WASHINGTON, DC – CMS recently announced that there will be no Round 2021 competitive bidding contracts awarded for product categories bid in this round with the exception of Off-The-Shelf Back Braces & Knee Braces. CMS’ move to essentially scrap all of Round 2021 for most HME products comes as a surprise to almost every HME leader I’ve spoken with over the last week. Opinions have varied, however, on whether this is an overall positive development for HME. You can count me among those who believe this is a win for our industry and the patients we serve.
First off, by not moving ahead with Round 2021, all HME suppliers in 130 CBAs nationwide will keep access to the still-growing Medicare market. For thousands of suppliers who might have lost access to that market, it’s an unquestioned win and major relief.
Many leaders I’ve spoken with are also enthusiastic about the opportunity to work with policymakers, clinicians, and patient groups to develop a new approach for Medicare reimbursement. For more than a decade, our industry has felt the impacts of a payment approach that is designed to find the lowest possible reimbursement rates that a segment of HME suppliers will accept.
Do we think this industry can thrive – or even survive – while continuing to operate under a payment model that prioritizes cost-cutting over quality care? CMS’ decision to pause bidding for most of our industry for three years gives us an opening to work toward a better model.
In CMS’ announcement last Tuesday, the Agency explained that the program was being halted because bid results “did not achieve expected savings.” I’m proud that our efforts to improve the bidding methodology, remove speculative bidders from the program, and involvement in “bid-smart” educational efforts contributed greatly to that result.
I also understand the concerns that some individuals have about potentially missing out on higher rates that Round 2021 results might have delivered. In a call with CMS leaders this morning, I asked the Agency to provide transparency on these results on the 13 categories that were bid; that information will be important to our work to advocate for sustainable rates and relief in the near-term and beyond.
On that call, CMS leaders also provided assurance that rates in current bid areas will receive annual CPI increases for 2021 and beyond, and that increase will also be applied to the adjusted fee schedule portion of the 50/50 blended rate in rural areas. The CPI increase was not noted in last Tuesday’s announcement, so that was particularly welcome news.
I also emphasized that the operating and cost environment for HME has changed dramatically in the wake of the COVID-19 pandemic, and some of these changes will be felt even beyond the end of the Public Health Emergency – and that reimbursement policy needs to reflect that.
I believe CMS’ announcement is a positive for the health and stability of our industry as we move into 2021, and also provides an opening to reshape Medicare reimbursement policy for years to come. Significant and positive change will require our industry to redouble our advocacy efforts and develop even stronger relationships with policymakers – but the potential payoff of a stable and sustainable reimbursement model will make that investment worthwhile.
I want to thank the HME advocates in this Association and throughout the HME community for your work educating and engaging Capitol Hill, and helping generate strong Congressional support for a pause in the bidding program. Your hard work, coupled with the efforts of leaders like Reps. Cathy McMorris Rodgers and Dave Loebsack, has also played a significant role in our success on this issue and in securing other gains for HME this year.
We now have an opportunity to move beyond bidding. I am excited by this opportunity and look forward to working with you all to make it a reality.
Tom Ryan is president and CEO of the American Association for Homecare.