Rancho Bernardo, Calif. Speaking at the American Association for Homecare's Leadership Conference Feb. 27, Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, told attendees the road ahead could be tough for HME. But, he said, with a focused message to Congress and an educational effort directed at CMS, the industry should be able to avoid “a double-whammy” when lawmakers tackle the nation's budget deficit.
“I know you have had a little bit of a rough year, and I think I'm probably about as popular with this group as Ralph Nader would be at a Corvair convention,” quipped Scully, who worked to get Medicare reform through Congress. “The bill passed, and despite a lot of people's views that they're going to get it fixed this year … it ain't gonna happen,” Scully said. “The fact is there won't be a Medicare or Medicaid bill in Congress this year.”
What's more, he said, the industry's next big challenge is to avoid getting hit again in 2005 when Congress deals with the country's $500 billion deficit. Regardless of whomever is elected president, Scully explained, after the election “there's going to be a big budget deficit reduction bill, and every one of those in history … [has been] built around Medicare, and every one of them has been built around provider cuts.”
Scully said that during last year's four-and-a-half-month Medicare debate, the industry fell victim to bad timing and larger political issues. “There were a lot of strange outcomes,” he said, calling the last-minute inclusion of Federal Employees Health Benefits Program (FEHBP) pricing in the bill “bad luck, bad policy or a combination of both.”
However, he pointed out, “The good news is even though you may have gotten hammered in certain places in the bill, everybody likes home health. Everybody wants their mom not to be in a nursing home. Every governor, every legislator … wants to drive more delivery home.” But Scully said both legislators and regulators remain “shockingly” under-informed about HME, and he urged providers and manufacturers to educate Congress and CMS about the industry.
This will take a big effort because CMS' main focus will be “heavily, heavily, heavily” on the drug portions of the new law, he said. “[CMS has] a new drug benefit that they've got to put in for 41 million people over the next 18 months … and to get their attention and make sure you get a fair outcome … is going to be a big challenge and [will] take a lot of work.”
The issue for the industry, Scully said, is where to go from here. “The reality is in the next 18 months you've got two big goals. One is to make sure CMS treats you right … and two, you've got another giant bill [coming up] in the summer of 2005 that won't be giving money back but will be taking more money away.”
Scully, who left CMS in December to join Alston & Bird's Washington, D.C., law office, has signed on to consult with AAHomecare in addressing changes set in motion by the Medicare Modernization Act (MMA). Since his speech, the former government official has been named in an investigation regarding MMA's projected costs. See “OIG Investigates MMA Cost Estimate,” page 10.
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