Supreme Court ruling includes challenges, opportunities for HME

WASHINGTON, June 30, 2012—Authorities say the Supreme Court’s ruling on health care reform will lead to many millions of uninsured Americans gaining coverage, and that means opportunities for the HME industry. But the Affordable Care Act also contains provisions that will keep financial pressure on providers.

James E. Walsh, Jr., corporate counsel for the VGM Group, wrote in response to the ruling that these provisions are included in health care reform:

• A requirement that competitive bid pricing is applied nationwide as early as 2015 but no later than 2016.
• Elimination of a 2 percent fee schedule increase for items bid in 2014.
• A 2.3 percent manufacturer excise tax on medical devices and equipment.

Ryan Ball, an associate at the VGM Group/OPGA/Strategic Media Ltd., wrote in reaction to the ruling that the addition of 21 more metropolitan areas for Round 2 of competitive bidding will also have a negative impact on the HME industry. “However, new programs created by the law also create a potential opportunity over the next several years if providers can make it to 2014,” he wrote.

Although the Affordable Care Act has been in effect since 2010, major provisions of the law are scheduled to start in 2014. They include:

• The opening of Internet-based insurance exchanges for each state.
• A new law requiring large employers to provide insurance or face a penalty.
• The individual mandate requiring all Americans to have insurance.
• Changes in how the government pays for the medical care and the type of care it will accept as adequate.

Ball noted that one area of opportunity for the HME industry lies in the development of “essential health benefits packages” that will determine what is covered by insurance policies being sold through insurance exchanges. HME providers must promote the value of home care, and ensure that it is included in these benefit packages, he said.
Val J. Halamandaris, president of the National Association for Home Care & Hospice (NAHC), noted that the Affordable Care Act rightly shifts the focus of inpatient and institutional care to community settings, but the NAHC wants a two-year delay of implementation. This would allow more time for exchanges to be established, save money and avoid further cuts to Medicare, he said in a prepared statement. Go to www.vgm.com.