US Politics: CALL TO ACTION - Competitive Bidding
NAAOP
Description
Collection
Title:
US Politics: CALL TO ACTION - Competitive Bidding
Creator:
NAAOP
Date:
7/24/2002
Text:
Competitive Bidding Update and Call to Action
The Senate has started its second week of debate on several Medicare
prescription drug bills. These bills do not currently contain
competitive bidding or any other provider giveback provisions. If one
of these drug proposals passes, it is likely that a provider package
will be considered on the Senate floor as early as mid-week. This could
potentially contain competitive bidding. However, should the
prescription drug bill fail to pass in any form, it is likely that
substantive action on competitive bidding will occur in September when
the Senate Finance Committee is expected to markup a provider giveback
package.
In June, the House of Representatives passed a Medicare prescription
drug benefit bill that would require the Secretary of Health and Human
Services (HHS) to establish and implement competitive bidding programs
for durable medical equipment, including some off-the-shelf orthotics.
Under the proposed system, the Secretary of HHS would be required to
enter into contracts with suppliers for competitive acquisition areas
for not longer than three years in duration. The items to be subject to
competitive bidding would be durable medical equipment and inhalation
drugs used with durable medical equipment as well as off-the-shelf
orthotics (defined as covered orthotics which require minimal
self-adjustment for appropriate use and does not require expertise in
trimming, bending, molding, assembling, or customizing to fit the
patient). It is unclear as to exactly which orthoses this would
include, but CMS would have a large degree of latitude.
The political situation in the Senate surrounding the ultimate passage
of some form of competitive bidding is still very fluid, but signs are
beginning to point toward a growing opposition to it in the Senate.
NAAOP's own efforts along with those of other organizations are
appearing to have some success in convincing members of the Senate that
competitive bidding will be detrimental to patient care. To date, NAAOP
has been actively involved in the following advocacy efforts:
. NAAOP's General Counsel and Co-Chair of the Coalition of Citizens
with Disabilities Health Task Force, Peter Thomas, spearheaded a
sign-on letter urging Senate Majority Leader Tom Daschle (D-SD) to
oppose the implementation of Medicare competitive bidding. As the
letter explains, Medicare beneficiaries with disabilities and chronic
conditions rely on these devices and services to remain functional and
independent. The incremental benefit that Medicare beneficiaries might
realize from competitive bidding (as a result of slightly reduced
co-payments) is far outweighed by the serious threat to quality, access,
and choice of provider that this proposal represents. The CCD Health
Task Force Letter opposing competitive bidding was signed onto by 25
disability-related organizations. See attached letter below:
. NAAOP has joined the Coalition for Access to Medical Services,
Equipment and Technology (CAMSET), a new coalition comprised of 22
industry, provider, and consumer groups that are opposed to competitive
bidding. In a new report, the coalition describes how implementing a
national Medicare competitive bidding program would require a 35 percent
increase in CMS' workforce thus creating an expansive bureaucracy. The
CAMSET report concluded that the competitive bidding program outlined in
the House-passed bill would require CMS to hire 1,626 full-time
employees to manage the initiative, a huge increase in staff and
administrative costs considering CMS' current workforce of 4,630.
. NAAOP also joined CAMSET in releasing an alternative estimate of
cost-savings to the Medicare program from competitive bidding.
Currently the Congressional Budget Office has scored the competitive
bidding system as saving $7.7 billion over the next 10 years. However,
a report commissioned by the coalition and completed by
PriceWaterhouseCoopers illustrates the potential budget consequences of
not recognizing the risks and uncertainties involved in interpreting the
scope of competitive bidding and of having only very limited data to
support an analysis. This alternative set of assumptions reduces CBO's
$7.7 billion estimate of cost savings to about $1 billion over the
ten-year period, 2003-2012.
CALL TO ACTION: CALLS NEEDED THIS WEEK
NAAOP urges its members to contact their Senators and tell them to
oppose Medicare competitive bidding especially for orthotics and
prosthetics. Use the letter attached as talking points to help you make
strong arguments. Although progress is being made, it is still very
much an uphill battle to ensure that competitive bidding does not become
a reality for O&P providers and our patients. Call the Capitol
Switchboard at (202) 224-3121 to speak with your Senators' offices
today.
July 22, 2002
The Honorable Thomas Daschle
Senate Majority Leader
C/o Jane Loewenson
United States Senate
509 Hart Senate Office Building
Washington, D.C. 20515
RE: CCD Health Task Force Opposes Medicare Competitive Bidding
Proposal
Dear Majority Leader Daschle:
As the Senate considers the provider payment section of the Medicare
reform bill, the undersigned members of the CCD Health Task Force urge
you to oppose the implementation of Medicare competitive bidding for
durable medical equipment (DME) and some orthotics. Medicare
beneficiaries with disabilities and chronic conditions rely on these
devices and services to remain functional and independent. CCD believes
that the incremental benefit that Medicare beneficiaries might realize
from competitive bidding (as a result of slightly reduced co-payments)
is far outweighed by the serious threat to quality, access, and choice
of provider that this proposal represents. The House has included
competitive bidding in its Medicare reform legislation and we strongly
urge the Senate to oppose these provisions and not cast people with
disabilities to the lowest bidder.
CCD's Health Task Force is a coalition of national disability-related
organizations working together to advocate for national public policy
that ensures self determination, health, independence, empowerment,
integration, and inclusion of children and adults with disabilities in
all aspects of society. For too long, the DME competitive bidding
debate has been dominated by providers and suppliers of DME, and
disability-related organizations have not been heard on this
important issue. Now that DME competitive bidding has been included in
the House bill, we feel that it is time to express our views.
Under the current Medicare program, the reimbursement level for DME,
orthotics, prosthetics and supplies is set by fee schedule and providers
and suppliers compete for Medicare patients based on the quality of the
service they provide to the beneficiary, how quickly service calls are
performed, how responsive the company is to the physician who refers the
patient, and how functional the patient is with the service and/or
device provided. Under government-imposed competitive bidding:
. Price becomes the sole and determining factor in securing
Medicare referrals and the quality of care and range of services
provided to the patient are sacrificed in order to put forth a low bid;
. The quality of care is bound to suffer as providers search for
ways to cut corners and costs so they can make ends meet. It will not
take long before providers discontinue product lines that are no longer
sufficiently profitable or that require extra time or attention to the
beneficiary, to the detriment of patient outcomes;
. DME that is customized to the patient is nearly impossible to
competitively bid as one is not comparing identical products.
Customizing DME entails the skills of the provider, the experience of
the provider with similar or complex patients, and different techniques
for achieving particular therapeutic goals. This is evident in
wheelchair design that requires customization and other DME such as
oxygen therapy that requires a high degree of service.
. Competitive bidding should never be considered for professional
orthotic and prosthetic care due to the uniqueness of the service, the
high degree of clinical/professional care involved, and the
customization entailed in providing orthotic (orthopedic braces) and
prosthetic (artificial limbs) care. Even competitive bidding of
prefabricated orthotics is problematic because it treats orthotic care
as the provision of a commodity rather than recognizing the
clinical/professional judgment required to provide quality care;
. Medicare beneficiaries under the fee-for-service program will be
restricted in accessing the provider of their choice. Long-standing
relationships between beneficiaries and familiar providers will be
interrupted causing disruption in service and dissatisfaction for
patients. Small, community-based providers will be displaced by larger
chain providers that can take advantage of economies of scale, but which
may not be in the interests of beneficiaries. Beneficiaries who do not
value choice of provider have the option of joining the Medicare Plus
Choice program, but the key feature of Medicare's fee-for-service
program is choice of provider and this must be vigilantly safeguarded;
. The efforts of companies, entrepreneurs, and researchers to
innovate in this area will be significantly curtailed if there is not an
adequate funding stream to reward innovation; and
. Implementation of Medicare competitive bidding is premature in
that the impact on beneficiaries of the two competitive bidding
demonstration projects has not been adequately assessed. In fact, the
only study that assessed this issue stated, It is premature to declare
that competitive bidding is either an appropriate or an inappropriate
reimbursement mechanism for durable medical equipment and related
items.
For these reasons, the undersigned members of the CCD Health Task Force
strongly urge you to oppose the imposition of competitive bidding on
Medicare durable medical equipment, orthotics and prosthetics. Thank
you in advance for your consideration and if you have questions, please
call Health Task Force Co-Chair, Peter Thomas at (202) 466-6550.
Sincerely,
Adapted Physical Activity Council
Advancing Independence: Modernizing Medicare & Medicaid
American Academy of Physical Medicine & Rehabilitation
American Association on Mental Retardation
American Association of People with Disabilities
American Council for the Blind
American Medical Rehabilitation Providers Association
American Occupational Therapy Association
American Physical Therapy Association
American Therapeutic Recreation Association
Association of University Centers on Disabilities
Brain Injury Association
Center on Disability and Health
Disability Rights Education and Defense Fund
Easter Seals
Epilepsy Foundation
Paralyzed Veterans of America
Rehabilitation Engineering and Assistive Technology Society of North
America
Research Institute for Independent Living
National Association for the Advancement of Orthotics and Prosthetics
National Association of Protection and Advocacy Systems
National Council on Independent Living
National Organization on Disability
The Arc of the United States
United Cerebral Palsy Association
cc: The Honorable Trent Lott (C/o John Mashburn)
The Honorable Max Baucus (C/o Pat Bousliman)
The Honorable Charles Grassley (C/o Linda Fishman)
The Honorable Tom Harkin (C/o Peter Reinecke)
The Honorable Bob Graham (C/o Jocelyn Moore & Lisa Layman)
The Honorable Max Cleland (C/o Tamara Jones)
Visit our web site at www.oandp.com/naaop
Come share YOUR view! Government Relations is what WE do!
The Senate has started its second week of debate on several Medicare
prescription drug bills. These bills do not currently contain
competitive bidding or any other provider giveback provisions. If one
of these drug proposals passes, it is likely that a provider package
will be considered on the Senate floor as early as mid-week. This could
potentially contain competitive bidding. However, should the
prescription drug bill fail to pass in any form, it is likely that
substantive action on competitive bidding will occur in September when
the Senate Finance Committee is expected to markup a provider giveback
package.
In June, the House of Representatives passed a Medicare prescription
drug benefit bill that would require the Secretary of Health and Human
Services (HHS) to establish and implement competitive bidding programs
for durable medical equipment, including some off-the-shelf orthotics.
Under the proposed system, the Secretary of HHS would be required to
enter into contracts with suppliers for competitive acquisition areas
for not longer than three years in duration. The items to be subject to
competitive bidding would be durable medical equipment and inhalation
drugs used with durable medical equipment as well as off-the-shelf
orthotics (defined as covered orthotics which require minimal
self-adjustment for appropriate use and does not require expertise in
trimming, bending, molding, assembling, or customizing to fit the
patient). It is unclear as to exactly which orthoses this would
include, but CMS would have a large degree of latitude.
The political situation in the Senate surrounding the ultimate passage
of some form of competitive bidding is still very fluid, but signs are
beginning to point toward a growing opposition to it in the Senate.
NAAOP's own efforts along with those of other organizations are
appearing to have some success in convincing members of the Senate that
competitive bidding will be detrimental to patient care. To date, NAAOP
has been actively involved in the following advocacy efforts:
. NAAOP's General Counsel and Co-Chair of the Coalition of Citizens
with Disabilities Health Task Force, Peter Thomas, spearheaded a
sign-on letter urging Senate Majority Leader Tom Daschle (D-SD) to
oppose the implementation of Medicare competitive bidding. As the
letter explains, Medicare beneficiaries with disabilities and chronic
conditions rely on these devices and services to remain functional and
independent. The incremental benefit that Medicare beneficiaries might
realize from competitive bidding (as a result of slightly reduced
co-payments) is far outweighed by the serious threat to quality, access,
and choice of provider that this proposal represents. The CCD Health
Task Force Letter opposing competitive bidding was signed onto by 25
disability-related organizations. See attached letter below:
. NAAOP has joined the Coalition for Access to Medical Services,
Equipment and Technology (CAMSET), a new coalition comprised of 22
industry, provider, and consumer groups that are opposed to competitive
bidding. In a new report, the coalition describes how implementing a
national Medicare competitive bidding program would require a 35 percent
increase in CMS' workforce thus creating an expansive bureaucracy. The
CAMSET report concluded that the competitive bidding program outlined in
the House-passed bill would require CMS to hire 1,626 full-time
employees to manage the initiative, a huge increase in staff and
administrative costs considering CMS' current workforce of 4,630.
. NAAOP also joined CAMSET in releasing an alternative estimate of
cost-savings to the Medicare program from competitive bidding.
Currently the Congressional Budget Office has scored the competitive
bidding system as saving $7.7 billion over the next 10 years. However,
a report commissioned by the coalition and completed by
PriceWaterhouseCoopers illustrates the potential budget consequences of
not recognizing the risks and uncertainties involved in interpreting the
scope of competitive bidding and of having only very limited data to
support an analysis. This alternative set of assumptions reduces CBO's
$7.7 billion estimate of cost savings to about $1 billion over the
ten-year period, 2003-2012.
CALL TO ACTION: CALLS NEEDED THIS WEEK
NAAOP urges its members to contact their Senators and tell them to
oppose Medicare competitive bidding especially for orthotics and
prosthetics. Use the letter attached as talking points to help you make
strong arguments. Although progress is being made, it is still very
much an uphill battle to ensure that competitive bidding does not become
a reality for O&P providers and our patients. Call the Capitol
Switchboard at (202) 224-3121 to speak with your Senators' offices
today.
July 22, 2002
The Honorable Thomas Daschle
Senate Majority Leader
C/o Jane Loewenson
United States Senate
509 Hart Senate Office Building
Washington, D.C. 20515
RE: CCD Health Task Force Opposes Medicare Competitive Bidding
Proposal
Dear Majority Leader Daschle:
As the Senate considers the provider payment section of the Medicare
reform bill, the undersigned members of the CCD Health Task Force urge
you to oppose the implementation of Medicare competitive bidding for
durable medical equipment (DME) and some orthotics. Medicare
beneficiaries with disabilities and chronic conditions rely on these
devices and services to remain functional and independent. CCD believes
that the incremental benefit that Medicare beneficiaries might realize
from competitive bidding (as a result of slightly reduced co-payments)
is far outweighed by the serious threat to quality, access, and choice
of provider that this proposal represents. The House has included
competitive bidding in its Medicare reform legislation and we strongly
urge the Senate to oppose these provisions and not cast people with
disabilities to the lowest bidder.
CCD's Health Task Force is a coalition of national disability-related
organizations working together to advocate for national public policy
that ensures self determination, health, independence, empowerment,
integration, and inclusion of children and adults with disabilities in
all aspects of society. For too long, the DME competitive bidding
debate has been dominated by providers and suppliers of DME, and
disability-related organizations have not been heard on this
important issue. Now that DME competitive bidding has been included in
the House bill, we feel that it is time to express our views.
Under the current Medicare program, the reimbursement level for DME,
orthotics, prosthetics and supplies is set by fee schedule and providers
and suppliers compete for Medicare patients based on the quality of the
service they provide to the beneficiary, how quickly service calls are
performed, how responsive the company is to the physician who refers the
patient, and how functional the patient is with the service and/or
device provided. Under government-imposed competitive bidding:
. Price becomes the sole and determining factor in securing
Medicare referrals and the quality of care and range of services
provided to the patient are sacrificed in order to put forth a low bid;
. The quality of care is bound to suffer as providers search for
ways to cut corners and costs so they can make ends meet. It will not
take long before providers discontinue product lines that are no longer
sufficiently profitable or that require extra time or attention to the
beneficiary, to the detriment of patient outcomes;
. DME that is customized to the patient is nearly impossible to
competitively bid as one is not comparing identical products.
Customizing DME entails the skills of the provider, the experience of
the provider with similar or complex patients, and different techniques
for achieving particular therapeutic goals. This is evident in
wheelchair design that requires customization and other DME such as
oxygen therapy that requires a high degree of service.
. Competitive bidding should never be considered for professional
orthotic and prosthetic care due to the uniqueness of the service, the
high degree of clinical/professional care involved, and the
customization entailed in providing orthotic (orthopedic braces) and
prosthetic (artificial limbs) care. Even competitive bidding of
prefabricated orthotics is problematic because it treats orthotic care
as the provision of a commodity rather than recognizing the
clinical/professional judgment required to provide quality care;
. Medicare beneficiaries under the fee-for-service program will be
restricted in accessing the provider of their choice. Long-standing
relationships between beneficiaries and familiar providers will be
interrupted causing disruption in service and dissatisfaction for
patients. Small, community-based providers will be displaced by larger
chain providers that can take advantage of economies of scale, but which
may not be in the interests of beneficiaries. Beneficiaries who do not
value choice of provider have the option of joining the Medicare Plus
Choice program, but the key feature of Medicare's fee-for-service
program is choice of provider and this must be vigilantly safeguarded;
. The efforts of companies, entrepreneurs, and researchers to
innovate in this area will be significantly curtailed if there is not an
adequate funding stream to reward innovation; and
. Implementation of Medicare competitive bidding is premature in
that the impact on beneficiaries of the two competitive bidding
demonstration projects has not been adequately assessed. In fact, the
only study that assessed this issue stated, It is premature to declare
that competitive bidding is either an appropriate or an inappropriate
reimbursement mechanism for durable medical equipment and related
items.
For these reasons, the undersigned members of the CCD Health Task Force
strongly urge you to oppose the imposition of competitive bidding on
Medicare durable medical equipment, orthotics and prosthetics. Thank
you in advance for your consideration and if you have questions, please
call Health Task Force Co-Chair, Peter Thomas at (202) 466-6550.
Sincerely,
Adapted Physical Activity Council
Advancing Independence: Modernizing Medicare & Medicaid
American Academy of Physical Medicine & Rehabilitation
American Association on Mental Retardation
American Association of People with Disabilities
American Council for the Blind
American Medical Rehabilitation Providers Association
American Occupational Therapy Association
American Physical Therapy Association
American Therapeutic Recreation Association
Association of University Centers on Disabilities
Brain Injury Association
Center on Disability and Health
Disability Rights Education and Defense Fund
Easter Seals
Epilepsy Foundation
Paralyzed Veterans of America
Rehabilitation Engineering and Assistive Technology Society of North
America
Research Institute for Independent Living
National Association for the Advancement of Orthotics and Prosthetics
National Association of Protection and Advocacy Systems
National Council on Independent Living
National Organization on Disability
The Arc of the United States
United Cerebral Palsy Association
cc: The Honorable Trent Lott (C/o John Mashburn)
The Honorable Max Baucus (C/o Pat Bousliman)
The Honorable Charles Grassley (C/o Linda Fishman)
The Honorable Tom Harkin (C/o Peter Reinecke)
The Honorable Bob Graham (C/o Jocelyn Moore & Lisa Layman)
The Honorable Max Cleland (C/o Tamara Jones)
Visit our web site at www.oandp.com/naaop
Come share YOUR view! Government Relations is what WE do!
Citation
NAAOP, “US Politics: CALL TO ACTION - Competitive Bidding,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/219358.
