Page 23 - HME Business, March 2017

and replace it with the industry’s alternative, the Market Pricing Program. In addition to the Price appointment, Pres.-elect Trump also named Seema Verma, founder and president of healthcare policy consulting firm SVC
Inc. to serve as Administrator of the Centers for Medicare and Medicaid Services. Together, it is likely that Price and Verma will wield their consider- able oversight to control how policies that impact the industry are orga- nized and run. And they have broad discretion to start making common- sense fixes to the program.
It’s also important to remember that President Trump clearly ran on a platform of deregulation, so the Executive
Office will be expecting its agency heads to carry
out that mission.
“It is all about deregulation,” notes John Gallagher, vice president-government relations for the VGM Group Inc. “One of the first things he did — on the day he was sworn in — his first executive order was about delaying and stopping overregulation that impedes small business, and beneficiary access.
“And [Trump] talked about providers being over- regulated,” Gallagher continues, adding that Trump also signed an executive order removing regulations when new regulations are passed. “I can give you about 20 of those that would be great for the DME industry,” he jokes.
And it’s important to note that there is not just
a leadership change. Price will be bringing staff
with him that share is same desire to deregulate
and create a healthcare landscape that reflects that perspective. There will be a welcome cultural shift in the agency, Gallagher believes.
“The people he’s bringing over to HHS and CMS are great staffers that really understand what DME providers have been going through,” he explains. “And that will be to our advantage, as well.”
And in instances, we have already seen CMS enjoy moments of clarity where it has been willing to change program flaws administratively. The agency reset the bid ceiling to avoid a perpetual downward spiral of bid amounts until the program became unsustainable — something the industry had been asking for.
Then we saw it again when CMS announced plans in its Round 2019 announcement (see News, Trends & Analysis, page 8 to learn more) to incorporate a “lead item” bidding methodology into the program for certain items. Under this approach, suppliers
will bid for a lead item within a grouping of similar equipment that takes into account the costs of furnishing all of the equipment in the grouping. The single payment amount for the other items within the grouping will be based on their relative differences in fees when compared to the lead item. This again, was something the industry had been asking for as part of the Market Pricing Program.
So now we have the one Congressional champion who repeatedly launched legislation to replace competitive bidding with the Market Pricing Program heading up HHS. This could be a golden opportunity to see implementation of the various components of the MPP that haven’t been secured, such as basing bid prices on clearing prices, rather than the median prices of winners.
“That’s another administrative fix that we’ll be pushing for,” Bachenheimer says. “There’s a whole series of them.”
An agency that will work with the industry — it
almost seems like a novel concept after the past 10 years or so. Add to that a legislature that is most likely going to be acting far more in concert with that agency, and the industry should be taking a whole new perspective on how it addresses its more pressing problems.
Which brings us to our two most pressing problems that will dominate the industry’s legislative and regulatory agenda in coming months.
“We really have two top priorities,” says Seth Johnson, vice president of government relations for Pride Mobility Products Corp. “Talking with The American Association for Homecare and working very closely with
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