Roundtable: Home Care Is No Place for Competitive Bidding

WASHINGTON — Disability groups have long opposed
competitive bidding, according to advocate Peter Thomas, who took
part in a Tuesday roundtable on the role of home care in health
care reform.

Under the DMEPOS bidding program, Thomas said, “There is real
concern about limitations on choice of provider. In many instances,
these are beneficiaries with long-standing relationships with
providers. … Those relationships get fractured under
competitive bidding …

“We’re very concerned that service is going to go out the
window, that quality is going to decrease and that patient choice
is going to become compromised,” continued Thomas, co-chair of the
health care task force for the Consortium for Citizens with Disabilities.
“There are other ways to get at overpayment in the DMEPOS fee
schedule. We think that competitive bidding is not the way to do
it.”

Provider Georgie Blackburn, vice president of government
relations and legislative affairs for Blackburn’s,
Tarentum, Pa., agreed. Even as a Round 1 bid winner, she said, her
company had “fought tooth-and-nail” against competitive bidding
“because we just feel this is poor health policy. And the patients
we have served since 1936 as an independent provider … the
types of care we give to them cannot be done under competitive
bidding.”

The Capitol Hill discussion was sponsored by the American Association
for Homecare for members of the Washington media and
congressional staff. Other speakers included former Senate Majority
Leader Tom Daschle, D-S.D., and Rep. Jason Altmire, D-Pa. Tyler
Wilson, AAHomecare president, moderated the panel.

Altmire, who chairs the House Small Business Subcommittee on
Investigations and Oversight, referenced the committee’s hearings
on the bid program. “What we found is when you have a regulation in
place that’s putting cost over quality, that’s not only going to
impact the beneficiary, and we all know how that works, it’s also
going to affect small businesses that are staples to our
communities in the durable medical equipment field.”

About efforts to reform health care, Altmire said, “We’re going
to preserve what works in our current system, first and foremost,
and one of the things that works best in the current system is home
care. And if you look at what the goals are for health care reform,
home care touches on every one of them. When you think about
wellness and prevention … that can be done in the home better
than anywhere else. There’s no more cost-effective setting than in
the home.”

Daschle, President Obama’s first nominee as HHS secretary,
pointed to the $7-a-day cost of home oxygen compared with the
$5,000-a-day cost for a hospital stay under Medicare. The
difference “shows clearly how much of a panacea home health care
can be,” he said.

Now a policy advisor at law firm Alston & Bird,
Daschle is the author of a 2008 book titled Critical: What
We Can Do About the Health-Care Crisis. The former senator
told the roundtable about his own family’s experience with home
care.

“My mother’s quality of life is a hundred times better given the
fact that she can live at home rather than be institutionalized at
86,” he said. “Her quality of life is proof positive that we can
help improve quality, lower costs and provide greater access if we
put the emphasis where it belongs — at the base of the
pyramid with good home health care.”