WASHINGTON—Can you trim enough fat from the health care
system to pay for widespread health care reform? President Obama
thinks so, mentioning “waste” four times in his
mid-week
health care address to a joint session of Congress.
“We’ve estimated that most of this plan can be paid for
by finding savings within the existing health care system, a system
that is currently full of waste and abuse ...,” said Obama
during his nationally televised address on Sept. 9. “Reducing
the waste and inefficiency in Medicare and Medicaid will pay for
most of this plan.”
The president’s speech was the opening salvo of a health care
debate that has once again heated up with lawmakers back in
session. For HME advocates, the president’s focus on waste
struck a nerve.
“What scared me in President Obama’s speech is his
claim that health care reform can be paid for in large part by
elimination of waste, fraud and abuse,” said John Gallagher,
vice president of government relations for the VGM Group, Waterloo,
Iowa. “He went on to say that the $500 billion the plan will
cut from Medicare can be found in waste, fraud and abuse—not
by cuts to seniors’ care.
“This will make it difficult for our industry to push for
legislative or regulatory relief from competitive bidding, the
oxygen cap and elimination of the first-month purchase
clause,” Gallagher said. “We must get to Democrats in
both the House and Senate before this line is written in the
hymnal.”
While praising Obama’s attempts to reach across the aisle and
correct misconceptions, Apria Healthcare’s Lisa Getson agreed
with Gallagher that Obama “ascribed far too much to waste,
fraud and abuse” when pinning down the reasons for spiraling
costs.
“He glossed over the real, concrete cuts to home care and
other services that are planned and have nothing to do with
systemic waste or abuse,” said Getson, executive vice
president, government relations and corporate compliance, for Lake
Forest, Calif.-based Apria. “He mentioned nothing about
reducing the ever-increasing and often redundant government
bureaucracy involved in administering Medicare and Medicaid, which
also add costs to the system.”
Adding his voice to the concern is Michael Reinemer, vice president
of communications and policy for the American Association for
Homecare, who also believes a renewed focus on waste and fraud
could indeed translate into pressure to cut HME, tighten Medicare
enrollment and reimbursement and perhaps raise revenue from fees
and taxes. All of those proposals are set out in the Senate Finance
Committee’s recently released health care reform
“framework.”
“As we've known all along, we'll have to work to avoid even
deeper and more damaging cuts,” said Reinemer. “At the
same time, HME has the opportunity to demand recognition for our
sector’s ability to keep health care costs down while
providing choice and competition based on quality and
service. AAHomecare’s
13-point anti-fraud legislative action plan is a model that
Congress and the administration should adopt as a smart element of
health care reform.”
Georgie Blackburn, who serves as vice president, government
relations and legislative affairs for Blackburn’s, Tarentum,
Pa., is yet another advocate who mentioned the president’s
over-emphasis on systemic waste.
“When speaking directly to seniors, waste, fraud and
discontinued subsidies were mentioned as payment, while assuring
their services would not be cut,” said Blackburn, who is also
co-chair of AAHomecare. “Our industry knows better. Removing
$500 billion from Medicare provider payments to help pay for health
care reform is not feasible without changing coverage, service,
access and outcomes.”
Obama’s focus on reform at the payer level could also be
viewed as troublesome, says Baltimore-based Gary Gilberti,
president and CEO of Chesapeake Rehab Equipment. “One thing
that we have learned is that any cuts or levies imposed on payers
usually trickle down to cuts to providers-suppliers,” laments
Gilberti. “While CEOs of the largest payers get rich, the
providers take away less.”
Gilberti agrees with many parts of the Obama plan, but says some of
the concepts may not be realistic. “I would believe that
there are ways to achieve reform by taking manageable pieces of the
system and fixing them,” he says. “We could do that
rather than risking the whole thing blowing up by taking on too
much and letting it get bogged down in politics.”
With emotions running high, did the president do enough to convince
Republicans, win back fiscally conservative Democrats and increase
the odds for reform?
Seth Johnson, for one, was skeptical. “I’m not sure he
went far enough to appeal to his adversaries and ultimately get the
job done,” said Johnson, vice president of government affairs
for Pride Mobility Products Corp., Exeter, Pa.
“From an industry perspective, the devil always seems to be
in the details in these large health care bills, as we have seen in
the past. I remain concerned with the mechanisms to be used to
‘pay for’ a health care reform plan and the impact such
changes will have on the home care industry, which already provides
lower cost, more efficient care and is an integral part of the
health care solution.”
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