Our Numbers Don’t Lie

Mark Twain said, “There are three kinds of lies: lies, damned lies, and statistics.” No doubt, numbers can be twisted to distort the truth, but in the case of home care, there are a number of good statistics that don’t lie and that can go a long way to correct misconceptions in Washington.

Here are a few examples:

• Fewer than 2 percent of Medicare dollars go to HMEThe best way to appreciate this statistic is in a chart on the AAHomecare Web site that shows Medicare spending from 1993 to 2005. The chart shows a rising line for total annual Medicare spending and lines for hospital care, physician and clinical services, home health and home medical equipment spending. HME is not only a small fraction of Medicare spending; it is clearly not driving the budget crisis in Medicare, or Medicaid. After the president issued his proposed 2008 budget in early February, AAHomecare responded the same day. We pointed out that the proposed cuts to Medicare for FY 2008 would heap yet more unwarranted cuts on the most cost-effective form of health care in the Medicare program. And in testimony to the House Ways and Means Committee, we mentioned that the president’s proposed budget would take a disproportionate whack at home care. We pointed out that HME is less than 2 percent of Medicare spending, and yet the administration’s proposed budget would cut HME by about 4.5 percent.
• We can save Medicare 5 percent while preserving access to mobilityThe association also opposes another provision in the president’s budget that would establish a 13-month rental period for power wheelchairs. This change would reduce beneficiary access and would actually increase costs to Medicare. The Rehab and Assistive Technology Council at AAHomecare has done some excellent math to illuminate this issue. RATC found that the average Medicare fee schedule payment for a “Group 2 Standard Weight with Captain Seat” (HCPCS code K0823) is $4,023.70. By eliminating the beneficiary’s purchase option and requiring power wheelchairs to be rented over a 13-month period, the total rental payments would be $4,224.91. Thus, the Medicare program would pay 5 percent more for power wheelchairs under the president’s budget proposal.
• Congress has cut oxygen nearly 50 percent over 10 yearsOne of the targets of the proposed 2008 budget cuts in Medicare is home oxygen therapy, in the form of a proposal to cap reimbursements at 13 months. To set the record straight when speaking with lawmakers, it’s useful to point out how much Congress has reduced Medicare reimbursement for home oxygen therapy over the past 10 years. The Balanced Budget Act of 1997 mandated oxygen cuts of 25 percent in 1998 and 5 percent more in 1999, along with a CPI freeze. The Medicare Modernization Act of 2003 included a 12 percent reduction (the difference between Medicare 2002 payment and the Federal Employees Health Benefits program price). The MMA also froze HME prices for five years and instituted the competitive bidding program, which will likely push prices down even further. After all of these reductions, we invariably hear congressional members and staff ask “what would you be willing to give up” in order to prevent another round of cuts? The answer, to put it bluntly, is: Do the math — we have given our pound of flesh.
• A staff of 12, a budget of $3 millionFinally, consider these numbers. The orthotics and prosthetics industry is a $3 billion industry. I led their association for six years until last September when I joined AAHomecare. Their association has a staff of 26 and a $5 million annual budget.

Let’s compare that to home care. HME is roughly a $25 billion industry. AAHomecare, which represents an industry many times larger than orthotics and prosthetics, is about half the size in terms of staff (12) and budget (about $3 million).

These numbers help tell a story: Our industry is a small but cost-effective piece of the nation’s health care system. It’s under attack. It needs your support.

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.