Editor's Note

CMS's CRT End Run

In the fight against competitive bidding expansion, a key detail pops up.

• By David Kopf
• Nov 01, 2015

Don’t you hate it when someone slips something past you? As a parent of three girls, I encounter that a lot. Something will get broken, or a mess will get made, or a bad grade will come in on the report card, and invariably the strategy my kids will always opt for is to hope dad won’t notice.

I would have thought a career in journalism would have better prepared me. It doesn’t always happen, but there are times when you’re researching a story and someone will try to pull the wool over your eyes in hopes that you don’t discover an uncomfortable truth that they would prefer not be subject to public scrutiny. It’s rare, but it happens. So it’s natural for anyone doing this kind of work to develop at least a bit of an internal BS detector.

So of course, I thought I’d be able to use those “keen” senses to sniff out when my kids are trying to pull a fast one on dear old dad.

Nope. It turns out I’m just as easy to fool as any slow-witted father figure on a television sitcom. I’m pretty sure my kids could set the kitchen on fire and then handily distract me from the conflagration.

Pretty Sneaky, CMS

So, I wasn’t too surprised at my dull-wittedness when I realized that CMS slipped something right past me. I discovered my oversight while interviewing sources for HMEB’s annual mobility outlook (see “The Tip of the Spear”).

Specifically, I’m talking about CMS’s national expansion of competitive bidding as it relates to complex rehab technology. Under the expansion, CMS will apply its bid pricing scheme to CRT accessories (read more about CMS’s pricing methodology in “How National Expansion Will Work”).

To begin with, that’s a bit of a misnomer, because the word “accessory” almost implies the unnecessary; things that aren’t needed. Clearly, in the realm of CRT, that is not the case. CRT accessories are needed items that ensure a patient can properly use his or her chair and receive its intended therapeutic benefit. CRT accessories aren’t options; they’re vital to the use of the chair.

But let’s not get hung up in semantics. Let’s focus on what CMS is doing. Did you catch how CMS put one past me? I’m hoping other people didn’t notice, as well, so that I don’t feel like such a dope. It’s the fact that CMS is even applying its bid pricing scheme to complex rehab accessories. CMS shouldn’t be doing that.

Way back when Congress passed the Medicare Improvements for Patients and Providers Act (MIPPA) in 2008, the main thing the law did was delay CMS from going through with Round One of competitive bidding. But it also did one other critical thing: it protected CRT from competitive bidding. CRT was carved out of the program.

Re-discovering that fact was a real “I could have had a V-8” moment for me. I’m pretty sure I audibly slapped my forehead when one of the story’s sources reminded me of that key fact.

And I have to admit that once the sting of my forehead slapping wore off, I was still left a little befuddled: How can CMS simply ignore a law? If CRT is supposed to be immune from competitive bidding, how can CMS apply bid pricing to CRT accessories?

I guess the answer comes down to the letter of the law vs. the spirit of the law. MIPPA doesn’t specifically list CRT accessories, as opposed to chairs, so apparently CMS doesn’t think the MIPPA carve out applies. Now, I might be your average, garden-variety dunderhead, but if you read MIPPA, I think it’s pretty clearly those accessories should fall under the carve out.

But CMS is pushing forward with its plan, and with just two months to go, the industry — and patients — can’t wait on a legal fight. That’s why supporting H.R. 3229 and S.2196, which protect CRT from the national expansion, is so important. Make sure you reach out to your lawmakers' offices and convince their that they must support the bills as co-sponsors (read more).

Thanks and Farewell

Lastly, I want to bid a happy retirement to Carolyn Cole, vice president of communications for VGM Group Inc., and Peggy Walker, billing & reimbursement advisor for VGM’s US Rehab Division. Both have been indispensable aids to HME Business magazine and their input and assistance has helped HMEB serve up content that I’m very proud of. I wish you both the best of luck and happy travels in your new adventures.

This article originally appeared in the November 2015 issue of HME Business.