Tuesday, December 15, 2009
Sloppy, Inaccurate Wheelchair Story in AARP Bulletin Is Rebutted by Paul Tobin of United Spinal Association
Tobin writes in a letter to the editor, “‘The Case of the Expensive Wheelchair’ compares prices Medicare paid for wheelchairs versus the cost to suppliers and assumes the difference is due to fraud. We’re dead set against Medicare fraud, but this assumption fails to recognize that wheelchairs—like people—are not fungible. A person with permanent paralysis needs an individualized wheelchair. Someone 6 feet 4 inches tall, paralyzed from the neck down with little use of hands, who depends on a breathing tube, needs a power wheelchair with individualized electronic controls and room for oxygen supplies. Adapting wheelchairs to an individual is essential and requires professional consultation. That’s why they cost more than something bought off the shelf.”
Tobin was being polite. The AARP story was extraordinarily misleading.
AARP Bulletin incorrectly assumed that the only cost of providing a wheelchair in the home of a person with disabilities is the acquisition cost.
AARP Bulletin inaccurately claimed that “efforts to address the excess have been stymied,” citing campaign contributions from the “medical equipment lobby.” It failed to account for the numerous, deep reimbursement reductions for wheelchairs and other durable medical equipment over the past 10 years.
AARP Bulletin apparently bought the canard that the durable medical equipment sector killed the competitive bidding program and escaped scott free, again, a wildly inaccurate notion with no basis in reality.
AARP Bulletin failed to mention that a long list of disability groups in the US also advocated the delay in the bidding program, including American Association of People with Disabilities, the American Foundation for the Blind, the American Medical Rehabilitation Providers Association, the American Occupational Therapy Association, the America Physical Therapy Association, the Brain Injury Association of America, the Disability Rights Education and Defense Fund, Easter Seals, Lutheran Services in America, the National Association of Social Workers, the National Disability Rights Network, the National Multiple Sclerosis Society, the National Rehabilitation Association, the National Spinal Cord Injury Association, Paralyzed Veterans of America, United Cerebral Palsy, and the United Spinal Association, among others.
AARP Bulletin careered back and forth between the issue of rate setting by Medicare and criminal fraud, very effectively blurring the two distinct issues. The legitimate wheelchair providers in the HME sector suffer when policymakers and the media disparage them and conflate honest homecare operators with criminals engaged in fraud.
Finally, AARP Bulletin ignored the real story – that a robust home medical equipment sector that competes on the basis of speed and quality helps to move patients out of hospitals more quickly into quality post-acute care at home, reducing hospital length of stay and saving the healthcare system money. It’s also one of the reasons why Medicaid systems can successfully “rebalance” their beneficiary population out of institutions and into home and community-based settings.
Wednesday, December 9, 2009
Deep Flaws in Medicare Competitive Bidding Program for Durable Medical Equipment Were Not Fixed and Are Not Addressed by Recent GAO Study
“The first round of Medicare’s competitive bidding program for wheelchairs and other forms of ‘durable medical equipment’ was poorly timed, was unclear about what had to be included in bids and failed to notify all suppliers that losing bids could be reviewed, according to a new Government Accountability Office study,” reports CQ Healthbeat News.
The report further details the lack of notification to providers about the post-bidding review process. The report recommends that CMS improve future rounds of bidding by notifying all suppliers if a disqualification review process is conducted, giving all suppliers an equal opportunity for such reviews; and contains a recommendation that CMS make it very clear how suppliers can request a review.
AAHomecare continues to say that there are underlying flaws with the bidding program that CMS has not addressed such as evaluating CMS’ methodology for determining bid rates and the fact that there was significant variation in bid rates for the exact same product billing codes across various bidding areas. Beneficiaries will be forced to go to multiple, unfamiliar providers for different items and services and will see reductions in service and quality of items based on artificially low winning bid amounts. Also, the bidding program, as currently structured, will force the majority of providers out of business.
“The fact remains that CMS has not fixed the fundamental problems in the design and structure,” said Tyler J. Wilson, president and CEO of the American Association for Homecare. ‘Those fundamental flaws in the structure of the program are dangerous because they will reduce seniors’ access to quality, cost-effective care at home, and the flaws will needlessly put thousands of competitive, hard-working medical equipment providers out of business.”
To learn more, visit associations/3208/files/AAHomecare Comments on GAO Study of Bid Program December 2009.pdf.
Thursday, December 3, 2009
“The American Association for Respiratory Care (AARC) a 49,000 member professional association for respiratory therapists offers its support of HR 3790, legislation that seeks to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner.
Respiratory therapists provide clinical care and services to pulmonary patients across the continuum of care. While the majority of respiratory therapists work in the hospital setting, an increasing number are employed in alternative care sites such as nursing homes, physician offices, rehabilitation facilities and home care companies.
The AARC and our members are very much aware of the struggles many of our pulmonary home care patients are having in receiving the full range of Medicare services for which they are eligible and which they desperately need. Constant changes in Medicare coverage policy for durable medical equipment, such as the 36 month cap on oxygen rental and the impending implementation of the competitive bid program have had a negative impact on the pulmonary patient’s ambulatory care.
HR 3790 will repeal the competitive bid program and include provisions that will assure the budget neutrality through other payment reductions.
The AARC believes your legislation is good for the patient, a sound Medicare policy and is fiscally responsible.”
To read the full letter, visit http://www.aahomecare.org/associations/3208/files/AARC_HR3790_Support_Nov09.pdf.
Monday, November 30, 2009
Shirvinsky was quoted in a November 29 article titled “Upcoming limits worry device providers” in the Pittsburgh Post-Gazette. The article describes western Pennsylvania as home to 479 durable medical equipment providers who are gravely concerned about the new bidding process which will limit the number of companies that can serve Medicare patients.
Bidding for the program will close December 21 and CMS will announce next year the successful bidders for contracts, which will begin in January 2011.
"We're very concerned that if we again end up with a small number of inexpert bidders that we're going to consistently be getting equipment that isn't right for us," said Lucy Spruill, a cerebral palsy patient and director of public policy for United Cerebral Palsy of Pittsburgh.
The article and Spruill’s quotes were prompted by a recent conference call organized by Shirvinsky to examine the misguided bid program and push congressional legislation to end it. The article explains:
“A bill introduced in the House of Representatives by Rep. Kendrick Meek, D-Fla., would repeal the competitive bid program. It has garnered 75 co-sponsors, including Reps. Jason Altmire, D-McCandless; Tim Murphy, R-Upper St. Clair; John Murtha, D-Johnstown; Kathy Dahlkemper, D-Erie; and Glenn Thompson, R-Centre. The bill also would phase in price reductions, which Mr. Shirvinsky said would produce the same savings without upending the industry.
‘I understand why in terms of the Deficit Reduction Act and with this competitive bidding why this was looked at, but really it was misguided,’ said Mr. Thompson, who worked in rehabilitation services before running for Congress.
In 2008, Mr. Altmire played a role in pushing back the implementation of competitive bidding because, he said, the focus on cost was too shortsighted. ‘Cost is certainly a part of it, but so is the quality of care you're seeing, so is the fact that local suppliers are a part of our communities,’ Mr. Altmire said.”
To read the full article, visit http://www.post-gazette.com/pg/09333/1017132-114.stm#ixzz0YGzkifJE.
Tuesday, November 24, 2009
The article states the rules are "leaving patients scrambling to find new providers. The new payment rules, effective Jan. 1, affect the more than one million people who rely on Medicare to pay for oxygen services, which relieve the symptoms of conditions such as emphysema and chronic obstructive pulmonary disease.
'It's totally penny-wise and pound-foolish,' says Barbara Renzullo, a nurse and case manager at Massachusetts General Hospital in Boston. Some patients, unable to find a new supplier because their reimbursement rate has fallen so far, 'wind up in the hospital.'"
To read the full article, visit
For further information about oxygen policy changes, visit www.aahomecare.org/oxygen.
Friday, November 20, 2009
WVLT zeroed in on the fact that home medical services have been disproportionately cut in the past few years despite the fact that homecare is cost-effective. The TV crew interviewed F. Scott Tygert, a 72-year old patient with sleep apnea who appreciates the price and independence that homecare provides. In addition to several quotes from Randy Wolfe, owner and president of Lambert’s Healthcare in Knoxville, the segment used footage from the Lambert’s facility in Knoxville.
“Part of the solution is to drive people away from … expensive care when they don’t need it, and keep them healthy and active at home as long as they can. Part of the solution in reform is reform where health care is taking place,” said Wolfe.
The segment also included a comment from Congressman Jimmy Duncan (R-Tenn.). To view the segment and leave a comment, visit http://www.volunteertv.com/health/headlines/70247582.html.
Thursday, November 19, 2009
Homecare provides tremendous value to more than eight million Americans who require some type of medical care in the home. A cost-effective alternative to institutional care, home medical equipment can be provided and maintained for just dollars a day, which is why homecare is an important part of the solution to our nation’s healthcare crisis.
Over recent years, however, the homecare sector has been the target of a long series of deep and disproportionate cuts by Congress. These cuts have a negative impact on the ability of homecare providers to furnish high-quality equipment and services to the people who require them.
In honor of National Homecare Month, the American Association for Homecare urges homecare patients, their families, and care providers to speak up for homecare and call or email their members of Congress and ask them to “Please stop cuts to homecare.” Sign the online petition to Save Homecare at http://www.thepetitionsite.com/1/save-homecare.
To learn more about how you can help save homecare, please visit: www.aahomecare.org/athome.
Wednesday, November 18, 2009
Representatives Altmire and Thompson Address the Value of Homecare and the Importance of Eliminating the Flawed Bidding Program
“CMS’s competitive bidding program was flawed from the beginning, and unfortunately it is has not improved over time,” U.S. Congressman Jason Altmire (PA-04) said. “There is still ample reason to believe that CMS’s competitive bidding program would greatly hurt small businesses and make it harder for seniors to obtain the specialized medical equipment that they need. The common sense legislation we have proposed would eliminate this flawed program and protect seniors and small businesses without adding one penny to the federal deficit.”
“Competitive bidding, as CMS has framed it, is anything but competitive,” said U.S. Congressman Glenn “GT” Thompson (PA-5). “Looking at savings solely on a balance sheet is not a smart government solution. If the number of smaller home providers of durable medical equipment declines, I’m concerned that more home care patients will need to be hospitalized, particularly in rural areas because of their distance from one of the massive contract holders. CMS should be working to keep homebound Medicare recipients in their homes—the quality of life is better for the patient and will involve an overall cost savings to Medicare.”
The Congressmen were joined on the call by Lucy Spruill, Director of Public Policy and Community Relations, United Cerebral Palsy of Pittsburgh; Georgie Blackburn, VP Government Relations and Legislative Affairs, BLACKBURN'S, and John Shirvinsky, Executive Director, Pennsylvania Association of Medical Suppliers.
“As a power wheelchair consumer, I am very concerned about the small number of providers that will be available as a result of competitive bidding,” said Lucy Spruill, Director of Public Policy and Community Relations, United Cerebral Palsy of Pittsburgh. “We already experience long waits between ordering equipment and actual delivery. This will take a very bad situation and make it intolerable. Medicare needs to be concerned with secondary conditions that may arise due to fewer providers being available to serve our needs. Bed sores, pneumonia and depression due to longer stays in the house are all very costly conditions for the Medicare system to treat.”
To learn more about the Representatives support of this bill and conversation with the media, visit the AAHomecare Newsroom. H.R. 3790 has 70 cosponsors as of November 18, 2009.
Wednesday, November 11, 2009
Poynter Institute Encourages Second Look At DME Fraud Story—Legitimate Homecare Providers Are Hurt by Medicare Fraud
I heard from a group called the American Association for Homecare http://www.aahomecare.org/stopfraud, which represents business that sell home medical equipment. The spokesman for the group, Michael Reinemer, says journalists should look into how Medicare fraud is hurting legitimate medical equipment providers. He commented on the piece I wrote about the investigation (http://www.poynter.org/article_feedback/article_feedback_list.asp?user=614470) and sent me an e-mail with his thoughts.
In his e-mail, Reinemer said these providers furnish "... not just the equipment but all the accompanying, required services that allow seniors to get the care they need and remain independent at home."
The legitimate businesses, Reinemer said, have actually asked Medicare to be more strict in its oversight (http://www.aahomecare.org/displaycommon.cfm?an=1&subarticlenbr=496) and to try to do something to weed out what the federal government says is $60 billion in Medicare fraud. Reinemer wrote:
"There is a terrific story to be told, but it won't help the public understand this issue if you leave out the fact that the vast majority of home medical equipment providers are scrupulously honest, pray to actually get reimbursed for equipment and services they have in fact furnished, and have fought for decades for Medicare to adopt higher standards for those businesses to whom they give Medicare a supplier number (the credential to bill Medicare). Moreover, as of 2009, home medical equipment providers (DMEs) must be accredited by a federally recognized accrediting agency, they must meet surety bond requirements, and meet a host of other mandated standards. We were gratified to see that you told the story of one beneficiary who complained for years that a supplier company was charging Medicare for things she didn't need or receive. "
Why does Medicare support homecare? Because if a patient can get health care at home rather than in a hospital, it is a huge cost savings and often is more comfortable. Here are some basic stats about homecare that provide additional insight, as well as information about how home health care can help save money http://thinkhomecare.wordpress.com/2009/09/10/hampshire-daily-gazette-home-health-care-saves-money-serves-people-well/.
I think Reinemer is right. His arguments address an interesting part of the health care reform story. As American ages, homecare suppliers will become increasingly important.
Monday, November 9, 2009
The home medical equipment industry has become the scapegoat du jour in the cost-savings debate over health care reform.
The false narrative in circulation is that the home medical equipment sector has escaped reimbursement cuts -- most pointedly by persuading Congress to prevent competitive bidding.
The reality is the bidding program is on track, even though home medical equipment services already have been cut by legislation passed in 2003, 2005 and 2008. Additionally, two items that help beneficiaries remain independent by keeping them out of institutional care -- power wheelchairs and home oxygen therapy -- were cut by 26 percent in 2007 and 27 percent in 2009.
While the controversial bid program was delayed by Congress last year in order to address numerous flaws, the home medical equipment sector paid for the delay through a nationwide 9.5 percent reimbursement reduction on all bid-upon items.
Home medical equipment represents less than 2 percent of Medicare spending and is one of its slowest-growing segments, increasing by just 0.75 percent annually compared with the more than 6 percent annual growth for overall Medicare spending, according to National Health Expenditures data from Medicare.
Home care providers compete daily on the basis of speed and quality of service, since Medicare dictates the fee schedule and pays at the identical rate. The bidding regulations would eliminate as many as 90 percent of qualified providers through selective contracting and prevent us from caring for our customers for a three-year contract period. This reduces local patient access to quality care and removes a patient's right to choose a provider.
Competitive bidding is similar to a closed-model HMO and would result in government-mandated consolidation in the home medical equipment and services sector. Over the long run, the bid program will increase costs by complicating the transition from hospital to home, lengthening hospital stays and increasing the likelihood of re-hospitalizations.
The reality is that our sector's reimbursement has been cut many times in this decade alone. Many members of Congress oppose additional cuts because those reductions will erode the nation's battered infrastructure for providing home care. Both the Bush administration and President Barack Obama have publicly stated the obvious: home-based care is the most cost-effective setting for health care.
We are all for increasing competition and cutting costs, but not through a flawed bid system that reduces patient care and precludes 90 percent of existing providers.
Georgie Blackburn is vice president, government relations and legislative affairs, for home medical equipment and service provider Blackburn's in Tarentum.
Read more: http://www.post-gazette.com/pg/09311/1011500-432.stm#ixzz0WAyi7tJV
Friday, November 6, 2009
AAHomecare urges HME providers, clinicians, manufacturers, and other stakeholders to put the logo to good use in educating the public, the media, and policymakers about the value of homecare.
Update: As of March 2012, the old logo has been replaced by a newer one (shown above).
Tuesday, October 27, 2009
You did not mention the new accreditation and surety bond requirements that will go far toward excluding criminals from operating phony medical supply companies and billing Medicare. You did not mention that the amount of Medicare fraud that can be attributed to the home medical equipment sector cannot possibly account for more than one or two percent of the $60 billion in Medicare fraud you cite in your headline. What about the rest of the fraud? Where is your coverage of that?
Nor did you mention the fact that this medical equipment industry has proposed tougher anti-fraud measures than any other entity. See www.aahomecare.org/stopfraud to view the Association’s 13-point anti-fraud legislative action plan. The national association representing this sector, the American Association for Homecare, is working with Congress to get these proposals enacted into law.
The home medical equipment sector provides wheelchairs, oxygen, hospital beds and other durable medical equipment to seniors and people with disabilities. We would welcome an opportunity to provide you with accurate information and a complete picture of the home medical equipment sector.
Friday, October 23, 2009
There are many ways to save money in our healthcare system, but the most attractive-sounding programs aren’t necessarily the best.
One example is the Medicare competitive-bidding program for durable medical equipment. Durable, or home medical equipment, enables patients and seniors to receive quality care at home. It provides a cost-effective alternative to institutional care, and seniors prefer to receive care at home rather than in an institution.
Last year, a bidding program for home medical equipment was started in 10 areas, including Fort Worth, but it was delayed by Congress because of concerns about access to care and the impact on small businesses that provide home care. In the law delaying the program, Congress also required a 9.5 percent fee cut by home medical equipment providers nationwide to save seniors and taxpayers every dime that the bid program had been projected to reap.
Now, the Medicare agency is restarting the bidding program, launching the process this week in Dallas-Fort Worth and in eight other U.S. metropolitan areas.
This program was supposed to increase competition and reduce spending when providers bid for contracts to serve a given area for specific product categories. But in addition to lowering prices, the program also allows only a very small percentage of the low bidders to serve Medicare beneficiaries and excludes the vast majority of home-care providers even if they agree to the lower, competitively bid prices. The result is fewer competitors, which means less access to quality care in the long run.
Because the companies that provide home medical equipment rely on the Medicare-age population for rental or purchase of equipment and services, being excluded from Medicare is a death knell. Home medical providers already compete by providing quality service, because Medicare sets the fee schedule. Doctors and hospitals want to use providers who can deliver high-quality services quickly, and reducing the number of home-care providers reduces the choices available.
Several economists have questioned the underpinnings of the Medicare bid program for home medical equipment. An article last year in the Southern Economic Journal concluded that the Medicare competitive-bidding process is "inefficient, leads to price increases and may cause decreases in the quality of services."
Is there a way to save money in Medicare and allow providers to continue serving the millions of Americans who need home medical care?
Yes. A bill in the House, HR 3790, would eliminate the bid program but preserve the projected savings to Medicare through a series of cuts to home medical reimbursements to match the projected savings. The legislation would also allow existing home medical providers to continue serving Medicare patients.
The bill, introduced Oct. 13, has bipartisan support ranging from Democrat Eddie Bernice Johnson of Dallas to Republican Jo Ann Emerson of Missouri.
Home medical equipment rates have been cut numerous times, and disproportionately so, in recent years. Spending growth in the home medical sector is virtually flat: less than 1 percent per year. And at just dollars per day, home-based care is vastly more cost-effective than a nursing home or hospital.
Home care is not the problem with our healthcare system it’s part of the solution. Congress should approve HR 3790 and allow home care to flourish.
To view online, visit http://www.star-telegram.com/1021/story/1705487.html.
Tuesday, October 20, 2009
AAHomecare and Consumer Organizations Back Bipartisan Bill to Eliminate Medicare Bidding Program for Home Medical Equipment
The National Spinal Cord Injury Association, United Spinal Association and other consumer organizations have all joined AAHomecare in praising a bipartisan group of lawmakers in the House of Representatives for backing introduction of H.R. 3790, a bill to eliminate the controversial, deeply flawed “competitive” bidding program for durable medical equipment and services in Medicare.
To ensure that seniors and taxpayers receive the savings projected for the bid program, the bill would reduce Medicare reimbursements to home medical equipment providers in 2010, 2011, 2012, 2014, and 2015. At the same time, the bill will allow thousands of home medical providers to keep their doors open to serve the millions of Americans who require home-based care and will allow patients to continue to receive services from the providers of their choice.
The bill, introduced by Rep. Kendrick Meek (D-Fla.), is cosponsored by Jason Altmire (D-Pa.), Steve Austria (R-Ohio), John Boccieri (D-Ohio), Bruce Braley (D-Iowa.), Jo Ann Emerson (R-Mo.), Sam Farr (D-Calif.), Alcee Hastings (D-Fla.), Eddie Bernice Johnson (D-Tex.), Ron Klein (D-Fla.), Dan Maffei (D-N.Y.), John Murtha (D-Pa.), Tim Ryan (D-Ohio), Heath Shuler (D-N.C.), Glenn Thompson (R-Pa.), Patrick Tiberi (R-Ohio), and Debbie Wasserman Schultz (D-Fla.).
The introduction of the legislation comes just days before the scheduled start-up of the bidding process for the bid program for home medical equipment. The Medicare bidding process will begin on October 21 in nine metropolitan statistical areas (MSAs) across the U.S. – Charlotte, Cincinnati, Cleveland, Dallas-Fort Worth, Kansas City, Miami, Orlando, Pittsburgh, and Riverside, Calif. The bid prices and bid winners would be selected in 2010 and the new prices would become effective January 1, 2011. Another round of bidding would begin shortly after that in 100 MSAs across the U.S.
Categories subject to the bid program include medical oxygen, which is a highly regulated prescription drug, complex rehabilitative power wheelchairs, enteral nutrients (used in tube feeding), and hospital beds, among other categories.
Paul J. Tobin, president and CEO, United Spinal Association, said, “Congressman Meek and other bipartisan leaders in the House have recognized that wheelchairs and a host of other home medical devices are essential tools which, when properly configured for each individual patient, can liberate a person and maximize their quality of life. Unfortunately, the competitive bidding process will eliminate the home medical equipment provider’s ability to individually customize equipment based upon each patient’s medical needs and restrict the patient’s ability to work face-to-face with a local provider. If implemented, competitive bidding will have tragic, unintended consequences for seniors and people with disabilities.”
Visit www.aahomecare.org/competitivebidding for details about the bid program.
Monday, October 5, 2009
The segment lacked some important context and detail and the American Association for Homecare requested an opportunity to respond on the air as soon as possible.
Congress BRIEFLY DELAYED the competitive bidding program last year because it is a SMALL BUSINESS KILLER. It was designed to knock most of the providers out of Medicare, which is a death knell for this sector, even if they agreed to new, competitively bid rates. How is that “competitive” in the long run?
Fox and Friends RIP OFF charts shown on air are extremely misleading. Comparing what one would pay over the Internet vs. what it costs to deliver, set up, and maintain home medical equipment, whether a medical oxygen system or power wheelchair, is comparing apples to oranges. Even an item as simple as a walker must be delivered to the patient’s home, must be adjusted, and the patient must receive instructions. The whole point of quality home care is that it allows people to leave hospitals quicker and it keeps them out of nursing homes. Consider the fact that when COPD patients receive medical oxygen in their home (oxygen is a highly regulated prescription drug) it costs less than $7 dollars per day. Compare that to an average daily cost of a hospital day in Medicare – more than $5,000 per day.
Congress required the home medical equipment sector to pay for the delay in the bid program THROUGH A BILLION DOLLAR CUT to reimbursements effective January 1, 2009 -- which pays for EVERY DOLLAR the bidding program had been projected to save.
Just to be clear, Medicare sets the fee schedule for reimbursement of oxygen, wheelchairs, hospital beds, etc.
This sector represents less than two percent of Medicare spending. Medicare spending for durable medical equipment is less than one percent per year.
AAHomecare is waiting for a response from Fox and Friends at this time. To express your thoughts (please be polite and share your own personal perspective as a provider), contact Steve Doocy at Fox News, 212-301-3033 (firstname.lastname@example.org) and William La Jeunesse, the correspondent, at 310-571-2000 (William.email@example.com).
Thursday, October 1, 2009
"The editorial piece apparently relies solely on the highly selective observations of the political appointee, former Health and Human Services Secretary Mike Leavitt, whose agency oversees this Medicare bidding program. In his own often-repeated words, Leavitt says he was “politically stoned” by opponents of the bidding program. Your editorial continues, “In a competitive bidding process, low bidders who meet the specifications win the contracts. The rest go away empty-handed. So they start complaining to their congressional representatives. And their industry representatives start pressuring members of Congress to pull the plug on the pilot project, which they did.”
Leavitt apparently did not mention any details about the bidding program, which was designed to put most of the equipment providers (competitors) out of business – even if they agreed to new, lower, competitively bid rates. If the program had been implemented as Leavitt had envisioned, the most providers would have been put out of business. How does eliminating competitors – on top of lowering prices – breed competition in the long term?
Your phrase “brief flirtation” to describe Medicare approach to competitive bidding is extremely misleading. Leavitt apparently did not mention the fact that the bidding program was briefly delayed by Congress in order to make it less of a business killer. Congress did not “pull the plug” on the program by any stretch of the imagination. It is very much alive. New regulations were issued in January 2009 and bids are due by the end of December of 2009.
Finally, Leavitt apparently did not mention the fact that the durable medical equipment community paid for every dollar the bid program had been projected to save (in the form of a 9.5 percent nationwide cut to home medical reimbursement rates in Medicare effective January 1, 2009.) Again, to be clear, this nationwide cut on the bid-upon items equals the savings that Medicare would have realized in the 10 large metro areas in last year’s first round of the bidding program.
As a result of last year’s congressional delay, the following occurred: Taxpayers reaped approximately $1 billion in savings. Thousands of small businesses were spared extinction. And tens of thousands of Medicare beneficiaries were spared disruptions to their services and access to quality medical care at home, which everyone agrees is the most cost-effective setting for care.
So, what exactly is Leavitt’s complaint? That Congress held him accountable?
Consider these statistics. The durable medical equipment sector in Medicare (oxygen, wheelchairs, hospital beds, etc.) help keep millions of Americans in their homes and out of more expensive institutional care. This sector of Medicare represents less than two percent of total Medicare spending and is growing annually at a rate of less than one percent a year. So spending in this sector is not the problem in Medicare – it’s part of the solution.
Your newspaper’s failure to cover this issue accurately or fairly or in any context is discouraging to say the least.
We would welcome the opportunity to provide a complete rebuttal as a guest editorial or at least a letter to the editor on this topic."
To read the editorial, visit http://www.deseretnews.com/article/705333094/Fear-hinders-health-care-reform.html.
Thursday, September 24, 2009
The article suggested that lobbying has prevented reductions in Medicare payments for these items. The reality is that Congress delayed a competitive bid program in 2008 after countless problems in the bid process emerged and it became clear that the vast majority of providers would have been denied permission to continue serving Medicare beneficiaries, even if they agreed to new, lower reimbursement rates. The home medical equipment sector took a 9.5 percent cut this year in order to pay for every dime the bidding program had been projected to save taxpayers.
Also, the data used in the August 2009 Inspector General report on wheelchair payments, mentioned in the article, is from 2007. Since then, Medicare rates have dropped dramatically. The report focused on acquisition cost to the supplier, which is only a fraction of the total cost of providing a properly adjusted power wheelchair to Medicare beneficiaries in their homes. That study perpetuates the myth that a person with MS, spinal cord injury, or other serious condition can order a power wheelchair and have it dropped off the back of a truck at their front door, ready to use.
Home-based care made possible by durable medical equipment and services is part of the solution to rising healthcare costs. It’s not the problem.
To read the article AAHomecare responded to, visit: http://www.newsday.com/news/health/obama-congress-should-let-panel-set-medicare-payments-1.1454600
Wednesday, September 23, 2009
Monday, September 21, 2009
Dr. Siegel spoke about the importance of keeping this benefit available for beneficiaries because not everybody has someone to push them around in a wheelchair. He says, “69% of those who need the motorized wheelchair are not even the elderly, they are the disabled and they can’t speak for themselves they need us to speak for them.”
The segment was in response to Senator Claire McCaskill’s (D-MO) recommendation to cut payments to power wheelchairs. Dr. Siegel said he is “worried our lawmakers have no education on what is actually happening in health care.”
To view the segment with Dr. Siegel, visit http://www.foxnews.com/search-results/m/26467928/costly-cuts.htm#q=medicare
Monday, September 14, 2009
Friday, August 28, 2009
Mr. Vladeck responded that he “misspoke” about cuts to DME and he misspoke about the cuts to oxygen.
To listen to AAHomecare’s rebuttal, visit the following link (around the 1:50 mark): http://www.c-span.org/Watch/Media/2009/08/28/HP/A/22564/Washington+Journal+Entire+Program.aspx
Thursday, August 27, 2009
Former Medicare Administrator Bruce Vladeck Makes Wildly Inaccurate Statements about Durable Medical Equipment on C-SPAN
Specifically, Vladeck said, “Every administrator of what used to be HCFA, it’s now Centers for Medicare and Medicaid Services, going back to the 1980s has tried to change what Medicare pays for durable medical equipment.… Every single time that the executive branch, under both Republican and Democratic presidents, has tried to change the system to eliminate those ridiculous overpayments, the Congress has prevented it.”
This is patently false. Congress has cut durable medical equipment (DME) payments in Medicare numerous times since Vladeck left his job: It was cut in the Balanced Budget Act of 1997, in the Medicare Modernization Act of 2003 (MMA), in the Deficit Reduction Act of 2005, and in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Moreover, Congress has approved competitive bidding for DME in two separate pieces of legislation that were signed into law – MMA in 2003 and MIPPA in 2008. This legislation, in combination, has resulted in reductions in oxygen therapy payments of more than 50 percent since the end of the 1990s when Mr. Vladeck left public office. The cost of treating COPD patients with oxygen therapy at home under Medicare is less than $7 per day.
Commenting about oxygen therapy provided in the homes of beneficiaries, Vladeck said Medicare pays, “$3 billion for air – because that’s all it really is.”
This is an extraordinarily cavalier comment. Medicare pays for medical oxygen and oxygen devices, both of which require prescriptions, as well as certain accompanying services which Mr. Vladeck chooses to ignore completely. Medical oxygen is a highly regulated prescription drug which more than one million Medicare beneficiaries depend on in order to breathe. The Food and Drug Administration, Department of Transportation, Department of Homeland Security, local fire authorities and state licensing boards are just a few of the groups that regulate or provide oversight to the home oxygen sector.
Vladeck also said, “And yet every effort for the last 20 some years to reduce Medicare payments for oxygen has run into a large lobbying campaign from the supplier industry generally organized to frighten beneficiaries to say, you know, if you let this go ahead, Congress is literally going to cut off your air supply. And Congress has stepped in to prevent reductions in oxygen payments every single time.”
This statement also is patently false, and the significant reductions to Medicare oxygen payments cited above are ample proof. The legislation from 2005 and 2008 alone reduced oxygen payments by over $900 million starting this year, bringing the annual total spending down into the low $2 billion range to support over one million frail Medicare beneficiaries at home for less than $7 per day. Vladeck’s description of advocacy efforts by the oxygen provider community is a grotesque distortion of the legitimate concerns that have been expressed not only by oxygen providers but by patient and consumer advocacy groups as well. We find it reprehensible that a former public official should make such reckless and inaccurate statements in a public forum such as C-SPAN.
Wednesday, August 26, 2009
The article, which focuses on Daschle’s relationship with healthcare organizations, was triggered by a meeting last week between Daschle and President Obama. Daschle continues to play a role in the healthcare debate even though he took himself out of consideration to be Secretary of the Department of Health and Human Services earlier this year.
To read the full New York Times article, visit http://www.nytimes.com/2009/08/23/health/policy/23daschle.html.
Friday, August 14, 2009
Discussing proposed Medicare reforms, Obama said, “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.”
The President made the remarks at a healthcare reform town hall meeting in Shaker Heights, Ohio on July 23.
The American Association for Homecare applauds the President’s recognition of homecare as a cost-effective alternative that reduces healthcare costs and allows millions of seniors to live in the comfort of their own homes. We urge Congress to recognize that homecare should be a critical component — not a casualty — of healthcare reform.
Video of the President’s remarks can be found here (at 2:15):
Thursday, August 13, 2009
New Economic Study Exposes Faults in Controversial Medicare Competitive Bidding Program Scheduled to Start this Fall
The study analyzed the results for round one of the bidding program, which took place in ten areas nationwide last year. The bid program, which began on July 1, 2008, was delayed by Congress on July 15, 2008 because of serious flaws in the bidding process. O’Roark’s study revealed several shocking flaws in the competitive bidding program:
• During the bidding implementation, nearly 40 percent of companies awarded durable medical equipment contracts for Pittsburgh patients were located outside of Pennsylvania.
• Had the competitive bidding program continued, homecare providers would have had no choice but to cut service, lengthen patient response times and give up providing some equipment altogether. Contracts were also awarded to unlicensed providers, which would have violated state standards.
• Reduced access and declining quality of care under competitive bidding will force patients into institutionalized care. This will lead to higher long-term costs for Medicare—not lower as CMS suggests.
• One group that would benefit from competitive bidding is private insurance firms. Medicare reimbursement rates are the gold standard and the basis for reimbursement by all other forms of health insurance. An artificial lowering of Medicare rates is immediately followed by a lowering of all others. As price schedules fall, insurance firms’ costs fall with them.
Despite the glaring flaws identified in this study, the competitive bidding program is set to go into effect in late October, 2009.
“There is nothing competitive about this misconceived program,” says Tyler J. Wilson, president of the American Association for Homecare. “This study joins an extensive body of evidence showing that this bidding program will produce fewer competitors, fewer homecare services, and lowest-common-denominator healthcare for older Americans and people with disabilities who require medical care at home.”
The full report and summary of findings are at www.aahomecare.org.
Tuesday, July 28, 2009
This position will be responsible for:
- Lobbying Congress
- Supporting the Association’s communications and membership functions
- Work with the Centers for Medicare and Medicaid Services.
- A minimum of 5-7 years of health care experience is necessary.
- Candidate must possess strong communications and analytical skills.
The home medical equipment and service (durable medical equipment) sector is one of the slowest growing spending areas in Medicare (0.75 percent per year per 2007 National Health Expenditures data) and it represents about 1.6 percent of Medicare spending. Good home-based care helps prevent rehospitalizations. Ironically, the Wall Street Journal has a front-page story about that topic. Quoting the Journal’s news article about reducing readmissions, "The breakdown was occurring not in the hospital, but in the transition to home." http://online.wsj.com/article/SB124873545269485081.html.
Homecare is not the problem -- it's part of the solution. But you wouldn't know that reading this editorial.
Friday, July 24, 2009
Oxygen payments are about half of what they were 10 years ago. How can Orszag be worried about higher rates for oxygen?
The perception of overpayment stems from the law, which only recognizes the cost of the oxygen equipment. The assumption is you could deliver an oxygen concentrator (and back-up system for power outages) to a COPD patient and they will be able to handle every detail of receiving medical oxygen, which is a highly regulated prescription drug.
The HME sector is low hanging fruit for cuts, representing politically easy “pay-fors,” given the numerous cuts over many years. What other sector has been cut more? The entire sector (oxygen, wheelchairs, etc) represents about 1.7 percent of Medicare spending and spending growth in the HME sector was 0.75 percent (2006 to 2007 National Health Expenditures data).
Moreover the article fails to mention, with respect to competitive bidding, that the home medical equipment community accepted a 9.5 percent cut beginning in January of 2009 that pays for every dollar of the approximately one billion that the bid program was projected to have saved taxpayers during the delay. The program is still designed to put most providers out of business, even if they agree to new competitively bid rates.
So it's discouraging to see no context or history or figures in the Journal’s discussion of oxygen and bidding – if the topic is controlling healthcare spending in Medicare. Homecare is not the problem in healthcare by any stretch of the imagination.
To view the article, visit http://online.wsj.com/article/SB124839406488477649.html
The CNN producers and correspondent reported incorrect and inflated numbers related to the cost of the wheelchair to taxpayers, and the segment highlighted an unusually long rental situation in which the user elected to continue renting instead of allowing Medicare to purchase the chair for her, resulting in a higher cost to taxpayers. Apria Healthcare has responded to CNN about the numerous specific errors in its report.
However, the CNN reporter and producers perpetuated two myths that harm the public’s understanding of home medical equipment benefit in Medicare.
Myth Perpetuated by CNN: Medicare overpays for durable medical equipment because the same items can be purchased more inexpensively over the Internet. CNN failed to report that the value of medically required services and medical equipment (such as a wheelchair) provided to frail seniors or people with disabilities in their home in compliance with Medicare and other federal and state regulations cannot be equated with the value of the purchasing the wheelchair alone via the Internet or via a simple cash transaction at a store. Yet CNN made this myth premise of its entire segment, using incorrect and overstated figures for the cost of the chair to taxpayers. The costs of providing home medical equipment and services to Medicare patients include delivery, often within hours of discharge from a hospital, set-up, patient education, compliance, and 24-hour on-call service. It is the consumer who values the local provider as demonstrated by data that an extraordinarily small number of consumers purchase these products over the Internet and instead actively choose their local provider.
Myth Perpetuated by CNN: Home medical equipment providers escaped the price reductions that competitive bidding would have imposed. The CNN producers and reporter know that the competitive bidding program was not, in fact, “stopped after two weeks.” It was delayed in order to fix serious flaws in the program. In a far more serious omission, CNN reporter failed to report the fact, which he knew, that taxpayers benefited fully in the billion-dollar savings that last year’s competitive bidding program was projected to have produced: Providers of home medical equipment were subjected to a 9.5 percent reduction in the reimbursement rates, beginning in January 2009, for items subject to competitive bidding, as mandated by the Medicare Improvements for Patients and Providers Act of 2008. This reduction was imposed by Congress as a condition for delaying the bidding program so the program could be fixed and re-implemented. CNN had this information but failed to mention it. Instead, CNN left its viewers with the impression that providers of medical equipment escaped any negative impact because of intervention by Congress. The stark reality is that hundreds of providers of home medical equipment are struggling and in some cases failing as a result the 9.5 percent cut, and a 27 percent total cut for oxygen therapy in 2009, and even deeper cuts in reimbursement for power wheelchairs in recent years. Nor did CNN explain that the competitive bidding system is designed to reduce the number of competitors by as many as 80 percent, by arbitrarily excluding providers from Medicare, even if they agree to lower bid prices.
The net effect of this extraordinarily misleading segment is a false impression about the nature of the home medical benefit in Medicare and completely inaccurate picture of the competitive bidding issue.
To view the CNN piece, visit http://www.cnn.com/video/#/video/politics/2009/07/20/griffin.wheelchair.medicare.cnn?iref=videosearch.
Friday, July 10, 2009
Your recent article “Home Oxygen Industry Trying to Change Way Government Pays to Provide Service to Seniors” addresses the impact of new Medicare rules on oxygen patients and providers. The American Association for Homecare and our members who provide millions of patients with oxygen home therapy, have reached out to Congress to explain how the new Medicare rules do not recognize the services and equipment maintenance necessary to provide quality oxygen care.
In your article, CMS underestimates the intensive service component of home oxygen therapy, claiming that service is the “exception, not the rule” and that equipment “requires very little servicing.”
Despite CMS’ claims, services are a substantial, critical component for home oxygen therapy. While oxygen equipment only accounts for 28% of costs, service and maintenance components constitute the other 73%, including: Customer Service (6%), Preparation, Return, Disposables/Scheduled Maintenance (12%), Unscheduled Repairs/ Maintenance (3%), Patient Assessment, Training, Education/Monitoring (9%), Delivery (21%), and Monthly Operating overhead (21%).*
We ask members of Congress to seriously consider the negative impacts these rules have on quality services needed by patients who rely on life-sustaining oxygen.
Tyler J. Wilson, President and CEO
American Association for Homecare
* Source: “A Comprehensive Cost Analysis of Medicare Home Oxygen Therapy,” a study for the American Association for Homecare, June 2006, by Morrison Informatics, Inc., 1150 Lancaster Blvd., Suite 101, Mechanicsburg, PA 17055. (717) 795-8410.
Similar letters describing the importance of the first-month purchase option were sent by the Consortium for Citizens with Disabilities, the American Association of People with Disabilities, the Clinician Task Force, the Amyotrophic Lateral Sclerosis Association, the Independence Through Enhancement of Medicare and Medicaid Coalition, and the National Council on Independent Living.
The American Association for Homecare has expressed concerns as well stating, “The elimination of the first-month purchase option will diminish access to power wheelchairs for people with a defined medical need. In the current fiscal environment, financial institutions will not extend lines of credit to power wheelchair providers to cover the up-front costs of furnishing costly equipment. If homecare providers do not have access to capital and are unable to secure financing, providers will not be able to provide items and services to these Medicare beneficiaries. The negative result of providers having restricted access to capital and lines of credit is that Medicare beneficiaries will not have access to the most appropriate product to address their medical needs.”
Tuesday, July 7, 2009
“Current proposals under consideration in Washington will undoubtedly limit Americans’ choice to access home medical equipment and services. But what many policymakers don’t realize is that further cuts to this sector are also likely to increase Medicare costs over time because they will force more people into nursing homes and hospitals and spur more frequent visits to emergency rooms. If legislators are serious about lowering Medicare costs, they should understand that home care is actually a cost-effective alternative to more expensive forms of care, and should therefore be a critical component — not a casualty — of American health care reform.
Access to quality home medical equipment reduces health care costs. A recent study in the New England Journal of Medicine demonstrated that up to one-fifth of all Medicare patients are readmitted to hospitals within one month of being discharged. These unplanned visits cost Medicare an estimated $17 billion in 2004. One reason for the high readmission rates is that there is no continued interaction and guidance once patients are dismissed. Home medical equipment providers help to fill this gap by smoothing the transition from hospital to home with the equipment and services patients need.”
The editorial also discusses the limited price of receiving home oxygen as compared to a day in the hospital or nursing facilities. Medicare pays less the $7 per day for equipment and services for home oxygen. The average daily cost for nursing facilities is $200 and hospital stays are more than $5,000 per day. Mr. Wilson described the reimbursement cuts oxygen has already received, totaling 27 percent so far this year.
“Home medical equipment and service is already the most cost-effective slowest-growing portion of Medicare spending, increasing only 0.75 percent per year, according to the latest National Health Expenditures data from Medicare. That compares to more than 6 percent annual growth for Medicare spending overall. Moreover, home medical equipment represents only 1.6 percent of the Medicare budget.”
To read the full editorial, please visit: http://www.rollcall.com/news/36487-1.html
Tuesday, June 23, 2009
Your recent article on home oxygen therapy (Medicare Rule on Paying for Oxygen Vexes Patients, June 16) underscores the often overlooked negative impact of Medicare cuts on the beneficiaries who depend on medical oxygen.
In recent years, payments to providers for the home oxygen therapy benefit have been significantly cut many times. Today, Medicare payment rates are 50 percent lower than they were 10 years ago. In 2009 alone, Medicare will cut oxygen rates by 27%, a result of the 36 month cap highlighted in your article, and a 9.5% cut to all home oxygen therapy reimbursements. These reimbursement cuts reduce access to quality care, and the new Medicare rules create problems for patients who want to move to another city to be closer to their families.
As leaders in Congress discuss healthcare reform, this is the ideal time to consider fundamental, budget-neutral reform of the home oxygen benefit. This Medicare benefit should be improved to define a uniform set of required services for all patients. Reform should also ensure adequate payment to providers for all beneficiaries, throughout the patient’s entire length of medical need.
Repeated cuts to this benefit are not a solution. Properly reforming the home oxygen benefit will require a structure that aligns Medicare payments with the cost of care and the essential patient services that providers deliver.
We hope that Congress will advance a solution that will protect the patients we serve and preserve our ability to provide the level of service they need.
To read the Wall Street Journal article, please visit http://online.wsj.com/article/SB124511204251317173.html.
Monday, June 22, 2009
While there was no cut to oxygen mentioned in the House bill, AAHomecare believes that a cut will emerge later in the legislative process as a way of paying for health reform. The Association believes a similar threat of reductions in oxygen reimbursement exists in Senate proposals.
In hopes of delaying the inevitable protests from affected healthcare sectors, legislators in both the House and Senate have not tipped their hands about all of their proposed cuts and financing options. Oxygen and wheelchair users should weigh in on this issue with their Senators and Representatives in Washington. It’s important for patients as well as providers to speak up in opposition to these cuts.
Power wheelchairs were cut by approximately 26 percent in 2007 and incurred another cut of 9.5 percent, effective January 1, 2009 as a result of the delay to competitive bidding. Remember that home medical equipment is one of the slowest-growing sectors of Medicare in terms of spending (0.75 percent annually in 2007) and is cost-effective, preferred by patients, and good home-based care achieves a chief goal for health reform through fewer re-hospitalizations.
Huge deficits in government spending were reversed due to similar legislation in the 1990s and many members of Congress and the Obama Administration hope to see similar effects from the current legislation. The bill does limit which types of legislation can be included in the law, excluding providing higher Medicare payments to physicians.
Wednesday, June 10, 2009
The President’s plan included tasking the OMB with maintaining a Paygo ledger to record the average 10-year budgetary effects of all legislation enacted through 2013 affecting mandatory spending.
Thursday, June 4, 2009
The American Association from Homecare responded the Heritage Foundation’s “Foundary” blog posting with the following response:
I wish Heritage Foundation would simply check some of its facts. You weaken your argument if you sprinkle in false information. For instance, the "competitive" bidding program for home medical equipment and services was NOT "canceled" by any stretch of the imagination. George F. Will made the same false claim. The program was delayed by Congress in the MIPPA bill last year in order to try to address the fact that the "competitive" bidding program would have eliminated 90 percent of the competitors (virtually all small businesses) regardless of the pricing (which is set by the government anyway). The home medical equipment sector (which delivers home medical care to Medicare beneficiaries in their homes, by far the most cost effective setting for care) in fact did PAID for the delay in the bid program through a 9.5 percent reimbursement cut effective Jan. 1, 2009 in order to save the taxpayers EVERY DOLLAR that the bid program would have saved. The delay stemmed from bipartisan concern about patient access to quality care at home and the impact on small businesses. By the way, the home medical sector represents 1.6 percent of Medicare spending and spending growth in this sector of Medicare is less than 1 percent, in spite of growing demand. We're hardly your poster child for out of control spending. And the idea that a person who needs a customized power wheelchair would buy one on the Internet is just dumb. Who would deliver it? Fit it to prevent pressure wounds? Service it? etc. etc. Seriously, you should attempt to fact check this blog since the readers apparently buy it. Yes, I work for the home medical equipment sector. Please check my facts independently. Or visit www.aahomecare.org/competitivebidding.
See the Heritage Foundation blog at: http://blog.heritage.org/2009/05/29/morning-bell-show-us-the-savings/
Monday, June 1, 2009
AAHomecare believes this troubled program is moving forward without addressing the many severe problems that prompted Congress to mandate reform of the program last summer. Disability groups, patients, providers, and even members of Congress expressed concern with aspect of the program. Moving forward with competitive bidding at this time represents a big step backwards for the Medicare beneficiaries who receive services.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) required a delay in the bid program to allow CMS to reform it. CMS is encouraging providers to begin preparing for the bidding process by updating NSC files, obtaining all necessary licenses, and becoming accredited and bonded. CMS issued the following rough timetable:
• CMS begins pre-bidding supplier awareness campaign
• Program Advisory and Oversight Committee (PAOC) meeting on June 4, 2009 in Baltimore
• CMS announces schedules for bidding and education events
• CMS begins bidder education campaign
• Registration period begins for bidders to obtain user identification and passwords
• Bidding begins
Visit the CMS web site at www.cms.hhs.gov/CompetitiveAcqforDMEPOS/ for the details on the bidding program.