Marx Lays Out Home Health Care Issues on C-SPAN

WASHINGTON — Home medical equipment provider Joel Marx
stood up for home care on C-SPAN’s Saturday edition of
Washington Journal, pressing the point that home care
could save billions of dollars for Medicare and private insurance
companies.

“Home health care is one of the ways that we can save
money for Medicare. People prefer to be cared for in their homes;
it is the most cost-effective health care we can have,” Marx
told program host Libby Casey.

Marx, owner of Medical Service Company in Cleveland and a board
member of the American Association for Homecare, represented the
organization. His appearance followed an Aug. 27 program in which
Bruce Vladeck, a former administrator of the Health Care Financing
Administration (the precursor to CMS), asserted that Medicare was
paying $3 billion a year “for air” in reimbursing
providers for home oxygen services.

That sparked a swift rebuttal from AAHomecare and the invitation
from C-SPAN to discuss the issue. Marx fielded questions from both
the host and callers, managing to hit many of the HME
sector’s hot topics during Saturday’s half-hour
segment.

On home health
care: “There are several ways that we can save
Medicare dollars within health care—getting more people
included with some sort of insurance so they see a physician before
they go to the emergency room at 10 at night; getting people to
take control of their health care and doing preventative health
care; and transferring a lot of services to the home rather than to
a long-term care facility or a hospital.”

A caller with muscular dystrophy noted, however, that Medicare
does not cover a lot of the items and/or services she needs to stay
in her home.

“Home care is the solution, and providing these services
in the home would be less expensive to the system,” Marx
replied, adding that this does not, however, appear to be the way
Medicare is going.

“One of the choices Medicare seems to be making,”
Marx said, “is to limit access to the type of items you need.
Providers in my sector are more than happy to provide these items,
but the coverage isn’t there for them. It’s something
we need to talk to Medicare about—embracing home care as a
solution.”

On the effectiveness of home
care: A caller who had a knee replacement and went
directly home from the hospital rather than to a rehab or step-down
facility noted that she had recuperated faster than friends who did
not go immediately home. “Is there any data to show that
people who are getting home health care and doing therapy and such
as that, that we do better than those who go to step-down units in
the hospital?” she asked.

“I don’t know of any empirical data comparing
recovery rates; I do know there is data that says patients would
prefer to be home,” Marx responded, adding that in the last
20 years medicine has made enormous strides and now, even patients
on dialysis and those needing infusion and home inhalation drug
therapy can be treated at home. “You don’t need to be
in the hospital for many of these things … The faster that we can
get patients in their home, the happier they are going to
be.”

On Senate and House health
reform bills: “None of the health bills seems to
be expanding coverage within the home. This would result in
savings. Most of the changes that are being proposed have to do
with expanding accessibility to insurance.”

The bills currently being discussed by both legislative bodies
would pay for this accessibility in part by doing just the opposite
of expanding home care coverage and instead “ratcheting down
the reimbursement rates,” Marx said.

On home
oxygen: “Since 1997, Medicare and Congress have
reduced the reimbursement level for home oxygen for patients who
prefer to be in the home utilizing oxygen, and these [reductions]
have been considerable … almost 50 percent over the last 12
years,” Marx told viewers as a chart showing the cuts was
screened. “We’re at a point where further reductions
are going to start affecting the outcomes patients will
have.”

The ability of patients to ambulate and retain their vitality in
the community will be compromised, he said.

A California caller questioned why her father, who lives in
Florida, was having so many challenges with his oxygen and inquired
about the 36-month home oxygen rental cap that was implemented Jan.
1.

Marx explained the cap and noted: “After 36 months,
Medicare has chosen to stop reimbursing the provider for two more
years. The challenge comes when the patient travels or moves
to another area. Medicare’s position is that another provider
should pay [the current provider] for that service.”

On Bruce
Vladeck: “Dr. Vladeck is not a physician …
he spoke of ‘air’
being delivered to patients in the home. This is particularly
hurtful to the millions of patients who use oxygen—medical
oxygen ordered by their physician”—and who are unable
to breathe on their own, Marx said. He noted that medical oxygen
nurtures their organs more effectively and provides greater
saturation in the bloodstream.

Vladeck’s comment, Marx said, was “unsympathetic”
and “seemed particularly hurtful. Perhaps he wasn’t
aware of what the services actually were that are
provided.”

On competitive bidding: Host
Casey referenced a study on DMEPOS competitive bidding by
Brian O’Roark, PhD, and asked Marx to explain the
program.

“Congress has proposed this program, which is being
implemented right now in 10 market areas of the country,”
Marx said. “It is a program where providers will bid on
providing different services, and the lowest provider will end up
providing those services in the Medicare program. One provider may
provide oxygen, another provider may provide a walker and another
provider may provide a hospital bed. So you have three different
providers providing equipment.”

He added that “80 to 90 percent [of providers] will be
excluded. In the long run, we are going to lose providers and, as a
result, prices will go up.”

Marx said that, like many other HME providers, his company has a
high ratio of Medicare patients. About 60 percent of his revenue
comes from Medicare, he said.

A Florida provider, noting that he was aware the initial Round 1
of the competitive bidding project had been delayed by Congress
last year, inquired about the changes CMS has made to the new
round.

“Last year, Medicare awarded contracts to providers around
the nation who were not licensed in the state for which they won
the bid,” Marx responded. “It was inappropriate and it
would hurt patients … Medicare has made some changes; I’m
not sure what they are.”

Emergency
service: Responding to a California caller’s
remark about the good service oxygen patients continued to receive
in spite of being in the area of the state’s wildfires, Marx
explained that HME providers serving Medicare patients must be
accredited and that accreditors require them to maintain services
and availability in case of an emergency.

“All home medical equipment providers have elaborate
back-up plans, so at 3 in the morning when the power goes out and
[patients] are evacuated from their homes, you have back-up tanks,
you provide them with portable oxygen. These are all items that are
not reimbursed directly by Medicare.”

On the increasing need for home
health care: Noting that “we have an aging
population,” a home health case manager called in to stress
the growing necessity for home health care. Marx took that
occasion to press the need to get that message to legislators.

“This is something we all need to talk to our legislators
about, the need for increasing services for patients in their
home,” he said. “I’m not just talking about
medical equipment, I’m talking about mental health services,
physician services, nursing services, home health nurse services,
non-medical patient assistance—services that are going to
keep patients from more expensive settings.”

To view Marx’ Washington Journal appearance,
click here. (The segment
begins at the 2:32 mark.)