Report from the AA Homecare "Washington Fly-In"

Washington, D.C. - Tuesday, May 20th I was joined by eight other members of the Accredited Medical Equipment Providers of America (AMEPA) including Rudy Hernandez, Jr., our Chair of the Legislative Committee at the AA Homecare "Washington Fly In".
Rudy and I had meetings on Tuesday at the Offices of Representatives Alcee Hastings and Debbie Wasserman-Schultz (Both in the Miami MSA) and Tom Feeney (Orlando MSA). The staffers attended the House Staff Briefings that CMS held over two weeks ago and were very aware of the problems and contradictions of the Competitive Bidding Program in DMEPOS.

We showed the staffers the list of Oxygen Bid Winners, where we found that 8 of the Oxygen Winners in the Miami MSA did not have Medical Oxygen Retailers Licenses and are not Pharmacies. We also explained that providers in Florida currently waited 9 months to get a license from the Department of Health once a Physical location was established with local licensure and an HME license from the Agency for HealthCare Administration (AHCA). We also explained how 18 of the 39 Oxygen Winners in Orlando were either located out of state or at least an hour outside of the MSA. We also informed the staffers that CMS's own rules and Supplier Standards prohibited the use of Sub-Contractors for "Essential Items" that were included in the Categories of Oxygen, Respiratory Assist Devices and Enteral Feed. They offered their support and told us that they would immediately inform the legislators of these new facts and ask them to stop the current program from being implemented on July 1st.

Efforts by AA Homecare

After leaving the House Office Buildings, we attended a cocktail party at the AA Homecare office in Crystal City sponsored by Invacare, Covidien, Pride and Medtrade/Nielsen. Attendees enjoyed speaking with industry leaders like John Gallagher from VGM, Cara Bachenheimer and Mal Mixon from Invacare and Georgie Blackman from PAMS. I immediately gravitated towards Tom Ryan who spoke on behalf of the industry at the Health Subcommittee hearing on May 7th. We all offered him a hearty "Congratulations" and he in return thanked our group for our support and efforts as well.
While attendees were exchanging "war stories" in the battle to save the industry, Walt Gorski, AA Homecare's VP of Government Relations was having a "Brain Storming" session in his office. He was preparing for a Small Business Subcommittee Hearing. AA Homecare and VGM Members testified at that hearing which took place Wednesday morning.
The following morning the attendees enjoyed a "Continental Breakfast" at the Marriott Gateway Hotel and AA Homecare President Tyler Wilson briefed the group on the best lobbying techniques. AA Homecare provided the attendees with packets to leave with the Legislators which included their own summaries and a sample "Dear Colleague" letter from Congressman Jason Altmire (D-PA). This letter was similar to the one that was signed by 124 Members of Congress prior to the Easter Recess. AA Homecare also provided the attendees with a comprehensive booklet which lists all of the Legislators and their current staff for the 110th Congress. The first time attendees were impressed, especially since there was no fee to attend this "Fly In". It was sponsored solely by AA Homecare and the event sponsors listed above.

Florida US Senators Misinformed, Will not Delay Program Wednesday morning the AMEPA members were joined by other AA Homecare and VGM Members, Hal-Moore Medical Supplies from Jacksonville, and other providers from the West Coast as well as a Billing Company and a representative from Apria. We met at US Senator Mel Martinez's office. We planned the meeting out and we each took turns speaking on different aspects of the current Competitive Bidding Program. I spoke first as I met the Legislative Assistant, Michael Bassett back in March with FAMES President Raul Lopez. I brought him up to date with the new information of unlicensed providers in Florida and the problems with the out of area winners in Orlando. I also described how 501 current Oxygen providers in the Miami MSA were reduced to only 44 bid winners. Cindy Justice from Respicare of Central Florida, a Bid Winner in the Polk County Demonstration project and in the Orlando MSA in Round 1, explained how the Demonstration project was flawed. Enteral Feed, a category which requires more service calls than oxygen, was removed in Round 2 of Polk County. She also discussed how the Demonstration Project was limited in scope since it was based on only two items that were typical in Durable Medical Equipment (Oxygen and Hospital Beds) and two items that were not typical and rarely provided in the industry (Urological and Surgical Supplies). She also explained the contradictions from the reports form Robert Morris University, Kennesaw State and Drexel University.
Next a Bid Winner from the Miami MSA explained why he was unhappy with the bid as his company did not make a 26% profit last year and could not survive the bid. He also described how although he won the bid in a few categories he will not survive, as referral sources in Hospitals will give the business to a company that won in most or all of the categories, and how this will likely create monopolies.
There was a discussion by one of the largest providers in Mail Order Diabetic supplies. He explained how only a few Bid Winners in the first 10 MSAs were among the top 100 providers in the country in Mail Order Diabetic. He also described how even with the volume that he does he could not even purchase brand name supplies at the new contract prices.
Another described similar problems with the Enteral Feed Bid as this large provider was not aware of the companies that won in the Miami MSA. Rudy discussed the problems with Disqualifications and CMS rule changes, 7 weeks after most bids were accepted. He also talked about how competition of quality products and service would end as there was no longer a need for it or the funds for it under competitive bidding.
Others described how it would affect beneficiaries as providers could no longer afford to keep Respiratory Therapists on Staff. One attendee described how the crisis would force employees to be jobless during this recession with high inflation, high fuel costs and high unemployment.

Mr. Bassett was very sympathetic, although he would not commit to a letter of support from the Senator. He said that CMS told his office that if the program is delayed by one year it would cost Medicare $3.5 Billion. I asked him to calculate that since the entire program is only $9 Billion a year. I asked how could 7% of the suppliers in only 10 categories of equipment (the first 10 MSAs) cost nearly 40% of the entire annual budget of the program? He laughed at the absurdity of the facts and said that once the "Doc Fix" Bill (S2785) legislation was available the topic would be revisited by th Senator
Unfortunately, our meeting with Madeline Otto, the Health Aid for Senator Bill Nelson, was no better. She felt that CMS was being absolutely truthful and there was no problem with the way the program was moving forward. We replayed the presentation we gave to Senator Martinez's office. I again described the flaws of unlicensed oxygen providers and how nearly 40% of the providers in Orlando were way out of the area, but she was convinced that if CMS said it is okay then we were not justified in our complaints. She felt that the Senator was going above and beyond the call of duty as they have one employee handling the Disqualification reopenings in their Orlando office. How is that going anyway?

We explained that at this point we did not want to be in this program and it was going to be a disaster for beneficiaries, and all the ancillary businesses in Healthcare that rely on our services. She really did not understand what was happenning. I believe in her mind we were a bunch of disgruntled "Bid Losers" and the Director of CMS knew better than we did.

Positive Results from Representatives

Fortunately we had much better responses from our Representatives in Florida. The group split up and the Florida Providers were able to meet with many Legislative Directors and Chiefs of Staff. I was very pleased that they were not only educated and supportive, but many had family members that were using oxygen, CPAP and Diabetic Supplies. They were also very aware of the benefits of their current DME providers, the importance of competition in the market place and the dire consequences to their family members if the current program were implemented. As of Wednesday evening, I have already received confirmation that Congresswoman Debbie Wasserman-Schultz signed the Dear Colleague Letter. The following is a complete list of U.S. Representative's offices we visited on Tuesday and Wednesday that I believe will support a delay:
Lincoln Diaz-Balart (Miami MSA)
Mario Diaz-Balart (Miami MSA)
Corrine Brown (Round 2 - Jacksonville MSA)
Ander Crenshaw (Round 2 - Jacksonville MSA)
Alcee Hastings (Miami MSA)
Ric Keller (Orlando MSA)
Tom Feeney (Orlando MSA)
Ron Klein (Miami MSA)
Connie Mack, IV (Round 2 - Fort Myers MSA)
Kendrick Meek, Ways and Means Committee (Miami MSA)
Ileana Ros-Lehtinen (Miami MSA)
Debbie Wasserman-Schultz (Miami MSA)
Dave Weldon, M.D. (Round 2 - Melbourne MSA) Robert Wexler (Miami MSA)
Luis Fortuno (San Juan MSA)
We will be following up all day today in order to secure the Representatives support of the new Dear Colleague Letter.

AMEPA Member Teleconference at 2:00PM on Wed. 5/28/08

AMEPA will be holding a Teleconference on May 28, at 2pm EST.
The teleconference will address issues regarding our Legal and Legislative efforts to FIGHT the Competitive Bidding Program. This is a very important conference, featuring our Attorney Javier Talamo, and Industry experts who have been working feverishly on your behalf. Members may request the Teleconference Phone Number and Meeting number at info@amepa.us. You may also go to our web site http://amepa.us/www.amepa.us to get information about the Teleconference and to get updates. Additional information will be released a few days before the Teleconference and Members will have an opportunity to email questions during the Teleconference