No Magic Bullets

There are no magic bullets in the battle for good health care policy in Washington. I’ve learned that from my six years in the prosthetics/orthotics sector — and from my two short months in the DME sector.

But there are reliable bullets.

When home care takes an issue to Congress or CMS, we want to have ammunition of two distinct types: political support and data support.

Political support for the issue means some combination of grassroots backing in the district and support from key members of Congress. Data support is just as important. We need research and quantifiable evidence that demonstrates why our position makes sense in terms of accuracy, fairness and unfettered access to home care.

Of course, political support and data support are not mutually exclusive. We want to generate support for policies that make abundant good sense for patients, politicians and taxpayers alike.

As federal budget pressures inevitably translate — dramatically at times — into attempts to ratchet down home care payments further and further, good home care research takes on greater and greater significance. In recent years, AAHomecare has collected some of the numerous medical studies in JAMA, the New England Journal of Medicine and other journals that document the cost-effectiveness of home care.

During my brief tenure with the association, I’ve seen data and research move to the top of the agenda in efforts to prevent further erosion of the home oxygen benefit and in efforts to retract the power mobility fee schedule cut that is slated to occur this month. Specifically:

• A study of oxygen costs by Morrison Informatics released in June showed that only 28 percent of the cost of providing oxygen therapy in Medicare relates to equipment, while 72 percent is related to services. This is an essential point in rebutting congressional arguments that reduce the issue of oxygen reimbursement to a question of paying for a piece of equipment.
• Morrison also prepared a rebuttal to the September Office of Inspector General report on the cost and payment issues associated with oxygen equipment. The Morrison analysis demonstrated that the OIG report is too narrow and contains too many methodological flaws to offer reliable guidance for Medicare home oxygen pricing policy.
• Since much of the technology for today’s power mobility devices was developed after 1987 — the year CMS uses for historic pricing data in setting fees — a study of gap-filling conducted by Muse & Associates proposed a more accurate methodology for establishing payment rates for PMDs.

The need for good data for home care will continue throughout the potentially perilous lame-duck session of Congress this fall and will follow right into 2007, along with tight federal budgets.

Good home care research, which can be summarized and presented to congressional staff or CMS in a digestible format, is useful for making a strong case for better policy. Whether you’re meeting with a district office in your state or with a senator on Capitol Hill, solid, reliable data is invaluable.

However, credible and convincing research is not cheap. Commissioning a research firm that can do the analysis and also bring sterling credibility to the information is expensive. AAHomecare commissions this type of research. We fund some research from special assessments that several of our members have been generous enough to underwrite. Other times, the dollars come out of general funds.

So as you read about the battles being waged in Washington and perhaps even personally rely upon this research in your own lobbying efforts, I hope you will appreciate the importance of supporting the association as a member or as an ad hoc supporter who helps fund this important research.

Sterling data alone is no guarantee of success. But it is one of the most powerful levers to enlighten policy-makers and win over new champions for home care.

I was pleased to meet many HomeCare readers in Atlanta during Medtrade, and I hope to meet many more of you in the weeks and months ahead.

Tyler J. Wilson is president and CEO of the American Association for Homecare, Alexandria, Va. He may be reached by e-mail at [email protected]. For more information about the association, visit www.aahomecare.org.