Baucus Plan: Kudos and Cautions

WASHINGTON — Signaling the new Congress’ intention to
tackle the issue of health care early on next year, Sen. Max
Baucus, D-Mont., last week unveiled a comprehensive
reform plan that drew both kudos and cautions from HME industry
stakeholders.

While they commended the plan for building a more efficient
health care system, they did not overlook its red flags.

“[The plan] clearly puts our industry on notice that we must be
more vigilant than ever before in addressing head on the
fraud-and-abuse issue, and be willing to work with Congress
constructively on specific payment reform initiatives,” said Cara
Bachenheimer, senior vice president of government relations for
Elyria, Ohio-based Invacare.

At the heart of Baucus’ plan is an effort to boost the quality
of health care, make it accessible for all Americans and, at the
same time, streamline costs.

“The system can work better and cost less for everyone if
leaders are willing to work together for sound policy solutions,”
said Baucus, chair of the mighty Senate Finance Committee, which
oversees Medicare. “I am committed to working with my colleagues
here on Capitol Hill—Democrats and Republicans—and to
working with the incoming Obama administration to really move the
ball forward on health reform. In human and economic terms, there
is really just no more time to waste.”

The Baucus plan would, among other things:

• Ensure all Americans, regardless of pre-existing conditions,
  accessible, affordable coverage through a nationwide insurance pool
  called the Health Insurance Exchange;
• Allow a Medicare buy-in for Americans 55 to 64 as the exchange
  is created;
• Require all states to use the State Children’s Health
  Insurance Program (SCHIP) to cover children at or below 250
  percent of the Federal poverty level;
• Invest in detecting and eliminating fraud, waste and abuse in
  public programs;
• Consider policies to shift the focus from institutional care to
  services provided in the home and community;
• Focus on health and wellness rather than on illness and
  treatment.

Baucus, in his 89-page “Call
to Action: Health Reform 2009 (PDF),” also discusses ways to
defeat fraud and abuse, many of which have been championed by the
industry over the years but have not been enacted by CMS, said Seth
Johnson, vice president of government relations for Pride Mobility
Products, Exeter, Pa.

“Many of the specifics he mentions in his fraud-and-abuse
strategy are supported by the industry and are included in the
[American
Association for Homecare‘s] 13-point plan,” said Johnson,
referring to the proposal that the industry organization submitted
in October to Medicare and its contractors, the Department of
Justice, Congress and the FBI. (See
AAHomecare Offers 13-Point Plan to Stop Medicare Fraud,
HomeCare Monday, Oct. 27.)

However, Baucus also supports competitive bidding as a means
to fight fraud and abuse and pay for HME, a stance that drew
immediate criticism from AAHomecare.

“The underlying rationale for competitive bidding completely
misrepresents the nature of home medical equipment and related
services that are integral to home care,” said Tyler J. Wilson,
president and CEO. “Competitive bidding would reduce quality of
care and access to home care for millions of seniors and people
with disabilities.”

Johnson agreed, but said he was not surprised to see competitive
bidding championed in the plan. “The Democrats on the Finance
Committee want to make sure that remains on the table, since the
legislation enacted last year simply delays the program, it does
not eliminate it,” he said. “It really indicates clearly to the
industry that we need to remain focused on coming up with an
alternative proposal to save money.”

There is another reason for HME stakeholders to remain vigilant,
Bachenheimer said.

“In addition, in the fraud-and-abuse section, the document
mentions the government’s perception that the Medicare program pays
too much for oxygen,” she said.

Bachenheimer said while Baucus’ plan does not specify any policy
proposals on either the fraud-and-abuse or oxygen issues, it does
indicate the need for the industry to keep dialogue open with
Congress, a point Johnson made, too.

“I really look at [the plan] as providing the industry an open
door to go in and talk with the Finance Committee and address
appropriate means to raise the bar in the industry and increase
anti-fraud initiatives,” he said.

Baucus’ health reform plan is expected to be the first of
several. Rep. Fortney “Pete” Stark, D-Calif., House Ways and Means
Committee chair, and Sen. Ted Kennedy, D-Mass., chairman of the
Senate Committee on Health, Education Labor and Pensions, are
expected to reveal their plans soon, and President-elect Barack
Obama has promised more details on his health care plan.

“I see [Baucus’ plan] as a clear sign that the debate and
discussion on health care reform is already starting, and it will
be a huge year,” said Bachenheimer. “Plans will be unveiled,
hearings will be held, bills will be introduced by numerous
leaders. How it shakes out is unclear. The economy indicates that
it will be even tougher to pass a larger more comprehensive reform
plan; more likely are incremental measures.”

Whatever happens will begin soon. Baucus’ plan came on the heels
of a letter to Obama from several organizations representing
retirees, business and labor urging him to put health care at the
top of his to-do list in his first 100 days in office. The Los
Angeles Times reported the four groups represented in the
letter—AARP, the Business Roundtable, the National Federation
of Independent Business and the Service Employees International
Union—had
pledged to spend $1 million to push that initiative through
television and newspaper advertising.

For his part, Johnson said he believes the SCHIP plan will be
the first point of action for the new Congress.

“The SCHIP reauthorization has to occur before the end of March
when the current authorization expires,” he explained. He said he
believes the SCHIP will be paid for through a reduction or
elimination of bonus payments to Medicare Advantage plans and an
increase in the federal cigarette tax.

“It doesn’t appear that DME reductions are going to be needed to
fund SCHIP,” he said, “but anytime these proposals move forward
with any significant costs associated with them, then the industry
needs to monitor them very closely and ensure that no DME
reductions are included.”