Reform Reboots

Slamming the brakes on health care reform caused whiplash for everyone riding on the expectation that reform was just around the corner. But the slowdown means HME should speed up efforts to make the case that a strong home care sector is a key driver of cost-effective care and true reform.

Republican Scott Brown’s win in the previously Democratic Senate seat in Massachusetts reduced the number of senators who caucus with Democrats from a filibuster-busting 60 down to a game-changing 59. One headline joked that the Brown election had produced a 41-59 GOP majority.

President Obama’s State of the Union address made it clear that his administration has not given up on health care reform. But other priorities are piling up, and they received higher billing in his speech — jobs, the economy and other domestic issues.

The fate of health care reform legislation was not clear at press time. But several facts are certain:

Congress will seek to control Medicare spending by slowing growth in targeted areas. Home medical equipment and services is a common target, in spite of the fact that it has been repeatedly hit with reimbursement reductions over the past decade.

HHS’ Office of Inspector General will play a supporting role in the targeting of HME by perpetuating misperceptions about Medicare “overpayments” of HME items.

Anti-fraud efforts and spending in Medicare will increase, which are welcome as long as they focus on preventing fraud rather than merely adding meaningless regulations that drive even more HME providers out of business.

So providers should use this time to convey key messages about controlling costs, preserving quality care and saving jobs. Priorities for the HME sector speak to problems in existing law as well as threats that will remain on the table in terms of potential congressional action:

• The Medicare “competitive” bidding program for HME is anti-competitive, kills jobs and reduces access to quality home care for seniors and people with disabilities. This is the worst possible time to put HME providers, most of whom are small companies, out of business. H.R. 3790, the bipartisan bill introduced by Rep. Kendrick Meek, D-Fla., would eliminate the bidding program in a fiscally responsible manner, reducing HME reimbursement rates.
• There is no debate about the fact that the home is the most cost-effective setting for care and is a key to true health care reform. Quality home medical equipment and services provided in Medicare help reduce re-hospitalization, hospital length of stay, ER visits and more expensive institutional care. HME represents less than 2 percent of total Medicare spending and has endured numerous deep cuts in recent years.
• Congress should preserve the Medicare beneficiary’s option to purchase a power wheelchair during the first month of use and should support development of a separate benefit category for complex rehab wheelchairs. Providing wheelchairs to beneficiaries with severe mobility restrictions requires customization and clinical services that should be recognized by Medicare.
• AAHomecare’s aggressive 13-point anti-fraud legislative action plan would help prevent Medicare fraud and save taxpayer dollars. That plan calls for real-time claims audits, more site visits and tough penalties for fraud. The HME sector supports effective anti-fraud measures, such as the bill proposed by Sen. George LeMieux (S. 2128).
• Medical oxygen policy in Medicare must be reformed to ensure stability for patients and home care providers. Current law does not recognize the extensive, vital services required in providing home oxygen therapy.
• Congress should not impose an excise tax on manufacturers of durable medical equipment. Combined with Medicare cuts to HME, this tax will drive jobs overseas and cut into research and development efforts that keep American firms competitive.

Just because Congress may delay consideration of health care issues, the HME sector cannot slow down its advocacy efforts. Now is a good time to grip the steering wheel and step on the gas.

Read more AAHomecare Update columns.

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.