AAHomecare Members Fight MMA's Reimbursement Changes

As Washington rushed to prepare for former president Ronald Reagan's funeral, 200 industry stakeholders fanned out over Capitol Hill to drive the home care message.

During the American Association for Homecare's Legislative Conference, held June 7-9, HME providers and manufacturers skirted hastily erected security fencing and crowd-control rails to keep appointments with 165 members of Congress and their legislative aides. Chief topics of discussion with the federal representatives were the DME reimbursement cuts and revised pricing for inhalation drugs mandated under the Medicare Modernization Act (MMA).

In meetings with the legislative aides for Georgia Sens. Zell Miller and Saxby Chambliss, Dave Hunter of Air Products Healthcare laid out a case against the 2005 transition to an ASP (average sales price) plus-6-percent pricing system for Part B respiratory drugs. “From a provider standpoint, what that really means is that the only reimbursement we would see above our cost is a 6 percent margin, which is not even going to be enough for us to deliver the medications.

“While we will continue to honor and support the patients we currently have in providing respiratory medications,” Hunter said, “we're going to literally have to look at getting out of the business. We believe strongly that this is going to lead to an access issue.”

Phil Stone of Atlanta-based American Homecare Supply, another member of the lobbying group from Georgia, told the congressional staffers that he is concerned about the impact the FEHBP (Federal Employees Health Benefits Plan)-based pricing cuts to oxygen and other DME products will have on beneficiaries. “It's getting to the point where we are going to have access issues,” he said.

WestMed Rehab's Tim Pederson carried a similar message to all three of his state's Washington legislators, including South Dakota Sens. Tom Daschle and Tim Johnson, and newly elected Rep. Stephanie Herseth. Pederson's Rapid City business has 21 employees and serves 6,000 patients, some of them in outlying American Indian reservations.

“We do a lot of outreach to the reservation communities, and the margins are very tight,” he explained to Herseth. “If those [reimbursement] reductions are implemented, we may have to reevaluate the types of services we offer on an outreach basis. Now we do it because it's the right thing to do … but we don't make a great deal of return. We would like to continue to do it, but we have to do what's best for our business as well.”