Plotting the Road Map

With the dust settling in Washington, it’s easier to see the legislative and regulatory landscape for 2005. The president has delivered his fiscal year 2006 budget. Congressional committees and agendas are taking shape to tackle legislative priorities of the 109th Congress. Meanwhile, AAHomecare is looking at the road maps — as well as potential roadblocks — to stronger home care.

To move home care forward, we must consider the most pressing needs of patients and providers as well as the avenues that will allow us to get there by working with Congress and the administration. AAHomecare member committees and leadership have identified several key priorities for 2005:

• Protect home medical equipment and home health from further cuts in any legislation passed during 2005.
• Counter competitive bidding in light of recent reimbursement cuts and expand focus on the CMS Program Advisory and Oversight Committee (PAOC) on competitive bidding.
• Protect the dispensing fee amount of $57 for inhalation drug therapies, which we worked hard to secure in 2004.
• Maintain the market basket increase and rural add-on for home health services and oppose copayments for home health.
• Preserve current reimbursement for stationary oxygen systems in light of efforts to move to a modality-specific payment model.
• Change the exclusionary rule, which unfairly compares Medicare and private charges and could exclude from the Medicare program any providers whose charges are considered excessive based on that comparison.

This list will likely evolve as conditions, threats and opportunities change in Washington.

So far this year, AAHomecare has concentrated its efforts on presenting home care as the solution — not the scapegoat — for rising health care needs and expenditures. Home care can celebrate clearing the first hurdle of the year: avoiding hits in the proposed 2006 budget. The home care community of patients and providers was not singled out for reimbursement cuts. For that we can thank our “congressional champions” in Washington, those senators and representatives who have strengthened and elevated home care issues to the level they deserve.

Where the president’s fiscal year 2006 budget and congressional debates do focus on health care costs for seniors and the disabled, AAHomecare will continue to argue that home care is a patient-preferred and cost-effective solution to the nation’s growing health care crisis.

In his first speech as the new Secretary of the U.S. Department of Health and Human Services (HHS), Michael Leavitt stressed the importance of home care in delivering cost-effective care in the Medicaid system. Leavitt carried forward last year’s HHS emphasis on rebalancing institutional care with home- and community-based care through the New Freedom Initiative and other programs developed by CMS.

Of course, the advantages of home care in Medicaid also translate to Medicare. In early February, I was fortunate to have optimistic conversations about home care with both outgoing HHS Secretary Tommy Thompson and incoming Secretary Leavitt, key forces in steering the direction of the administration’s health care policy.

Secretary Leavitt clearly understands the dimensions of diseases, such as chronic obstructive pulmonary disease (COPD), that can be treated through home care. Life-sustaining and quality-of-life-improving oxygen can be provided to a COPD patient who resides in his or her home for one full year at about the same cost of one day in the hospital — a perfect illustration of value in home care.

Because home care now encompasses virtually every form of clinical and technological support short of surgery, home care offers the White House, Congress and CMS a great opportunity to reduce costs while expanding access to vital care for millions of Americans. Remember, you as home care providers deliver tremendous value for Americans’ health care dollar.

Kay Cox is president and CEO of the American Association for Homecare, Alexandria, Va. For more information about AAHomecare, visit www.aahomecare.org, or call 703/836-6263.