Editor's Note

It’s the Smart Play

While a bidding repeal is everyone’s first option, the MPP is our surest bet.

• By David Kopf
• Oct 20, 2011

They say that crafting legislation is akin to making sausage — a gruesome, gut-wrenching affair not intended for those of weak constitution — but I don’t think that’s right. I say it’s more like euthanizing a pet. Whatever political solution you come up with it’s absolutely not what you want to have happen, but it’s probably for the best.

At least that’s what you tell yourself. Just like having to put an animal down, you have no concrete assurance that the decision you made was absolutely the right on. Sure, you might feel 99 percent confident that you made the right move, but there’s always going to be that nagging suspicion in the back of your mind that you might have had a better option available.

That, in a nutshell, is the lawmaking process; a frustrating quest to forge imperfect solutions to complex problems, because that’s really the only option you have. Too many interests, too many voices and too many points of view force compromise on every vote. A lawmaker or a lobby might offer up the perfect legislative solution for an issue, but it’ll never see the light of day. Instead, they will have to accept some sort of half measure that isn’t the ideal, but is the only way to get just a portion of their agenda into law.

And they are the left with those pernicious doubts: Will this be enough? Could they have done a better job of lobbying? Could they have crafted a better compromise? That is lawmaking.

And that is the industry’s fight against CMS’s national competitive bidding program. The industry has fought a long and frustrating battle to stop a policy that is so clearly at odds with not only patients’ access to quality care and equipment and the positive outcomes they provide, but CMS’s best interest from a budgetary perspective, as well.

Despite being such a wrong-headed program, the industry has had a tough slog: It worked to secure a delay through MIPPA, but that cost providers 9.5 percent funding cuts to various NCB categories, and has engaged in two attempts to repeal it, first with the nearly successful H.R. 3790, and currently with slow-going H.R. 1041.

And H.R. 1041 is definitely creeping along. So much so that 82 percent of HME-Business.com readers did not think the industry would be able to secure a repeal of competitive bidding before Round Two bidding is finalized.

And that’s why the industry has come up with an alternative: the Market Pricing Program, which aims to offer a replacement to competitive bidding that provides a market-based solution for setting reimbursement, something Congress and CMS wanted when they crafted the national competitive bidding program, but in a fashion that doesn’t kill the industry.

Essentially, the industry, through the American Association for Homecare, took the various recommendations made by the more than 200 economists and auction model experts led by University of Maryland Professor of Economics Peter Cramton and put them into an industry proposal that was sent in a letter to Congress in mid October. Make no mistake, the program is an alternative to CMS’s NCB, but it still seeks a competitive approach to setting Medicare reimbursement rates for DME/HME. The flip side is that it is actually competitive, unlike CMS’s program.

The MPP is the right approach to stopping competitive bidding. I know that most of us would prefer to have competitive bidding repealed, but it’s simply not going to happen. Besides the relatively slow uptake of H.R. 1041 sponsorship in the House, there is no Senate companion legislation, and a legislature that’s generally hostile to any new costs.

So, before you let the self-doubt endemic to the legislative process creep into your mindset, be sure of one thing: if we want to end competitive bidding before it ends the industry, then the MPP is the smart play to make.

This article originally appeared in the November 2011 issue of HME Business.