WASHINGTON - The HME providers who pounded the marble halls of Capitol Hill last week must have made quite an impression. H.R. 3790, the bill to repeal national competitive bidding, has picked up 13 new co-sponsors for a total of 163.
"The providers that aren't here owe a debt of gratitude to their colleagues," said Tyler Wilson, president and CEO of AAHomecare, at the association's Washington Legislative Conference last week. "Those who push aside work and money concerns to come to D.C. realize it's a matter of survival. Coming to Capitol Hill to push our cause is part of what they have to do."
Nearly 300 providers spent last Wednesday calling on lawmakers to talk up a range of issues from preserving the first month purchase option for power wheelchairs to repealing the 36-month cap on oxygen.
The biggest priority, however, remains repealing competitive bidding.
"Members are aware there has been a hiccup in the rollout of competitive bidding," Rep. Jason Altmire, D-Pa., told attendees. "One school of thought is that the issues have been resolved. You have to talk about the impact the program will make in the member's district, not just the impact on your business."
During an attendee luncheon last Tuesday, it became alarmingly clear that CMS thinks the issues have been resolved.
"We take the PAOC very seriously and we've learned from the past," Jonathan Blum, director of the Center for Medicare Management, told the crowd. "The online bidding system is smoother, and we are not aware of any significant concerns."
That's all well and good, but you're missing the point, providers told Blum. John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, summed it up this way: "No matter how hard you guys work, it's a fundamentally flawed program. This is going into the market, weaning the players and hoping that the chips fall where they may and everybody is served."
The timing of last week's event was serendipitous. Last Wednesday, healthcare reform, which in recent weeks had been on the backburner, was in the spotlight again as President Obama called on lawmakers to cast a final vote on legislation.
"A period of unprecedented national debate is occurring," said Wilson. "Health care is at a crossroads, and we are well positioned to get our issues out front and center."

BUFFALO, N.Y. - When industry stakeholders gave an overview of a "discussion paper" that details a separate benefit for complex rehab during a Webinar last week, providers and therapists had a lot of questions. That's exactly the response stakeholders were hoping for.
"We've labeled it a discussion paper for a specific reason," said Don Clayback, executive director of NCART and chairman of a steering committee working to create the benefit. "It's meant for discussion. It's not a final plan; it's not a finished product; it's not something that's take-it-or-leave-it. It's meant to be circulated to allow people to respond."
The 24-page paper has been posted to NCART's Web site, www.ncart.us. It proposes changes to products and coding; coverage and documentation; payment; and supplier quality standards.
Highlights from the Webinar:
Products and coding
Current HCPCS codes, where appropriate, would be classified as complex rehab technology (CRT) and would be available only through accredited CRT companies; modifications would be made, as needed, to codes that currently contain both CRT products and non-CRT products to separate CRT from DME; and new codes would be added for CRT products that are routinely provided but currently don't have assigned codes.
"At the end of the day, there should be a fairly bright line," said Rita Hostak, vice president of government relations for Sunrise Medical and a member of the steering committee. "One line says, 'yup, this is clearly DME,' and one says, 'yup, this is complex rehab technology.'"
Coverage and determination
Coverage criteria would be based on a beneficiary's functional abilities and limitations, not specific diagnoses; the burden of clinical documentation would be shifted to the therapist's shoulders instead of the physician's; and the "in-the-home" restriction would be eliminated.
Payment
A payment methodology would be established that covers both the product costs and related service costs that are associated with CRT products. Avalere Health Group will help to determine the potential options and preferred methodology.
Supplier quality standards
Complex rehab technology companies would be required to offer service and repairs to beneficiaries in their sales area, either through their own operations or through another accredited company. For beneficiaries outside their sales area, they would have to make their best effort to locate another accredited company.
Also, the companies would be required to have at least one rehab technology professional (RTP) on staff. An RTP is an individual who has passed RESNA's ATP exam and has fulfilled "additional requirements." Those requirements may include obtaining RESNA's seating and mobility specialist (SMS) certification or an enhanced version of NRRTS's CRTS credential.
Stakeholders pointed out that work on these areas will continue through various working groups.
Questions were largely detail-oriented. For example: In rural areas where there are no seating clinics and few therapists, how would providers comply with the benefit?
"We realize the ideal situation may not be achievable in every instance, but we won't let that dissuade us from getting there, or as close as we can," Clayback said.
Stakeholders plan to collect feedback on the paper all of March. Providers and therapists can do that two ways: e-mail comments to complexrehabtech@gmail.com or post comments to a new blog, http://complexrehabtech.blogspot.com.

NEW BRAUNFELS, Texas - The Scooter Store's image as just a big call center in New Braunfels, Texas, is no longer accurate, company officials say.
The provider announced last week that it plans to expand the number of storefronts it has from eight to 59 nationwide.
"A lot of it has to do with buyer types," said Mike Pfister, The Scooter Store's executive vice president of government relations and external affairs. "There are buyers that respond to direct mail and TV ads, and there are buyers that like to walk in and kick the tires or meet with a consultant who can talk them through things face to face. We're just trying to cover our bases."
The existing storefronts, mostly in the South, have been in place for several years, allowing The Scooter Store to experiment with what products they should have and how their employees should interact with customers.
The Scooter Store came up with a storefront that displays a variety of products--not just mobility products--and gives its 800 professionals in local markets, including 100 assistive technology practitioners (ATPs) and 175 healthcare relations consultants, a "rallying place" to meet with potential customers, Pfister said.
"Anyone can call to make an appointment to talk to someone," he said.
The driver behind The Scooter Store's latest move: diversification. In addition to different buyers, the emphasis is on different products (insulating itself somewhat from Medicare cuts to particular category) and different payers (meaning cash).
"Seniors are beginning to spend more and more of their discretionary money on health care, and we need to have retail locations that lead that," Pfister said. "That's the direction it has to go in. Medicare will not continue to pay for all of the same products at all of the same ratios forever."
The majority of the storefronts will be carved out of The Scooter Store's more than 50 distribution centers and "dressed up," Pfister said.
"You'd have to go back years, but The Scooter Store was called The Scooter Store because that's what it started out as," he said.