Transcript Document

Competitive Bidding – Where are we Today?
THE STATE OF THE INDUSTRY
John Gallagher
The VGM Group
3 May 2005
First of all, much of today’s presentation and related information may
be found on DC Link...To get there, first go to http://www.vgm.com
And you are there!
THE GOAL:
“EFFECTIVE LOBBYING”
GRASS – ROOTS LOBBYING
• THE MOST EFFECTIVE
FORM OF LOBBYING
• WHY – BECAUSE
YOU & YOURS VOTE!
YOU HAVE 15 MINUTES WITH YOUR
CONGRESSMAN OR SENATOR --Before you sit down with your Senator or Congressman,
Remember the SIX PPPPPP’s
Develop Triple Track approach to combating
National Competitive Bidding:
Legislative – Develop a champion for the industry
Grass-Roots – Coordinate Grass-Roots activity at Provider
Level
Legal – Develop Legal effort to delay and or defeat NCB
The MMA of 2003 (*) – HME Provisions
•
•
•
•
FEHBP Pricing
Inhalation & Infusion Drugs
CPI Freeze
Competitive Bidding
(*) On December 8, 2003, President George W. Bush signed
into law the Medicare Prescription Drug, Improvement and
Modernization Act (MMA) of 2003.
THE 2003 MEDICARE BILL & THE HME INDUSTRY:
FEHBP
•
Industry analysts originally estimated that CMS would likely reduce
reimbursement for stationary oxygen by about 11% on average and by 7% on
average for portable oxygen.
•
On Wednesday (30 March) the DHHS Office of Inspector General released its
revised report on Medicare fee schedule amounts for home oxygen for 2005.
•
The report indicates that the stationary oxygen equipment "Percentage Difference
Between Medicare and FEHB Weighted Mean" is 12.4%
•
The report indicates that the portable home oxygen equipment "Percentage
Difference Between Medicare and FEHB Weighted Mean" is 10.8%
•
CMS has notified providers that “These fee schedule amounts will be implemented
by the Medicare Contractors as soon as possible and by no later than April 8,
2005”.
THE 2003 MEDICARE BILL & THE HME INDUSTRY:
FEHBP & Oxygen…
• Note: The Morrison study, (AAHomecare)
which used data from about 107 FEHBP plans, found
virtually no difference between pricing for FEHBP
fee-for-service plans and Medicare rates for home
oxygen. E0431). And, the OIG study “did not address
the significant pricing, contracting, patient service and
administrative differences between the Medicare
program compared to FEHBP or Medicare + Choice
plans”.
THE 2003 MEDICARE BILL & THE HME INDUSTRY:
ACTUAL 2005 REIMBURSEMENT CUTS
Cuts vary widely by state; generally “less than
many industry observers had feared”.
•
•
•
•
•
•
•
diabetic test strips (A4253): 0 to 4 percent
diabetic lancets (A4259): 0 to 5 percent
semi-electric bed (E0260): 1.6 to 16 percent
power pressure-reducing mattress (E0277): 0 to 7 percent
nebulizers with compressor (E0570): 4 to 18.3 percent
manual wheelchair (K0001): 0 to 2.5 percent
power wheelchair (K0011): 0 to 3.3 percent
THE 2003 MEDICARE BILL & THE HME INDUSTRY:
Example = FEHBP Cuts - State of VIRGINIA Actual Data
HCPCS Code
Item
E1390, E4024,
E4039
Stationary oxygen systems
E0434, E0431
2005
Medicare
Allowable
VIRGINIA
2004
Medicare
Allowable
VIRGINIA
Reimbursement change
(%) between
2004 & 2005
$194.48
$194.48
-0.0%
Portable oxygen systems
$32.08
$35.97
-8.73%
A4253
Blood glucose test or
reagent strips,
$36.54
$38.52
A4259
Lancets, per box of 100
$12.06
$12.74
-5.33%
E0260
Hospital bed, semi-electric,
with mattress
$1,404.60
$1,679.30
-16.35%
E0277
Powered pressure-reducing
air mattress
$7,034.70
$7,593.60
-7.36%
E0570
Nebulizer, with compressor
$161.10
$167.70
-3.94%
K0001
Standard wheelchair
$532.70
$546.20
K0011
Standard-weight frame
motorized/power
wheelchair with….
$5,122.80
$5296.50
4.10%
2.47%
-3.28%
THE 2003 MEDICARE BILL & THE HME INDUSTRY:
Example = FEHBP Cuts - State of WEST VIRGINIA Actual Data
HCPCS Code
Item
2005
Medicare
Allowable
West Virginia
2004
Medicare
Allowable
West Virginia
E1390, E4024,
E4039
Stationary oxygen systems
$200.41
$228.80
-12.40%
E0434, E0431
Portable oxygen systems
$31.13
$31.13
-0.00%
A4253
Blood glucose test or
reagent strips,
$36.94
$38.52
-4.10%
A4259
Lancets, per box of 100
$11.48
$11.48
-0.00%
E0260
Hospital bed, semi-electric,
with mattress
$1,404.60
$1,627.60
-13.70%
E0277
Powered pressure-reducing
air mattress
$7,034.70
$7,593.60
-7.36%
E0570
Nebulizer, with compressor
$161.00
$195.20
-17.52%
K0001
Standard wheelchair
$532.70
$546.20
2.47%
K0011
Standard-weight frame
motorized/power
wheelchair with….
$5,117.40
$5,117.40
Reimbursement change
(%) between
2004 & 2005
-0.00%
Surviving and Thriving with the newest Oxygen
Reimbursement Cuts
• Use ABN’s for newest technology and equipment
upgrades
• Use financing to match reimbursement with payment
• Best Price at the best rate will allow you to
maximize cash flow
• Every time you set up a new oxygen patient you
know how much positive cash flow you have
created
• Take advantage of quantity purchases and
promotions to get the best possible purchase price
Surviving and Thriving with the newest Oxygen
Reimbursement Cuts
• Maximize efficiencies for certain patient populations that are
better handled with an outside source
• Utilize a patient follow-up program to increase quality of life and
quality of life for oxygen patients
• Utilize compliance programs to ensure patients are compliant
with their oxygen
• Select the best modality and the best products for individual
patients
• One size equipment doesn’t work for everyone
• Maximize positive cash flow by patient not by equipment
In 2004 (108th Congress)…
• Reps. David Hobson (R-Ohio) introduced a bill, H.R. 4491,
to repeal cuts in Medicare reimbursement for these items.
• Co-sponsors: 117 – VA = 4 0f 11 or 36% Rep. Goode,
Boucher, Goodlatte, Davis & WV = 2 0f 3 or 66% Rep.
Mollohan, Rahall.
• When congress adjourned “sine die”, all legislation that was
not brought to a vote dies in that Congress – hence H.R.
4491 is dead…
• AAHomecare, VGM, state/regional associations lobbied
hard for this repeal: Comparisons between Medicare and
FEHBP are inappropriate
• “FEHBP plans serve younger, healthier populations and
impose fewer administrative burdens on providers.”
H.R. 4491 was still a success…
• Our industry’s grassroots effort that pushed the bill
forward developed a relationship with 117 members of
Congress.
• In reality, the actual chances of HR 4491 coming to a vote
were slim during an election year as well a lack of a
companion bill in the Senate.
• Should a new bill be introduced in 2005, it is a good bet
that a large majority of the original 117 co-sponsors will
sign on again. A new bill will give us a chance to meet
with our elected officials once again to address the FEHBP
cuts as well as NCB. This can only help our cause moving
forward!
Rep. Hobson:
“I am committed to making
sure that seniors who depend
on durable medical
equipment will continue to
have access to the equipment
and services they rely upon
so they can maintain the
highest quality of life while
staying in their homes.”
109th Congress: New legislators include those
from the healthcare ranks
• HME's own Representative Mike Ross (D-AR)
has been appointed to the House Energy and
Commerce Committee. Contact Rep. Ross at
[email protected], or at his Washington
D.C. office (202.225.3772) and extend
congratulations to him for landing this plum
position. The HME industry finally has a friend on
this very powerful House committee!
• Ross and his spouse own and operate an
independent pharmacy/HME business
Other 2005 Issues: Part B Drugs
• Infusion drugs frozen at 95% of AWP (in effect
since October 1,2003) and then subject to
competitive bidding starting in 2007.
• Inhalation drugs based on the ASP plus 6% for the
drug. This amount would be updated quarterly. A
$57 monthly dispensing fee for inhalation
therapies applies for 2005. CMS also set a 90-day
fee of $80 in the fee schedule (*).
(*) It is assumed that you will no longer be able to bill the $5.00 (E0590)
dispensing fee per drug dispensed.
Nebulizer Medications Transition
On January 1, 2005, CMS transitioned to the ASP pricing model for nebulizer medications. This change in
reimbursement methodology has caused much confusion within the small to medium size pharmacy providers of
nebulizer medications. The appropriate drug mix for this type of patient must now change to provide results that
are best for both the patient as well as for the provider. As a result of this transition to more brand drug usage, the
smaller providers have found themselves in a difficult position as it relates to the usage of the Brand Drug Duoneb.
Dey has a pricing structure for this product that is not beneficial to the small and medium size provider. We have
made many attempts to work with Dey to solve this problem and have received Zero cooperation in doing so.
Dey’s current price structure for Duoneb allows for a large discount to providers purchasing 100,000 vials per
month. This would be 833 patient shipments every month. Dey offers as much as a 50% discount from what small
providers pay for providers purchasing 500,000 or more vials per month. Previously, when utilizing their albuterol
and Ipratropium generic products, small to medium size providers were within 5 cents of the same pricing offered
to the largest providers. For Duoneb the difference is in excess of .40 cents per dose allowing the large providers to
pocket an extra $50.00 per patient shipment.
To solve this problem and better even the playing field, we are suggesting that instead of
switching patients to Duoneb, your pharmacy should consider using one vial of Xopenex and
one vial of ipratropium (where necessary). This will offer you patients the benefits of Xopenex with equal
benefit of albuterol but with only half the active ingredients of albuterol. This benefit also reduces the side effects
of normal albuterol by as much as half. This is a true benefit to the physicians and patients. Sepracor has over
1,500 detail representatives ready to work with you and inform physicians of your choice to offer their product. It
is like adding sales reps to your company for free. When you compare the profitability, you will also find that you
will make a substantially higher profit that when using Duoneb.
We offer this solution to our VGM Members.
Other HME Provisions of MMA
(none positive…)
• CPI Freeze
5 year freeze in the CPI update for DME
and off-the-shelf orthotics in those areas
where competitive bidding is not being
phased in, in 2007 and 2008.
COMPETITIVE BIDDING
COMPETITIVE ACQUISITION AUTHORITY:
Section 302 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
(Pub. L. 108-173) authorizes the Secretary to utilize our competitive acquisition authority, as
outlined in the U.S. Code Section 1847(a). Section 302(b)(1) of the Medicare Modernization
Act, requires Medicare to replace the current durable medical equipment (DME) payment
methodology for certain items with a competitive acquisition process to improve the
effectiveness of its methodology for setting DME payment amounts. This new bidding
process will establish payment amounts for certain durable medical equipment, enteral
nutrition, and off?the?shelf orthotics. Competitive bidding provides a way to harness
marketplace dynamics to create incentives for suppliers to provide quality items and services
in an efficient manner and at reasonable cost. The Medicare DME Competitive Bidding
Program has five objectives:
1.
To operationalize competitive bidding for DME and to use this to determine appropriate
prices for categories of DME covered by Medicare Part B;
2.
To protect beneficiary access to quality DME throughout the program;
3.
To reduce the amount Medicare pays for DMEPOS and bring the reimbursement amount more
in line with that of a competitive market;
4.
To limit the burden on beneficiaries by reducing their out-of-pocket expenses; and
5.
To mitigate proliferation of use of certain items of DMEPOS by contracting with suppliers who
engage in a business model that is beneficial for the program and for Medicare beneficiaries.
In the coming months CMS will be publishing more information and resources related to this
provision.
Competitive Bidding
Commences in the 10 “of the largest”
MSAs in 2007; followed by the next 80
largest MSAs in 2009. After 2009, (the
DHHS) Secretary has authority to apply
Competitive Bidding prices nationally.
Note: CMS is interpreting Sec. 302 of the MMA to read “ten of THE
largest MSA with population of 1million or more.
Competitive Bidding – The Largest MSAs
1. Los Angeles—Long Beach, CA
2. New York, NY
3. Chicago, IL PMSA
4. Philadelphia, PA—NJ
5. Washington, DC/MDVA/WV
6. Detroit, MI
7. Houston, TX
8. Atlanta, GA
9. Dallas, TX
10. Boston, MA—NH
COMPETIVE BIDDING FACTS
• Total amounts paid under the contract (including
costs associated with administration of the
contract) be lower than the total amounts that
would otherwise be paid
• Requires re-bid of contracts ** NOT TO
EXCEED** every 3 years
• Allows limitation of number of contractors in a
“competitive acquisition area” to the number
necessary to meet product demand
• Requires the award of contracts to “multiple
entities” in each area for an item or service.
• Requires that entity to meet quality and financial
standards.
• Requires studies to determine whether suppliers
under competitive bidding influence physician
prescribing practices based on profitability of
products.
• Requires report to Congress annually on the
competitive acquisition program. Each report shall
include information on cost savings, reductions in
beneficiary cost sharing, access to and quality of
items, and beneficiary satisfaction. Requires GAO
to submit report to Congress on the impact of
Competitive Bidding on manufacturers and
suppliers by January 1,2009.
“PROTECTION OF SMALL SUPPLIERS”
• “In developing procedures relating to bids
and the awarding of contracts under this
section, the Secretary shall take appropriate
steps to ensure that small suppliers of items
and services have an opportunity to be
considered for participation in the program
under this section.”
Other MMA Regulatory Issues
• Requires establishment and implementation of
quality standards and accreditation requirements.
• One year after the quality standards are developed,
DHHS is required to designate and approve one
or more independent accreditation organizations.
• Quality standards as applied by accrediting
organizations must be met in order to receive or
retain a supplier number.
Mandatory Accreditation
• Many providers we surveyed comment that
accreditation had a positive impact on their
business, and others said they would investigate
accreditation as a way to improve their companies.
However, the majority of providers remain
unaccredited (estimated at about 60%).
• About one fourth of unaccredited providers are
considering accreditation in 2004.
REPORT ON IMPACT OF FEHBP CUTS ON COMPETITIVE
BIDDING SAVINGS
Summarized from report written by economist Dr. Kenneth Brown, Ph.D.
Allowed Charges
Under
Demonstration
(Modified)
Allowed Charges in
Absence of
Demonstration (Modified)
Polk County, Florida
$21,315,740
$26,184,833
San Antonio, Texas
$14,786,802
$18,731,722
$36,102,542
$44,916,555
Grand Total
Actual Administrative Expenses
Actual Savings to Medicare
Pro-forma Allowed
Charges in Absence of
Demonstration - After
FEHBP
Polk County, Florida
$21,315,740
$23,564,225
San Antonio, Texas
$14,786,802
$16,807,336
$36,102,542
$40,371,561
Actual Administrative Expenses
Actual Cost to Medicare
$4,869,093
$3,944,920
% Differential
18.6%
21.1%
$8,814,013
19.6%
-$4,800,000
-54.5%
$4,014,013
Allowed Charges
Under
Demonstration
Grand Total
Differential
Differential
$2,248,485
$2,020,534
8.9%
% Differential
9.5%
12.0%
$4,269,019
10.6%
-$4,800,000
-112.4%
-1.3%
-$530,981
Program Advisory and Oversight
Committee (PAOC) Overview
• In order to allow the industry to have input on the DME
provisions of the MMA (e.g., FEHBP cuts, competitive
bidding, mandatory accreditation), CMS formed the
PAOC.
• Equipment manufacturers (e.g., Sunrise, Invacare and
Pride Mobility), three state Medicaid programs, two
national provider associations, national and independent
HME dealers, independent pharmacies, accrediting bodies,
manufacturers that sell directly to patients and advocacy
groups make up PAOC. The committee is charged with
assisting CMS in the development of a national
competitive bidding program.
• PAOC MEETING SUMMARIES
INITIAL MEETING – OCTOBER 6, 2004
•
Review of the competitive bidding demonstration projects
•
Quality Standards
•
Scored savings from NCB
•
Items of concern following the meeting
•
•
•
•
Savings in light of the FEHBP cuts
What standards do winning bidders have to meet
Dealers allowed to form networks to bid
Cost shifting
SECOND MEETING – DECEMBER 6 & 7, 2004
Review of existing DME competitive bidding programs
VA
Utah O2
Minnesota Wheelchair
Possible program design
Bidding Cycles
MSA selection
Possible Phase-in process
MSA’s
Equipment/ HCPCS codes
THIRD MEETING – FEBRUARY 28, MARCH 1 & 2, 2005
Timetable for NCB process
Summer 2005 – Publish regulations for NCB
Fall 2005 – Review comments
Spring 2006 – Finalize proposed regulations and move them thru
Congress
Fall 2006 – Begin Implementation process
January 2007 – Implement in 10 large MSA’s
All decisions are preliminary until the final regulations are published.
PAOC will have an open door forum after the preliminary regulations
are made public.
Progress on issues raised in previous PAOC meetings
CMS has been given more money to study the impact on
small businesses
CMS allocated more time and money to development of
quality standards
Coding changes and improvements
CMS was told that the
Congressional Budget Office
factored in the FEHBP cuts and
CPI freeze when they scored the
NCB savings?
Bid solicitation process
Step 1 – Evaluate the Basic eligibility requirements
Valid NSC number
No current CMS sanctions
Valid state or local licenses ( if applicable)
Step 2 – Calculate the composite bid
Individual items?
Product categories?
Bid solicitation (continued)
Step 3 – Array the bids lowest to
highest
Step 4 – Evaluate Quality
Step 5 – Evaluate financial
capabilities of bidders
Bid solicitation (continued)
Step 6 – Calculate market and
supplier capacities
Step 7 – Select Pivotal Bid Everyone at or below the
pivotal bid is selected as a
winner if they meet all other
requirements
Options being considered for selecting number of winners
Pick enough winners so all estimated demand is met
Base bid on the median rate
Pre-select the number of winning bidders and take the
lowest rates
Base the bid on a target “composite” bid
i.e. Give the bid to anyone who bids 20% off
Determining Payment amounts
Bid individual HCPCS codes and set
rates on each
Bid a group of codes and award the
lowest total rate
Principles of Bidding
Principle 1 – Bidders at or below the pivotal bid
are selected as winners
Principle 2 – All winning supplies will be paid the
same price for each item
Principle 3 - Winning suppliers will have to
receive at least as much for an item as they bid
Rural Area and Low Population
Density Exemption Authority
Area Phase-in;
10 MSA’s in 2007
80 MSA’s by 2009
2010 - ?
Proposed Approach to
Accreditation
During Summer 2005, RTI will conduct
focus groups in 3 – 4 sites across the US
yielding responses from 40 – 1000 small
suppliers.
•First Focus group was at MedTrade West
•Potential market areas: Atlanta,
Cleveland, Denver, Chicago, Minneapolis,
Raleigh / Durham, NC
CMS Announces More Focus Groups for Small HME Providers
on "Competitive Bidding" and Seeks Email Feedback
•
The Centers for Medicare and Medicaid Services (CMS) has announced focus
groups in Dallas and Chicago for small home medical equipment (HME)
providers to help CMS evaluate the effect of quality standards, accreditation,
and the selection process under "competitive bidding."
•
By small, CMS means providers that have gross annual revenues of $3 million
or less and/or 10 or fewer full-time equivalents. Both accredited and nonaccredited providers are welcome.
•
In a statement, CMS says it is particularly interested in providers with $1.5 million or
less in revenues to "assist CMS in considering alternatives for the protection" of small
HME providers.
CMS plans two focus groups in Dallas, TX on Wednesday, May 4 and
two in Chicago, IL on Thursday, May 5.
To register for one of the focus groups, please contact [email protected] by Wednesday,
April 27th. CMS asks that you rank your location and time preferences and provide the
following information:
·
Name of Business
·
Mailing Address
·
Phone Number
·
Estimated gross revenue (2004)
·
Is your business accredited? (Y/N) If yes, by whom?
·
Number of FTE's (full time equivalents)
·
Primary product categories offered by your business (e.g. oxygen, mobility aids, etc.)
CMS says, "Space is limited to 16 participants per session and registration is on a first-come
basis. However, RTI may modify participants to allow participation from the various regions.
Input from the various areas is very important. Among those selected to participate, only one
participant per company will be allowed."
The statement notes that, "If you do not receive a confirmatory email by the end of the day on
Friday, April 29th, you have not been selected to participate in this round of focus groups."
However, CMS says those not attending the focus groups can provide feedback on these issues
via email by sending comments to [email protected]
To get full details, see the CMS announcement at:
http://www.cms.hhs.gov/suppliers/dmepos/dme_focusgroups_annou.pdf
Size of Competitive Acquisition Areas
May expand the size of areas for 2007 & 2009 to
include areas adjoining the MSA if it is
determined they are “highly” competitive or are
“high utilization” areas.
May carve out areas within an MSA if they are
not considered competitive
Nationwide Areas may be considered – Items
that can be provided via mail order.
Quality Standards
MMA Section 302
“…. The Secretary shall establish and implement quality
standards for suppliers of items and services described ….. To
be applied by recognized independent accreditation
organizations…..
This applies to;
1. Furnish any such item or service…
And
2. Receive or retain a provider or supplier number
Quality Standards Domains
Organization Structure
Financial Management
Human Resources
Patient/Client Management
Assessment and Evaluation of Quality
Facility and Patient Environment and Safety
Management
Ethics/Rights
Information Management (Patient Records,etc.)
Accreditation
Accrediting bodies
Rational for Accreditation MMA Section 302
“ The Secretary shall designate and approve one or more
independent accreditation organizations……”
Small Business
Companies are considered “small” by:
SBA & NAICS if they do less than $6 million in
annual sales
CMS if they employ 10 or > people
Based on these criteria 60% of DMEPOS
suppliers qualify as small businesses
KEEP IN MIND
MMA – 2003 does allow for the exclusion of some
products and geographical areas. CMS is looking closely
at the VA and some Medicaid programs for implementing
this program. Even through it was pointed out in a very
clear terms that these programs operated very differently
than Medicare. In fact, a CMS representative alluded to
the fact that Medicare is using HME Competitive Bidding
to see if there are other areas for “competitive acquisition
of health care”.
Summary: Your message to Congress
and federal regulators is simple:
• Homecare provides high-value, high-quality
care at a low cost. We are the solution – not
the problem.
• Homecare is the answer to the health care
crisis because it delivers tremendous value
for Americans' health care dollars.
GRASS-ROOTS EFFORT
You Can Do In Your Home District
Advocacy Tips
• Providers from the home district of a member of Congress
have much more clout than people from outside that
district. You represent an important service and important
business that contributes to the well being of the district, in
terms of jobs and the economy as well as health care.
• When you meet with or contact your member of Congress
by fax, put a human face on the issue. Describe how the
issue would affect people in the district.
• Encourage your employees to be politically active on
issues that affect this industry.
Advocacy Tips
• Become a valued resource to members of Congress and
their staff on homecare issues so you are the local expert
on these issues.
• Utilize HCVA (HCVA.com), AAHomecare
(www.aahomecare.org) and VGM’s DC Link
(www.vgm.com) for details about homecare legislation and
regulatory issues.
CONTACT YOUR LOCAL ELECTED
OFFICIAL
• Before you make the call, familiarize yourself with the issue and write
down the points you want to cover – visit www.vgm.com and click on DC
Link for additional support material.
• While at D.C. LINK get the telephone number and address for your
elected officials.
• When you call or go by the district office - Always identify yourself as a
CONSTITUENT
• Ask to set up an appointment with your elected official in their office or at
you store. Offer your location as the best option.
• Set the Agenda. Let the Staff member know what you will cover
Go to D.C. Link and click on VIRGINIA
Web Site:
www.house.gov/goode
E-mail: Contact Via
'Write Your Rep.'
Danville
Phone: (434) 792-1280
Fax: (434) 797-5942
Address:
437 Main St.
Danville, VA 24541
Farmville
Phone: (434) 392-8331
Fax: (434) 392-6448
Address:
103 South Main St.
Farmville, VA 23901
Rocky Mount
Phone: (540) 484-1254
Fax: (540) 484-1459
Address:
70 East Court St., #215
Rocky Mount, VA 24151
Rep. Virgil Goode (R)
5th District
4th Term =
Appropriations
Committee
Washington Office:
1520 Longworth House
Office Building
Washington, D.C. 205154605
Phone: (202) 225-4711
Fax: (202) 225-5681
Main District Office:
104 South 1st St.
Charlottesville, VA 22902
Phone: (434) 295-6372
Fax: (434) 295-6059
Go in person to your local Congressional
district office
Introduce yourself to the local Congressional
district office staff
MEETING WITH
YOUR LOCAL
ELECTED OFFICIAL
KEY MEMBERS
OF THE HCAV CONGRESSIONAL DELEGATION
SENATE:
Senator George Allen (R-VA) Small Business & Entrepreneurship
Senator John Warner (R-VA) Chairmen – Armed Services
Senator Robert Byrd (D-WV) Ranking Member - Appropriations
Senator John Rockefeller (D-WV) FINANCE
HOUSE:
* Rep. Jo Ann Davis (R-VA, 1st Dist) Armed Services
Rep. Thelma Drake (R-VA, 2nd Dist) NEW MEMBER
* Rep. Virgil Goode (R-VA, 5th Dist) Appropriations
* Rep. Bob Goodlatte (R-VA, 6th Dist) Chair - Ag
Rep. Eric Cantor (R-VA, 7th Dist) Ways & Means (Whip)
* Rep. Rick Boucher (D-VA, 9th Dist) Energy & Comm
* Rep. Alan Mollohan (D-WV, 1st Dist) Appropriations
* Rep. Nick Rahall (D-WV, 3rd Dist) Resource (Rnk Mem.)
•= Signed as co-sponsor to HR 4491
YOU HAVE 15 MINUTES WITH YOUR CONGRESSMAN OR SENATOR ---
WHAT DO YOU DO NOW?
1.
TELL ME WHAT YOUR GOING TO TELL ME
2.
TELL ME – tell your story
- promote the beneficiary
3.
TELL ME WHAT YOU TOLD ME
4.
CLOSE BY ASKING FOR SOMETHING
THE “ASK FOR” WITH YOUR MEMBER OF
CONGRESS
1.
In light of the FEHBP cuts that are going into place January 1, 2005, we
request that the CBO re-score the competitive bidding demonstration project
estimated savings.
2.
In order to bid something under NCB, a dealer needs to know what standards will
apply if they are a winning bidder. It does not appear that the MMA gives CMS
enough time to address the standards issue. What would be required to move the
Standards and Accreditation criteria forward on the fast track?
3.
For CMS to move forward with NCB, there needs to be a provision where groups
of companies can go together under one umbrella to bid, i.e. a network (RTI has
referred to this as a Alliance in their presentation). One concern is that the
organization functioning as the network administrator must be allowed to get a
Medicare Provider number. CMS needs to addres this possibility, and be prepared
to facture the “networks” or “alliance in to the NCB planning process.
4.
Several members of the PAOC board asked that CMS / RTI conduct a study of the
effect of Re-admission rates of patients who where involved in the Demonstration
Projects conducted in Polk Co., FL and San Antonio, TX. Is CMS following up on
this request to see if there was indeed a cost shift in the demonstration projects?
5.
Demand CMS complete all five Demonstration Projects mandated by the BBA97.
VGM ACTION PLAN
1. Develop Action Plan to have CMS or Congress request CBO to "RESCORE" NCB factoring the FEHBP cuts - are there any true savings (Dr. Brown's
study on Polk Co. and San Antonio, TX).
2. Determine what is the "COST" of implementing NCB and overlaying that
with the information in # 1. What % "SAVINGS" remain under NCB? (Have Dr.
Brown develop “cost overlay” study. Combine with study on FEHBP cut impact on
Savings)
3. Determining if there truly was a "COST SHIFT" during the demonstration
projects of patients from DME to Hospital Care. What is that cost? And, can we
get the numbers (perhaps a Dr. Brown number crunch with Mark H. help ** Look
at Average Admissions of people from Home Care to Hospital care). Develop
natural allies from NE Governors and other States to question the idea of "Cost
Shifting" to State Medicare budgets under NCB.
4. Request Senator Grassley, Congressman Nussle and others direct the
HHS Sec. to conduct the three Demonstration Projects that where never
completed during BBA-97 (Large, Under Served and Rural MSA's), thereby
delay implementation of NCB until this Demonstration Projects validate the
concept of NCB. Determine the legislative mechanism to delay NCB, while
not change the MMA law?
5. Contact polling firm to conduct survey of Residents (beneficiaries) in
large Metro / MSA areas (NY, NJ). Look for issues of access to quality of
care and concern over loss of current provider.
6. Develop Triple Track approach to combating National Competitive
Bidding:
Legislative – Develop a champion for the industry
Grass-Roots – Coordinate Grass-Roots activity a provider level
Legal – Develop Legal effort to delay and or defeat NCB
COPD CAUCUS
Urge Members of Congress to Join the Congressional COPD Caucus
The bipartisan Congressional Chronic Obstructive Pulmonary Disease (COPD) Caucus was
formed by Senator Michael Crapo (R-ID) who chairs the Caucus with Senator Blanche
Lincoln (D-AR), Rep. Cliff Stearns (R-FL) and Rep. John Lewis (D-GA). COPD is a growing
healthcare crisis that afflicts more than 14 million Americans and costs $18 billion in direct
medical expenses annually. The Caucus will focus on a vast coalition of patient/homecare
associations and physicians to both educate Members of Congress on COPD as well as
advocate public policies to strengthen and encourage early detection and prevention.
Additional members of the Caucus include Sen. Thad Cochran (R-MS), Sen. Richard Durban (D-IL),
Sen. Rick Santorum (R-PA), Rep. Tammy Baldwin (D-WI), Rep. Duke Cunningham (R-CA), Rep.
Jim Gerlach (R-PA), Rep. J.D. Hayworth (R-AZ), Rep. Raul Grijalva (D-AZ), Rep. James Langevin
(D-RI), Rep. Zoe Lofgren (D-CA), Rep. Karen McCarthy (D-MO), Rep. Thaddeus McCotter (R-MI),
Rep. Marty Meehan (D-MA), Rep. Victor Synder (D-AR), Rep. Ed Towns (D-NY), and Rep. Chris
Van Hollen (D-MD).
What does the future hold for DME?
“Of course those of us who have been in the business for a long time
understand that we are the favorite “whipping boy” of the politicians
and that we have to adapt to this along with fighting it. We have
learned and prospered. In the ‘80s, the industry encountered Medicare
reimbursement changes from pure rental, to purchase, to OBRA and
the six-point plan.”
“The ‘90s brought the BBA of 1997. Each of these drastic changes was
hailed as the death of our industry. And, as you know, each time that
death was prematurely reported and each attack was followed by
growth and continued earned prosperity for most providers.”
– Jim Walsh
Council - VGM
Ms. Wheelchair America – 2005 = Ms. Juliette Rizzo – Ms Maryland
Congratulations VIRGINIA for MWVA & MWA Runner Up – Dr. PAM CLARK
WEST VIRGINIA did not hold a 2003 or 2004 Ms. Wheelchair Pageant
http://mswheelchairamerica.org/
Thank You For Opportunity to
Speak to HCAV!
Presented by John E. Gallagher
The VGM Group
[email protected]