Editor's Note

If Not Now, When?

Providers must act if they want to fix audits, competitive bidding.

If there is one truly quizzical element of human nature, it’s our propensity to hesitate. Of course, anyone passing high school English remembers Shakespeare focusing on this very attribute in “Hamlet,” in which the titular prince dithers, hems and haws about avenging his father and doing in his murderous usurper of an uncle, Claudius.

Because Hamlet waits for the perfect moment to exact his revenge, circumstances spiral out of control and thanks to Claudius’s machinations, Hamlet dies unnecessarily. Sure, Hamlet gets his revenge, but the whole tragic end — eight people die — could have been avoided. In fact, at one point in the play, his father’s ghost actually scolds Hamlet for hesitating.

Consider this column to be penned by that very ghost. Right now, providers have two crucial bills that address very real and perilous industry threats in ways that should be very amenable lawmakers:

H.R. 5083, known as the Audit Improvement and Reform Act (aka, the AIR Act), was introduced into the House in July by Reps. Renee Ellmers (R-N.C.) and John Barrow (D-Ga.) to address many of the problems providers have been suffering due to Medicare audits.

H.R. 4920, known as the Binding Bids bill, would make all bids binding and would require providers to obtain special surety bonds before bidding. Don’t live up to your bid? There goes your bond. This would eradicate the practice of suicide bidding that has ravaged the industry. Reps. Pat Tiberi (R-Ohio) and John Larson (D-Conn.) introduced the legislation in late June.

These two bills contain very creative legislative fixes to Medicare problems that don’t force Congress to worry about whether or not there is a pay-for or wait on getting a billed scored. They simply fix flaws inherent in CMS’s current approaches to bidding and audits. In fact, H.R. 4920 is so non-controversial that it could be voted on as a standalone bill.

In addition to being as non-controversial as you can get, one of these bills has built-in support. H.R. 4920 is essentially an element within H.R. 1717, the much broader legislation that seeks to replace competitive bidding with the industry’s market pricing program. That MPP bill has 180 Representatives signed on as co-sponsors, which means that every one of those lawmakers already supports H.R. 4920; they simply need someone to tell them to sign one more time on the dotted line.

But we’re not there yet. As I write this, H.R. 5083 has 36 co-sponsors and H.R. 4920 has 49 backers. That’s a far cry from where those bills need to be. Moreover, Congress just wrapped a month-long August recess, which offered an excellent to lobby lawmakers and legislative staff in-person while they were working in their home district offices, rather than on the Hill.

Why the slow response? The answer could lie in two Provider Polls HME Business conducted in August on providers’ lobbying efforts on behalf of both bills. While the results aren’t scientific, they do point to a considerable level of hesitation among providers to do anything beyond a sending an email.

That hesitation is worrisome because these bills expire at the end of the 113th Congress, which happens at election time. Suffice it to say, the industry is in a race against time, and clicking “send” on an email isn’t getting us to finish line.

The solution for halting that hesitation is simple: act. First, go to whoismyrepresentative.com and find your Congress member. Then go to thomas.loc.gov and search on both bills to ensure your Representative hasn’t already backed the bill. Assuming he or she hasn’t, go to house.gov/representatives to get the phone number and call to lobby on behalf of both bills. Take it a step further by slating an appointment to meet with your Representative or staff, who, with the exception of Oct. 1 and 2, will be in their districts all month. You’ll never find a better time to fight for your business and patients than this very moment.

This article originally appeared in the October 2014 issue of HME Business.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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