Home Care Is the Answer

As challenging as this year has been, we will face at least as much activity and effort in 2005 to protect our industry. With the war, the deficit and many other pressures on the federal budget, it’s going to be a tough environment for preserving reimbursement rates for home care.

The message that must get through is that investment in home care is a key part of the nation’s health care solution. Home care delivers a great value for Americans’ health care dollar. Patients prefer care in their homes, and home care is clinically proven and cost-effective. From respiratory and infusion therapy to health monitoring, services that in years past would have required a doctor or hospital visit now can be done in a patient’s home.

Home care tends to be less visible than your region’s great medical center, or even the local doctor’s office around the corner. But it is no less important in meeting the growing demands for quality care in a way that we can afford as a nation.

Taking care of an ill relative or friend in the home is as old as the notion of family itself. Today, more than 25 million family caregivers provide some kind of personal assistance to someone with a disability or chronic illness. In fact, one out of every four households in this country cares for an older person, and almost two-thirds of older Americans who need long-term care depend on family and friends. That says a lot about the character of our nation. Home care is a real family value, touching millions of lives each and every day.

Members of Congress and local officials should be educated about the role home care plays not only for local families but in the broader state and national health care context. So don’t hesitate to put a human face on the issue. Talk about the difference it makes in families’ and patients’ lives. Chances are very good that elected officials have toured the major hospitals in their districts. Touring your home care facility is just as important.

Tell them about the impact of the pricing reductions for DME items that will kick in on Jan. 1, 2005, as required by the Medicare Modernization Act, which will base payment for certain items on median Federal Employees Health Benefits Plans (FEHBP) amounts. How much will reimbursements drop?

For oxygen reimbursement, the Office of the Inspector General (OIG) released its study on Sept. 13, and AAHomecare is working with OIG to discuss the methodology of the report. As for other key DME cuts, the 2002 OIG report indicates each item would be cut by the following percentages, though specific cuts have not been finalized:

• 22.27 percent cut for nebulizers (E0570)
• 20.34 percent cut for hospital beds (E0260)
• 11.77 percent cut for pressure-reducing air mattresses (E0277)
• 7.13 percent cut for manual wheelchairs (K0001)
• 5.36 percent cut for lancets, per 100 (A4259)
• 4.10 percent cut for blood glucose test strips (A4253)
• 3.28 percent cut for power wheelchairs (K0011)

The Hobson-Ford Bill, H.R. 4491, would repeal these cuts. As of Sept. 24, the proposed legislation had 64 House cosponsors. But the home care community must produce a groundswell of support to make our case that home care cannot afford more reductions on top of current Medicare rates.

On another front, a Notice of Proposed Rulemaking by CMS for the 2005 Medicare physician fee schedule recommended 89 percent cuts for two critical inhalation therapies — albuterol sulfate and ipratropium bromide — under the new average sales price formula. An AAHomecare study, conducted by Muse and Associates earlier this year, found that these cuts would under-reimburse these two inhalation therapies by $68 per monthly supply.

On these issues and others, we must continue to counter specific cuts with credible information about how they will hurt our patients. The home care community represents a large array of constituents, patients, voters, taxpayers and employers who must speak up and remind policymakers: Home care is the solution, not the problem.

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.