Policy-makers in Washington and experts in health care delivery recognize that home care is one of the most cost-effective forms of care. Yet the federal government has taken many actions that will weaken the nation's home care infrastructure and erode patient access to that care. But the good news is voters are with us. They get it.
One of the flaws in the competitive bidding program enacted in the Medicare Modernization Act of 2003 is the anti-competitive nature of the bidding program, which will put thousands of HME providers out of business — a very bad outcome. Voters agree with us on that point.
Almost three out of four American voters (72 percent) believe that “Congress should not pass laws that reduce the number of home medical equipment providers who compete for business.” That result holds true across all age groups and political viewpoints — young, old, conservative, liberal. During a big election year, this is important information. The finding comes from a December 2007 national survey of 1,000 American adults. The survey was commissioned by AAHomecare and was conducted by Harris Interactive, which conducts The Harris Poll.
The rules for competitive bidding outlined by Congress and detailed by CMS are stacked against the small provider, even with modifications designed to include a portion of the smaller providers in the winning bids. Smaller home care providers do not have the economies of scale to negotiate lower prices from manufacturers or the physical size to cover an entire bidding area.
While the American voter and members of Congress may not be conversant with all the details of the bidding program, their basic sense of fairness is a potent factor in our favor.
Another recent study, conducted by economics professors Brian O'Roark and Stephen Foreman at Robert Morris University, confirmed what the home care community has suspected all along — that the competitive bidding program will reduce competition and quality of care. The study, released by the Pennsylvania Association of Medical Suppliers, found that by limiting the number of participating providers, the bidding program is actually uncompetitive. “The limits on competition that CMS is proposing to implement will have great potential to produce higher prices and lower service quality,” Foreman said.
The results of both the Harris poll and the Robert Morris study can be used to underscore the need for Congress and CMS to reexamine the bidding program.
The Harris survey also found other deep reservoirs of support for home medical equipment that were expressed in several ways:
Four out of five voters favor stronger Medicare coverage for home medical equipment. An overwhelming majority (78 percent) of voters say they would vote for congressional candidates who would strengthen Medicare coverage for power wheelchairs, oxygen devices, hospital beds, and other durable medical equipment and services used in the home.
Home is where people prefer to receive health care. More than four out of five Americans (82 percent) surveyed express a preference for home care over institutional care, agreeing with the statement, “If I required medical services, I would prefer to receive it in my home if possible, rather than in a hospital or nursing home.”
Only 9 percent disagree with the statement and 9 percent are neutral. Preference for home care is most common among Americans age 55 and older (91 percent). The strong preference for home care is consistent across all age group, gender, and income segments.
Americans view home care as part of the solution to rapidly rising Medicare spending. Three out of four Americans (74 percent) agree with the statement, “Home care is part of the solution to the problem of rapidly increasing Medicare spending for America's seniors.” Americans age 55-plus are more likely to agree (81 percent), which is a demographic group that AARP expects to vote in record numbers this year.
The months ahead are an important time to position all our key HME issues as election issues. For the Harris survey details and other information, visit www.aahomecare.org.
Tyler J. Wilson is president and CEO of the American Association for Homecare, Alexandria, Va. He may be reached by e-mail at tylerw@aahomecare.org. For more information about the association, visit www.aahomecare.org.
