CAN SOMEONE PLEASE help me understand why some members of Congress, and other federal agencies in Washington, continue to compare Medicare costs for durable medical equipment to costs incurred by the Department of Veterans Affairs?

I thought we'd been over this before. Remember, most recently in 1999, when the durable medical equipment regional carriers tried to take advantage of their new-found inherent reasonableness authority, comparing what Medicare pays for DME items to what the VA pays for items as justification for a new pricing system for certain DME products?

And remember the industry's response then? “It's like comparing apples to walnuts,” said Asela Cuervo, then vice president of legal and government affairs for the National Association of Medical Equipment Suppliers, or NAMES, which since has evolved into the American Association for Homecare. “The service levels provided in the industry have to start to be recognized. I think if you do that, there is less justification for these reductions. Until then, there can be no comparisons.”

Now fast-forward three years and the U.S. Office of Inspector General issues a report saying Medicare pays too much for DME compared to what the VA pays. AAHomecare once again searched through its fruit basket for a response. “Comparing the VA to Medicare is like comparing apples to oranges. The fundamental differences between the methods used by the VA … or retail suppliers, and Medicare suppliers to purchase, deliver and get paid for items of DME … render it inappropriate to compare payment rates between them.”

So why are we back here again, being compared to the VA? I believe it's because while some congressmen and policy makers want to fix the Medicare system, they don't want to invest the time and expense to overhaul the system. Instead, they want to provide temporary Band-Aids, such as inherent reasonableness and competitive bidding, as a solution.

In a way, I can't blame them. The system is wrought with problems and is teetering on insolvency. As a result, certain powers-that-be are clamoring for a fix, and the sooner the better.

But, if someone is bleeding, there are only so many Band-Aids you can use until the source of the hemorrhaging must be found and fixed. Medicare is its own unique beast. It's different from Medicaid, from retail supplier systems and from the VA system. Didn't Congress learn anything from the Balanced Budget Act of 1997, when a knee-jerk reaction to keep the Medicare system solvent virtually destroyed the home health industry? Apparently, and unfortunately, not.