As Congress left Washington for its August recess, neither the House nor the Senate had agreed on the details of a bill that would reform the nation's health care system.
Members in the U.S. House of Representatives had made huge strides, but agreed to go home for the month and continue work on the massive health reform measure upon their return after Labor Day.
In the Senate, while the Senate Health, Education, Labor and Pensions Committee had finished its reform package, the Senate Finance Committee left town without yet achieving a consensus. Those discussions will continue among the so-called “Gang of Six,” three Democratic and three Republican senators trying to craft a bipartisan health reform bill.
What all this points to is the complexity of President Obama's goal of reforming the nation's health care system, which will impact at least one sixth of this nation's economy.
So where do we as an industry stand among the various congressional health reform initiatives? We are certainly being considered as an opportunity to provide savings through additional payment cuts. Health reform and Medicare “reform” are part of the same legislative packages. There are DME-specific provisions already, as well as provisions that would impact all providers, including HME.
For example, while the House draft bill would eliminate the first-month purchase option for non-complex power wheelchairs, there are more general provisions such as “productivity gain adjustments” that would result in about a 1 percent payment reduction for DMEPOS items per year.
I mention this for a reason. If we as an industry are not united on our legislative goals, we cannot wisely use our scarce resources to promote or oppose both our specific issues or over-arching issues such as productivity gain adjustments.
The oxygen community has become dangerously fragmented on the issue of how Congress should change the way Medicare pays for home oxygen therapy. This splintering has undoubtedly hurt us on Capitol Hill. While I do not mean to minimize the material differences between the various groups' positions on how the Medicare benefit should be reformed, it appears that a large majority agree on a series of fundamental changes.
First, providers should get paid less for providing stationary-only systems and related services, and much more for providing ambulatory systems and related services. That makes sense because it would align payment with costs. (On a related note, this is tremendously important given the government's distorted perception, perpetuated through the 2006 Office of Inspector General Report comparing the acquisition cost of a concentrator to the total Medicare payment for home oxygen over a three-year period.)
Second, we need to ensure that the term “services” and details of those services are included in the Medicare statute. (Again, this would squarely address the prevailing perception in Washington that oxygen is an “equipment-only” benefit, and services are not necessary and not provided.)
Third, the payment cap needs to be eliminated. Yes, there are different opinions on other important details, such as whether oxygen firms should be “providers” or remain “suppliers” under the Medicare statute. But if we don't come together, achieve a consensus and unify our position, we will not move the benefit forward but only lay the groundwork for Congress simply to cut the benefit.
This is no exaggeration. If we continue to broadcast our differences on Capitol Hill, none of the groups will achieve their legislative objective. It's that simple. We are a small part of the Medicare program and are already battling a perception on the Hill that our industry is rampant with fraud and abuse. The few legislators who have become our strong allies and supporters will simply throw up their hands and walk away.
When Congress returns, the Senate Finance Committee will finalize its health reform package, and then the House and Senate will come together. Our window of opportunity is now, but we must have a united industry message if we are to have any hope of controlling our own destiny.
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A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her at 440/329-6226 or cbachenheimer@invacare.com.
