated he wouldn't be interested in sponsoring a companion bill to H.R. 1041. This year, his aide was familiar with MPP and said the office would try to schedule a bipartisan hearing with the CMS as early as this week.

"I'm hopeful," said Karyn Estrella, executive director of NEMED. "Last year she said to come back with a plan (and we did). I have to trust that things will work out the way they are supposed to."

To be sure, time is very tight for the industry to get anything done, with the Round 2 bidding window closing March 30. Auction expert Prof. Peter Cramton and economics professor Brett Katzman told conference attendees that if MPP passes this year, there is time to put it into place by July 2013, which is when Round 2 kicks off.

The annual conference drew about 300 attendees, including many providers who, spurred by Round 2, made the trip for the first time. 

"Round 2 has been crazier then expected," said Eric Cohen, president of Scarborough, Maine-based National Sleep Therapy. "I wasn't hearing the stories. We need simple, meaningful stories and I think I can tell those stories in a way that is compelling."



"The games not over", but it was certainly a major loss. Problem is that CMS estimates continue to show nearly $40+ Billion in total savings by moving forward with competitive bidding. Unfortunately, early MPP estimates still dont even come close to a number that one could realistically bring to their Congressperson and will require additional cuts. But from whom? Unfortunately, the vast majority of materials that say otherwise is severely biased and easily discarded.

One of these days unfortunately, when it will be too late, the industry will wake-up and understand the rules of CMS. They are quite simple. CMS has NO rules and the Industry has NO voice in what CMS does or can do! Currently, it runs as an Autonomous Agency that is the only "AA" they know!

Actually, there were many great and eloquent speakers like Karen Estrella from Nemed and Gary Sheehan from Cape medical that traveled the hill and met with various representatives. I only wish the process were a bit more transparent. With a real dialog with CMS, I am confident that the final plan would be better for all that the CB we're currently stuck with. Please cast your opinion here:

There is no political will to fix this situation. Sorry guys, but your effort would be better spent focusing on the transition to the next phase of your life.

Again Frank is on the mark on the fact that there is no imminent political fix. While the industry has spent more for less with lobbying efforts the only real fix for the industry is "protection from the courts". The industry wants to take on Capitol Hill with letters, meetings and phone calls to Congressionals. Until the industry gains some protection from the courts it is an undefensible opponent spinning it's wheels to go nowhere. In ALL the years of lobbying, letters, phone calls and a call to arms has not produced one motion of forward progress. Reimbursements continue to be reduced and regulations are stiffer. Doesn't seem to be what one may consider as progress!

I will never, ever be in a business that is a medicare vendor again for the rest of my life. I will sell pencils on the side of the road before I ever do something like this again. I am going to try to sell my business and if that doesn't work then I am just going to close my doors and move on.

Frank, there has been a positive development in my campaign of which I am not @ liberty to currently disclose but it is pretty big! More to come.

Dominic, I am very glad for you and I believe you. But I have been fighting this for years and I'm just done. People weren't meant to live like this. We are playing against a stacked deck. There are 1,000 ways to be wrong and maybe, just maybe 1 way to be right. The honest get hammered along with the dishonest. I am trying to sell my business and I seem to have a guy who is interested. And I will practically give him this company. All I want is to settle up my debts and maybe walk away with 30-40K. 30-40K for a decade of my life sucks but at least I can make a fresh start doing something, anything else. People just weren't meant to live like this.

FYI, The results of the Tri-Centurion Audit of my Company, Nichole Medical, is dated June 29, 2004. The 100% offset as a result of this atrocity started July 1, 2006. I believe this would entitle to speak from the same longevity. I also believe since NO one has gone before me with a battle such as this adds to why it is not one of an expeditious procedure.

Dominic, my point is that no one should have spent the last 8 years in unwarranted struggle like you have been forced to do. No one was meant to live like that. Soon Medicare patients will have as much trouble getting access to coverage as mediciad patients and when that day comes the only thing we can know for sure is that politiicians will point their fingers in every direction except their own.