"It is not an exercise in just cutting reimbursement rates. In fact, in some cases, we may need higher reimbursement rates for certain aspects. I actually think home care ends up being cost-efficient in many cases rather than institutional care — and it helps keep people in their homes."
— President Barack Obama discussing health care reform in Shaker Heights, Ohio, July 23, 2009
During the national debate about health care reform, our message must be clear: Home medical equipment and services play a vital role in controlling costs and preserving access to quality care, which are essential to a sustainable health care system.
The HME sector has been the target of numerous near-sighted, disproportionate cuts in Medicare. For that reason, the American Association for Homecare has been engaged in a large public awareness effort about the value of home care, thanks in large part to the Stand Up for Homecare campaign.
As part of this campaign, the Association hosted a roundtable on Capitol Hill in July to discuss the role of home care in the reform of the health care system. Speakers included former Senate Majority Leader Tom Daschle, D-S.D.; Rep. Jason Altmire, D-Pa.; Peter Thomas, who is co-chair of the health task force for the Consortium for Citizens with Disabilities; and Georgie Blackburn, vice president of government affairs for Blackburn's in Tarentum, Pa.
Health policy experts largely agree that the home setting is the most cost-effective venue for many types of care. Quality home care facilitates timely hospital discharges, reduces hospital readmissions and emergency room visits and helps keep seniors and people with disabilities out of more expensive institutional settings. President Obama recently made this point.
At the July roundtable discussion, Rep. Altmire said, “There's no more cost-effective setting than in the home.”
Remember, home care affects the lives of millions of Americans, including our elected officials.
Speaking about his family during the roundtable, Sen. Daschle said, “My mother's quality of life is a hundred times better given the fact that she can live at home rather than be institutionalized at 86. Her quality of life is proof positive that we can help improve quality, lower costs, and provide greater access if we put the emphasis where it belongs — at the base of the pyramid with good home health care.”
During the health care debate, a number of voices in Washington are touting competitive bidding as a solution to out-of -control spending. They have pointed to the bidding program for home medical equipment, which begins later this year. However, as HME stakeholders know, this program is not the answer. It is a business killer that will reduce access to care. The flaws in that program were not fully addressed by CMS in spite of reforms enacted by Congress last year in the Medicare Improvements for Patients and Providers Act.
Commented Thomas, “Disability groups have long opposed competitive bidding for DMEPOS. There is real concern about limitations on choice of provider. In many instances these are beneficiaries with long-standing relationships with providers. They've gotten to know the providers, the provider's gotten to know them. … Those relationships get fractured under competitive bidding. … There are other ways to get at overpayment in the DMEPOS fee schedule. We think that competitive bidding is not the way to do it.”
Also troubling is the fact that competitive bidding will have an anti-competitive result as it leads to the elimination of 90 percent of the home care providers. As the country's population ages, as home care utilization increases and as we bring 45 million uninsured Americans into the mainstream of the health care system, Medicare beneficiaries will have fewer choices, home care will be less accessible and a handful of providers will increasingly dominate the market.
As Congress prepares to resume debate on health care reform, plan to meet with your members of Congress or their staff and explain the value of home care.
Cuts:
We are fortunate to have champions in Congress who will work to protect the Medicare beneficiaries during the policy-making procedure. Congressman Altmire commented, “We're going to preserve what works in our current system, first and foremost, and one of the things that works best in the current system is home care. And if you look at what the goals are for health care reform, home care touches on every one of them. When you think about wellness and prevention … that can be done in the home better than anywhere else.”
Read more AAHomecare Update columns.
Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. You can reach him at tylerw@aahomecare.org. For more information on critical home care issues, visit the association's Web site at www.aahomecare.org.
