HME and Health Reform

Home medical equipment should play a starring role in the debate over health care reform.

Health care reform will be a top agenda item on Capitol Hill for the 111th Congress. The United States spends about twice as much per person on health care as the average high-income country — and many of those countries offer some sort of universal care or other type of nationwide coverage. And despite our skyrocketing expenditures in Medicare and other areas of health care, 47 million Americans remain uninsured.

Simply speaking, there are two ways to control Medicare spending. Coverage can be reduced or eliminated. Or reimbursements can be reduced or eliminated. The latter — adjusting reimbursement levels downward — is the more politically palatable alternative for politicians and it presents the HME sector with the more peril.

As veterans in the home medical sector know, the debate about Medicare reform can be a time of great opportunity — or a time of great peril.

The debate over broad health care reform is already well underway with ideas circulating from Senate Finance Committee Chairman Max Baucus, D-Mont., and Sen. Edward Kennedy, D-Mass. There appears to be coordination between the Senate plans and the plans envisioned by the Obama administration.

President Obama has made it one of his points to insist that seniors and people with disabilities have choices about their care, consistent with their needs, and not biased toward institutional care.

Sen. Baucus’ plan includes proposing health care policies that “shift the focus from institutional care to services provided in the home and community” to improve quality of care and reduce costs. But his plan also proposes that competitive bidding is an anti-fraud program and is a sound payment methodology for home medical equipment and services in Medicare.

The reforms floated by Sen. Kennedy aim for savings, but not enough to pay for the whole plan. This means the question of how to pay for health care will bring back what one of Kennedy’s top aides calls a “drearily familiar” debate about offsets, or “pay-for’s.” Predictions of a “free lunch” for any health care sector are premature.

Among other topics, the debate will focus on eliminating excess bureaucracy and duplicative tests, preventing disease and maintaining health and reducing fraud and abuse in Medicare.

So how do we turn the health care reform discussions into an opportunity for the HME community? By positioning the HME sector appropriately and by lobbying effectively. This is how we will benefit by being the cost-effective health care solution and the preferred health care choice for most Americans.

The bottom line is that policymakers must be made aware of the value of home care as a Medicare Part B benefit and the role of home care in preventing much higher hospital costs in Medicare Part A.

The American Association for Homecare will continue to work on several HME priorities during 2009 knowing that all of them will likely be considered in the broader context of health care reform.

• Competitive bidding alternative: The Association has established a task force looking at alternatives to competitive bidding that represents a cost-effective but fair and accurate means of setting reimbursement rates for HME.
• Fraud prevention: Our 13-point plan to stop fraud and abuse will be circulated among policymakers to ensure that the ideas are carefully considered and implemented. The HME sector is at the forefront of fraud prevention, and policymakers must be made aware.
• Home oxygen: While stakeholders work on a reform of the benefit that will include recognition of the vital, service-intensive nature of oxygen therapy, there are many immediate problems related to post-cap payment and services. These issues raise serious questions about patient safety, access to care and the importance of keeping seniors out of the emergency room. Oxygen represents an important example of why home care policy must remain strong if health care reforms are to succeed.

Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. You can reach him at [email protected]. For more information on critical home care issues, visit the association’s Web site at www.aahomecare.org.