Peril and Opportunity

By the end of President Obama’s health reform summit, held just days before the AAHomecare Washington Legislative Conference, it was clear that the administration would push to complete health care reform, drawing largely on the Senate’s version of the congressional legislation. Because the Senate’s reform proposals would pose serious risks for HME providers and their patients, this means that HME still faces immediate threats.

For instance, the Senate bill includes:

• An acceleration in the geographic scope of competitive bidding in Round 2, adding 21 MSAs across the country, and nationwide application of bid pricing by 2016;
• Elimination of the 2 percent fee schedule increase for bidded items promised to the HME community in return for the 18-month delay of competitive bidding;
• Elimination of the first-month purchase option for all power wheelchairs, except for complex rehab power chairs;
• A mandatory face-to-face requirement for all HME items;
• Application of a productivity adjustment to the HME fee schedule that is expected to lower payments by 1 to 1.5 percent annually; and
• A tax on medical devices.

So the HME stakeholders who participated in the Legislative Conference this month arrived at a time of both peril and opportunity. The perils are clear: There are numerous problems with competitive bidding and oxygen policy as well as the new proposed threats to the first-month purchase option.

At the same time, the HME sector had the opportunity to make a significant impact, with approximately 300 meetings scheduled with Capitol Hill lawmakers on the March 3 Lobby Day.

The next step is follow-up, whether you were in Washington or not. The adage “out of sight, out of mind” rings very true in Washington, which is why contacts by the HME community must continue with Congress in Washington and back in their district offices.

Please share the following key issues with lawmakers and congressional staff via phone, email or personal visits.

• Support H.R. 3790, a bipartisan bill to preserve access to home care and eliminate the misguided Medicare “competitive” bidding program for durable medical equipment. This bidding program will put most HME and service providers out of business and will reduce quality of care and access to medically necessary items and services for seniors and people with disabilities. The bid program will needlessly eliminate jobs and small businesses in every state. H.R. 3790 eliminates the bid program in a fiscally responsible manner.
• Support legislative changes to Medicare oxygen policy to ensure stability for patients and home care providers. Oxygen legislation should recognize services provided to patients and establish reimbursement rates that account for providers’ costs; eliminate the 36-month cap on payments and ensure appropriate reimbursements for the period of patients’ medical need; provide appropriate patient protections to ensure quality care; and prevent further cuts to total oxygen payments in Medicare.
• Preserve the patient’s option to purchase a power wheelchair during the first month of use. This option helps Medicare beneficiaries who have a lifetime need for powered mobility. Preservation of the option will allow patients to continue to have access to quality power wheelchairs and services.
• Do not impose an excise tax on manufacturers of durable medical equipment. Combined with Medicare reimbursement cuts to the DME sector, this tax will drive jobs overseas and will cut into research and development efforts that keep American companies competitive.
• Support effective anti-fraud measures such as the “Prevent Health Care Fraud Act of 2009,” S. 2128, and its companion bill, H.R. 4222. AAHomecare has proposed an aggressive 13-point anti-fraud plan to prevent Medicare fraud through real-time claims audits, more site visits and tougher penalties.

Unless we turn them back, the many threats to HME will undermine our nation’s home care infrastructure. That will create severe access problems for millions of home care patients and their families, force thousands of HME providers out of business and kill essential jobs all across America.

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.