NCB’s Wild Ride

• By David Kopf
• Aug 01, 2008

The twists and turns of H.R. 6331 and the competitive bidding delay.

You know what my favorite part of any roller coaster ride is? When it stops. Such is the case for the thrill ride otherwise known as H.R. 6331, the Medicare Improvement for Patients and Providers Act of 2008.

The legislation proposed to delay implementation of Centers for Medicare & Medicaid Service’s national competitive bidding program by between 18 months and 24 months, with the HME industry paying for the delay via 9.5 percent price cuts to DME and services covered by competitive bidding, except for oxygen and power wheelchairs.

From its inception, the bill has exemplified the expression that from humble beginnings grow great things, but watching the legislation has been a roller coaster ride to say the least. The process certainly has had its ups, its downs, and its stomach-churning loop-the-loops.
After much lobbying by industry associations and individual providers, the bill was introduced and passed in the House by a 355 to 59 margin and H.R. 6331 went to the Senate for debate and a vote. This was a true breakthrough moment for the industry; we were gaining ground. Consider that the slow, steady, uphill ascent before the spine-tingling downhill plunge.

I say that because the process became a true cliffhanger once the legislation hit the Senate, where debate and a possible vote ran right up against the July 4 holiday — and NCB’s round one implementation date. A procedural motion to end debate and put the bill to a vote failed, leaving the Senate to go on vacation, round one to go into effect, and the industry to go into fits of worry as the not-so-amusing ride seemed to spiral out of control.

Once the Senate reconvened, the ride seemed to even out. The Senate engaged in another vote and passed the bill by a 69 to 30 margin. Everyone in the industry could take a deep sigh of relief. That is, until the White House announced that the president intended to veto the bill, citing concerns that it would mean cuts to the Medicare Advantage plan.

Sure enough, that veto came quickly, but was followed nearly as fast by the House’s vote to override the veto and then the Senate’s override on the same day. After a gripping series of fast-paced twists and turns, competitive bidding had been delayed.
And so, the NCB thrill ride finally came to an abrupt halt, the safety bars were raised, and the industry stepped woozily out onto the platform, wondering what might come next.

Make no mistake — there are many questions left to answer. For starters, what happens to the providers who won contracts in round one? How will their business plans and revenues be affected? Also, how will providers handle the 9.5 percent cuts in the categories covered by the legislation?
Most importantly, the industry was left asking itself, what next? Eighteen months to 24 months isn’t forever. We might have to strap ourselves into Mr. Weem’s Wild Ride once again. In the meantime, how will we ensure that we have input into the process so that whatever program is crafted it is one that the industry can live with?

That’s why you need to use this time to consider the ways in which you can help your business flourish regardless of any future regulatory climate. That’s why we’ve devoted this issue’s cover story to four fertile opportunities for growing your business. Features editor Lunzeta Brackens has examined home access, auto access, sleep and urology and how providers can leverage those categories to reap new revenues. Turn to page 20 to read “HME Expansion: Comfort and Independence Pays” to see how you might be able to harvest a new cash crop.

For now, breathe easy and realize that the fight to delay competitive bidding was well worth it. The industry has bought itself valuable time so that if competitive bidding rears its head again providers will have put themselves in a position that they can fasten their safety belts and possibly enjoy the ride.

This article originally appeared in the August 2008 issue of HME Business.