Over the past 10 years of lobbying for the home health industry, many people have asked why elected officials don't understand the importance and cost savings of the Medicare home health benefit. Year after year, many home health agency and durable medical equipment/home medical equipment providers become frustrated as hospitals, physicians, Medicare+Choice plans and other health care providers get legislative and regulatory relief, while the home health and DME/HME segment seems to get little or no relief.

There are several reasons why this occurs. Physicians, Medicare+Choice plans and hospitals have effective grassroots lobbying bases that are unparalleled. Certainly, donating money to political action committees is essential, but money alone cannot change the hearts and minds of our elected officials. It's up to the individuals who are affected by policy changes to make their names known and their voices heard.

There are many examples of effective grassroots lobbying campaigns in the health care sector. In the 1980s, former Democratic congressman from Illinois Dan Rostenkowski, who at the time was chairman of the powerful House Ways and Means Committee, proposed a potentially catastrophic health care bill. When details of the bill emerged, senior citizens, backed by several national associations, loudly opposed this bill. You may recall television news programs broadcasting scenes of senior citizens jumping on Rep. Rostenkowski's car outside his Chicago townhouse.

Another effective grassroots lobbying campaign took place during the Clinton health care debate in 1992. When word leaked that the Clinton plan would consist of seven regional alliances that would control health care, radio talk show hosts across the country sounded the alarm. And, when a national senior citizen organization hinted at its endorsement of the Clinton plan, many members called the association in protest, while many others ceased their membership. You may also recall the famous “Harry and Louise” television ads. Harry and Louise, a fictional couple, sat at their kitchen table talking about the Clinton plan while Grandma listened with fear in her eyes. This three-pronged campaign effectively derailed the Clinton plan.

Let's play a word-association game. What images come to mind when you read the phrase “competitive bidding”? How about “Medicare reimbursement cuts”? These issues are only two of many issues facing today's home health providers that call for intensive grassroots lobbying efforts if providers are to hope for any relief from their potential burdens.

There's a scene in the recent movie, Mission to Mars, that I often use to describe to congressional members and their staffs the home health industry's perception of competitive bidding. In the scene, several astronauts sit in a space capsule on top of a massive rocket just before blastoff. One astronaut says to the others, “Isn't it comforting to know that you are sitting on a $10 billion rocket and that every piece of it was bid out to the lowest bidder?”

The example elicits a chuckle, but, sadly, it clearly illustrates the problem with competitive bidding. The government is prematurely forcing competitive bidding on home health providers and, consequently, Medicare patients. And while competitive bidding may sound like a good idea, in reality it will drive quality down to its lowest common denominator. Companies will be fighting against each other to win bids at the lowest price, and once the bid is won, it will be far too easy to change, for the worse, the quality of products and services provided to patients.

An example of what could happen if competitive bidding is implemented is the Medicare+Choice program. Medicare+Choice was touted as a saving grace for Medicare, but has proved to be a huge disaster. Medicare+Choice plans were to save Medicare millions of dollars. In reality, the insurance organizations that participated in the plans bid too low on the price for performing certain services, and now are begging for more money because the actual costs associated with performing those services were higher than they anticipated.

As a result, the country continues to see a mass exodus of Medicare+Choice plans leaving the Medicare program, consequently stranding hundreds of thousands of Medicare beneficiaries with no care. These patients will have to scramble to find another Medicare+Choice plan or they will be forced back into the traditional Medicare program.

Elected officials need to know that competitive bidding for medical equipment and technology is untested, untried, and that the demonstration projects in Florida and Texas have not even been completed. If Congress forges ahead with another program that could have results similar to those of the Medicare+Choice program, the Medicare beneficiaries who need durable medical equipment will be left with limited access to quality products, more bureaucracy to sift through, and an increased frustration with elected officials.

At the start of October, it's anyone's guess if nationwide competitive bidding will be signed into law. Everyone in the home health industry must let Congress know that those who vote for this measure will be held accountable at the ballot box.

Regarding the additional 15 percent cut to home care services, it's frustrating that our elected officials don't realize the cost savings of the Medicare home health benefit. When the Medicare Part A diagnosis-related group, or DRG, system-in which a hospital is paid a preset amount for the treatment of a particular diagnosis, regardless of the actual cost of treatment-was implemented in hospitals, hospitals made it a point to get patients out of the hospital as soon as possible.

Logically, home health care picked up those patients, and it is time that Congress realizes this. In the last decade, home care expenditures have increased while hospitalization days have decreased. Ten years ago, if a patient required open-heart surgery, that patient could be in the hospital for seven days or more. Today, that same patient can be out of the hospital in a matter of days, if not sooner.

However, Congress still passed the Balanced Budget Act of 1997, which forced home health agencies to return to 1994 reimbursement levels, and ushered in the Interim Payment System, or IPS. Thanks to IPS, more than 3,000 home health agencies were forced out of business. Another cut would force many of the remaining home health agencies to go out of business, cut care or, even worse, place yet another burden on their nurses.

Will the cut take place? It is difficult to say. The Congressional Budget Office predicts that it would cost approximately $10 billion to eliminate the cut. But the CBO doesn't take into account that Medicare home health spending decreased from approximately $20 billion in 1997 to approximately $9 billion in 2001. In addition, Congress understands that the BBA cut home health spending by too much. However, an increased federal deficit coupled with increased spending on homeland defense and the military, means it may be more difficult and unrealistic for Congress to adequately shore up the Medicare home health benefit at this time. Therefore, it seems likely that this year yet another postponement will occur, and not a full repeal of the law.

An effective grassroots lobbying campaign consists of three basic components. First, it requires an effective leader who can contact key members of the lobbying group to get the word out regarding legislative and regulatory changes affecting the industry. Second, it requires dedicated and enthusiastic members to spread the message to the group's general membership. And finally, an effective lobbying campaign requires an energized membership-people who are active in their local communities and who know their elected officials by their first names and who understand that the squeaky wheel gets the grease.

Once these three components are established, there's a simple procedure to follow for lobbying elected officials on the issues that affect your business.

Do your homework. Find out if your current elected Congressional official is a proponent of the home care industry. If not, find out if his or her opponent in the next election is an industry supporter.

Pick up the phone. Call the local office of your elected official (or his or her opponent, depending on who supports the home care industry). Ask to speak with the person in charge of the official's election or re-election campaign. Tell the campaign manager your name, the name of your business, how long you have been in business and how many employees you have. Then, Tell the campaign manager that you are interested in helping get that candidate elected or re-elected to his or her office.

Arrange a meeting. Set up a face-to-face meeting with the candidate. During the meeting, tell the candidate that you are counting on his or her support for the home care industry. Tell the candidate that you will work hard to help him or her get elected or re-elected. Offer to host a fundraising reception at your home or office. And, tell the official that you will actively voice your support his or her campaign to all of your employees and friends in the district-fellow constituents such as your accountant, your consultant, the person who sells you office supplies, your hairdresser.

Walk the talk. Tell the candidate that you are willing to work hard to get him or her elected, even if it takes-and in some cases, it does-walking door-to-door, making phone calls, stuffing envelopes, holding up signs or whatever else needs to be done. Financial donations are also important, but “person-power” is equally effective.

Understand that getting to know elected officials on a first name basis dramatically improves providers' chances of getting favorable legislation passed that will benefit the industry, their business, and most importantly, patients. Grassroots lobbying is essential in ensuring our continued ability to serve our patients.

Scott Lara currently is director of governmental affairs for Jacksonville, Fla.-based Health Care Management Consulting. He is a registered lobbyist and has been lobbying Congress for 10 years on the benefits and cost savings of the Medicare home health benefit. Lara has spoken at state and national home health meetings and has contributed several articles on the benefits of home health to various publications.