WASHINGTON — Signaling the new Congress' intention to tackle the issue of health care early on next year, Sen. Max Baucus, D-Mont., last week unveiled a comprehensive reform plan that drew both kudos and cautions from HME industry stakeholders.
While they commended the plan for building a more efficient health care system, they did not overlook its red flags.
"[The plan] clearly puts our industry on notice that we must be more vigilant than ever before in addressing head on the fraud-and-abuse issue, and be willing to work with Congress constructively on specific payment reform initiatives," said Cara Bachenheimer, senior vice president of government relations for Elyria, Ohio-based Invacare.
At the heart of Baucus' plan is an effort to boost the quality of health care, make it accessible for all Americans and, at the same time, streamline costs.
"The system can work better and cost less for everyone if leaders are willing to work together for sound policy solutions," said Baucus, chair of the mighty Senate Finance Committee, which oversees Medicare. "I am committed to working with my colleagues here on Capitol Hill—Democrats and Republicans—and to working with the incoming Obama administration to really move the ball forward on health reform. In human and economic terms, there is really just no more time to waste."
The Baucus plan would, among other things:
- Ensure all Americans, regardless of pre-existing conditions, accessible, affordable coverage through a nationwide insurance pool called the Health Insurance Exchange;
- Allow a Medicare buy-in for Americans 55 to 64 as the exchange is created;
- Require all states to use the State Children's Health Insurance Program (SCHIP) to cover children at or below 250 percent of the Federal poverty level;
- Invest in detecting and eliminating fraud, waste and abuse in public programs;
- Consider policies to shift the focus from institutional care to services provided in the home and community;
- Focus on health and wellness rather than on illness and treatment.
Baucus, in his 89-page "Call to Action: Health Reform 2009 (PDF)," also discusses ways to defeat fraud and abuse, many of which have been championed by the industry over the years but have not been enacted by CMS, said Seth Johnson, vice president of government relations for Pride Mobility Products, Exeter, Pa.
"Many of the specifics he mentions in his fraud-and-abuse strategy are supported by the industry and are included in the [American Association for Homecare's] 13-point plan," said Johnson, referring to the proposal that the industry organization submitted in October to Medicare and its contractors, the Department of Justice, Congress and the FBI. (See AAHomecare Offers 13-Point Plan to Stop Medicare Fraud, HomeCare Monday, Oct. 27.)
However, Baucus also supports competitive bidding as a means to fight fraud and abuse and pay for HME, a stance that drew immediate criticism from AAHomecare.
"The underlying rationale for competitive bidding completely misrepresents the nature of home medical equipment and related services that are integral to home care," said Tyler J. Wilson, president and CEO. "Competitive bidding would reduce quality of care and access to home care for millions of seniors and people with disabilities."
Johnson agreed, but said he was not surprised to see competitive bidding championed in the plan. "The Democrats on the Finance Committee want to make sure that remains on the table, since the legislation enacted last year simply delays the program, it does not eliminate it," he said. "It really indicates clearly to the industry that we need to remain focused on coming up with an alternative proposal to save money."
There is another reason for HME stakeholders to remain vigilant, Bachenheimer said.
"In addition, in the fraud-and-abuse section, the document mentions the government's perception that the Medicare program pays too much for oxygen," she said.
Bachenheimer said while Baucus' plan does not specify any policy proposals on either the fraud-and-abuse or oxygen issues, it does indicate the need for the industry to keep dialogue open with Congress, a point Johnson made, too.
"I really look at [the plan] as providing the industry an open door to go in and talk with the Finance Committee and address appropriate means to raise the bar in the industry and increase anti-fraud initiatives," he said.
Baucus' health reform plan is expected to be the first of several. Rep. Fortney "Pete" Stark, D-Calif., House Ways and Means Committee chair, and Sen. Ted Kennedy, D-Mass., chairman of the Senate Committee on Health, Education Labor and Pensions, are expected to reveal their plans soon, and President-elect Barack Obama has promised more details on his health care plan.
"I see [Baucus' plan] as a clear sign that the debate and discussion on health care reform is already starting, and it will be a huge year," said Bachenheimer. "Plans will be unveiled, hearings will be held, bills will be introduced by numerous leaders. How it shakes out is unclear. The economy indicates that it will be even tougher to pass a larger more comprehensive reform plan; more likely are incremental measures."
Whatever happens will begin soon. Baucus' plan came on the heels of a letter to Obama from several organizations representing retirees, business and labor urging him to put health care at the top of his to-do list in his first 100 days in office. The Los Angeles Times reported the four groups represented in the letter—AARP, the Business Roundtable, the National Federation of Independent Business and the Service Employees International Union—had pledged to spend $1 million to push that initiative through television and newspaper advertising.
For his part, Johnson said he believes the SCHIP plan will be the first point of action for the new Congress.
"The SCHIP reauthorization has to occur before the end of March when the current authorization expires," he explained. He said he believes the SCHIP will be paid for through a reduction or elimination of bonus payments to Medicare Advantage plans and an increase in the federal cigarette tax.
"It doesn't appear that DME reductions are going to be needed to fund SCHIP," he said, "but anytime these proposals move forward with any significant costs associated with them, then the industry needs to monitor them very closely and ensure that no DME reductions are included."
