Debt Ceiling Talks Target HME

WASHINGTON — Rumors of HME cuts turned real last week as
government officials continued to shuffle ideas around on the
nation’s financial predicament. According to a leaked document,
allegedly part of Vice President Joe Biden’s debt ceiling talks,
three cost-cutting ideas targeting HME are on the table:

• Applying Medicare competitive bidding rates for DME to Medicaid
  in states where the program is implemented, which would save $5
  billion over 10 years;
• Initiating a Medicare prepayment review of power wheelchairs,
  estimated to save $200 million over 10 years; and
• Reducing Medicare reimbursement for diabetic strips sold in
  pharmacies.

“The threat is real,” said John Gallagher, vice president of
government relations for Waterloo, Iowa-based VGM Group. “This one
has legs because if it is from Biden’s group; it has been kicked
around.”

When it comes to cutting health care as part of the budget
discussions, “just about everything is on the table,” said Michael
Reinemer, vice president, communications and policy, for the
American Association for Homecare. “Virtually everybody is at
risk.” While some health sectors “are facing much more drastic
cuts,” he said, “that doesn’t make it any better for us.”

With the situation changing daily, Gallagher said he believes
that “like everything else, this is going to be an 11th hour
finish, and everything and the kitchen sink will be thrown in as an
offset … We’ll see if [the HME cost-cutting measures] see the
light of day or just move in another direction.”

Both VGM and AAHomecare issued action calls to lobby against
more cuts to home care in any plan that emerges.

“Our message to the Hill is clear: No more cuts to home care!”
emphasized Jay Witter, AAHomecare senior director of government
affairs. “The nation’s debt problems cannot be solved by making
further cuts to the most cost-effective form of health care —
home care.”

That could be a hard sell, stakeholders acknowledged, especially
in light of such bad publicity as a new Office of Inspector General
report on power wheelchairs and a succeeding
article in USA Today.

The July 7 OIG report maintained that 61 percent of PWCs
provided by Medicare during the first half of 2007 were
unnecessary. USA Today followed the report with a July 13 article saying that Medicare will
triple its number of fraud-fighting strike forces from seven to 20
to catch the “scammers.”

The report and the article incensed industry stakeholders.
AAHomecare called the OIG report “misleading.”

“Their report clearly indicated that medical necessity was
actually only questioned on 9 percent of the claims,” the
association said in a “Mobility
Matters” issue July 14. “The fact that the OIG concluded that
information was missing in 52 percent of claims underscores that
the government needs to fix the documentation process for
determining the medical necessity for power wheelchairs.”

CMS needs to do more to educate its physicians, AAHomecare said.
It suggested creating a mandatory template for physicians to use in
documenting medical necessity for power wheelchairs.

As to the newspaper article, Gallagher said, “How do we respond
to USA Today? We can’t. They aren’t going to listen to us,
we aren’t going to get equal time. The damage is done.”

Despite such stumbling blocks, he said, it is critical that
providers and other stakeholders “create a lot of noise” against
any HME cuts.

How to do that? The hospital lobby alone is spending $1 million
per week campaigning against possible cuts in that sector, a figure
the HME industry can’t begin to match.

“There are many other groups clamoring to get their message of
‘no cuts’ in front of members of Congress,” said Witter. “But
regardless of what others are doing, we must remember there is no
one else fighting for home care. It is up to us to make our message
heard on Capitol Hill, and the most effective way to do that is to
call your members of Congress.”

HME has a “unique and powerful advantage” that other health care
sectors don’t have, Reinemer said, and that’s what stakeholders
need to use to get the message across. “What we may lack in terms
of budget we can make up for in terms of real-life stories,” he
said. “People just have to put a human face on this issue
…

“I think you have to stick with the basics. Everybody believes
that what you want to do is get people out of hospitals and nursing
homes if possible. It’s vastly more cost effective. And it is
preferred by patients. And it is clinically effective.

“We just have to keep our nose to the grindstone,” Reinemer
said. “This won’t be the last battle.”