Home Care Groups Bash Bush Budget

WASHINGTON–In a move both expected and dreaded by home medical
equipment providers, last week President Bush revealed his 2008
proposed budget, which includes a 13-month cap on oxygen rentals
and elimination of the first-month purchase option for power
wheelchairs.

In addition, the budget calls for a five-year freeze to the
Medicare market basket update for home health agencies and a
reduction of almost two-thirds of a percent for each year
thereafter.

The proposed $2.9 trillion budget provides nearly $700 billion
for the Department of Health and Human Services, but seeks to carve
out $66 billion in savings from Medicare and $12 billion in savings
from Medicaid over five years.

While the president’s budget must be approved by Congress before
taking effect, its provisions generally set the tone for debate.
Just hours after the budget was released, Bush’s proposals
triggered protests from a number of home care groups, who warned
such moves would curb accessibility for oxygen and mobility
patients and would threaten home care itself.

• A statement from the American Association for Homecare blasted
  the proposed 13-month cap on oxygen rental, calling it
  “particularly severe.”

  Issued jointly with the National Home Oxygen Patients
  Association and the National Association for Medical Direction of
  Respiratory Care, a physicians’ group, the statement said, “We
  believe the proposed change in payment methodology places an
  unfair, unsafe and unrealistic burden on the beneficiary.” The
  organizations said they are “deeply concerned that Medicare policy
  is increasingly at odds with the clinical needs of home oxygen
  therapy patients, as well as physicians’ and home oxygen providers’
  ability to deliver optimal home respiratory care.”

  “The president’s proposed budget significantly impacts citizens
  least able to manage ownership of respiratory medical equipment,”
  said Jon Tiger, president of NHOPA. “It leaves them without a
  network to ensure proper functioning of the equipment and to whom
  concerns can be raised. The proposal also removes the incentive for
  manufacturers to continually improve their equipment and will
  result in used prescription equipment ending up in the secondary
  market.”

  The statement also pointed out that the proposed 13-month cap
  comes on top of numerous other cuts and freezes mandated by
  Congress in recent years. AAHomecare President and CEO Tyler Wilson
  noted that “Congress has reduced Medicare reimbursement for oxygen
  therapy by nearly 50 percent over the past 10 years.”

• The Council for Quality Respiratory Care–an alliance of 11 of
  the country’s largest companies that provide home oxygen care to
  approximately 650,000 Medicare beneficiaries–joined with patients
  and physicians in opposing the 13-month rental cap.

  “Cuts of this magnitude have the potential to disrupt the
  quality and continuity of care for our patients,” said Mark Shreve,
  CEO of the Coalition for Pulmonary Fibrosis, which represents more
  than 128,000 patients with idiopathic pulmonary fibrosis, for which
  oxygen is a critical component of treatment. “We urge Congress to
  reject this provision in the president’s budget to ensure that
  patients are able to access the services they need to survive.”

  Concern over the proposed cuts is compounded by the fact that
  “the Medicare home oxygen benefit is still experiencing the impact
  of several years of cuts enacted by Congress as part of the
  Medicare Modernization Act of 2003 and the Deficit Reduction Act of
  2005,” CQRC said.

  According to Peter Kelly, the group’s chairman, “Providers of
  oxygen home health services are just starting to absorb the
  reductions in funding enacted by Congress in recent years …
  Further cuts in the benefit would be destabilizing to the system.
  Additionally, this proposed 13-month cap comes on the heels of the
  administration’s recent overhaul of the reimbursement system for
  home oxygen.”

• Industry providers agreed.

  Duane Greer, supervisor of RTA Homecare in Mesa, Ariz., said he
  is concerned about the effects of a 13-month cap on his customers,
  many of whom are winter visitors. “Now they’re going to be stuck
  with [transporting] all their equipment. They’re not going to have
  the freedom to go to a provider and get set up [when they visit],”
  he said. “And then, who is going to service them? They’re not going
  to be able to get the service.”

  He is also concerned, he said, about what will happen to used
  oxygen concentrators if providers are no longer able to remove
  them. “You’re going to see the market flooded with used
  concentrators because [people] aren’t going to know what to do with
  them after purchase,” Greer predicted. “It’s still a medical
  device, and [people are] going to be using them without a
  prescription and with oxygen picked up at a garage sale.”

• AAHomecare and others also vehemently opposed Bush’s proposal
  to establish a 13-month rental period for power wheelchairs–which
  would eliminate the first-month purchase option for the
  equipment–saying the change would reduce beneficiary access and
  increase costs to Medicare.

  “Currently, Medicare permits a beneficiary to choose to purchase
  a power wheelchair when it is prescribed by a physician,” the
  association said, noting that with the option, Medicare payment is
  made on a lump sum-basis. “In October 2005, the Senate debated a
  provision to eliminate the first-month purchase option for power
  wheelchairs and decided to reject this policy change,” the
  association said, based on the following reasons:

  –Beneficiaries in need of power mobility devices suffer from
  long-term debilitating conditions. More than 95 percent of all PWCs
  are purchased in the first month because beneficiaries who meet the
  coverage criteria have long-term life needs.
  –Many PWCs are custom-configured and individualized for the
  patient. These are not commodity items.
  –Eliminating the first-month purchase option would severely
  curtail beneficiary access as the supplier will be unable to cover
  the significant up-front service costs that go into the provision
  of the most appropriate power mobility device to accommodate the
  beneficiary’s needs.

  The association urged Congress to “reject the administration’s
  proposal and maintain the first-month purchase option for power
  wheelchairs to ensure beneficiary access and cost savings to the
  Medicare program.”

  Providers agreed with this, too.

  “Obviously, that’s unacceptable,” said Wendell Matas, president
  of Wheelchairs Northwest in Bellevue, Wash., president of the
  Pacific Association of Medical Equipment Services, about the
  president’s proposal. “I don’t think people ever think in terms of
  renting a power wheelchair. I can understand a capped rental for
  people who may need it for a short while. But when you get into
  rehab, those chairs are custom built for each individual. You just
  don’t turn ’em around [and give them to someone else].”

  Kurtis Blunt, owner of Santa Barbara Healthcare in Santa
  Barbara, Calif., said he’s already selective about the power
  wheelchairs he bills Medicare for, but if Bush’s proposal goes
  through, it would quash that business entirely.

  “If they’re going to do a capped rental on a power wheelchair, I
  am not going to do it at all. It’s not worth it to me,” he said.
  “Unfortunately, the people who are going to be hurt by it are the
  patients because they are going to need equipment and they aren’t
  going to be able to get it.”

  Said AAHomecare’s Wilson of the budget proposals, “Home care
  provides a clear path to more cost-effective care in Medicare and
  Medicaid. Home care delivers value for every health care dollar and
  is clinically effective and preferred by patients and families.
  These proposed cuts serve only to hobble the home care
  infrastructure that this nation desperately needs.”

  Congressional hearings on the budget proposal are scheduled for
  later this month. To view the proposal for the Department of Health
  and Human Services, visit http://www.hhs.gov/budget/08budget/2008BudgetInBrief.pdf.
  Go to page 50 for a discussion of proposals affecting home
  care.