Comments for 60 Minutes Producers, from AAHomecare

While your segment, “60 Billion Dollar Fraud,” correctly assigns responsibility for stopping Medicare fraud to the federal agency in charge (Health and Human Services’ Centers for Medicare and Medicaid Services), you did not mention that the vast majority of home medical equipment providers, who follow every rule and serve their communities extremely well, are also victims of this Medicare fraud because they are unfairly smeared with a broad brush by the media, by Congress, and by Medicare.

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.

Star Telegram Publishes Guest Column Highlighting Value of H.R. 3790

Can we save money in Medicare and still allow providers to serve the millions of Americans who require home medical care? Yes, says Tyler Wilson, president of AAHomecare. H.R. 3790 will allow us do this. In a guest column, special to the Star-Telegram, Wilson discusses the value of homecare and ills of the competitive bidding program. The columns states:

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.

AAHomecare and Consumer Organizations Back Bipartisan Bill to Eliminate Medicare Bidding Program for Home Medical Equipment

“A ‘competitive’ bidding program that relies solely on the price of a winning bid simply cannot guarantee quality of, and access to the care our members need,” says K. Eric Larson, executive director of the National Spinal Cord Injury Association. “Home medical equipment providers offer quality items and service to beneficiaries living with paralysis and complex conditions such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, and spinal cord injuries who rely on customized mobility equipment, life-dependent oxygen, and other life-preserving medical equipment, service, and care. This bidding program needs to be repealed before the program creates human tragedies across the country.”

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.

Fox News Calls HME a “Rip Off;” AAHomecare Requests On-Air Rebuttal

Fox and Friends this morning aired a segment about the Medicare competitive bidding program for durable medical equipment. This segment requires clarifications and a rebuttal.

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 (friends@foxnews.com) and William La Jeunesse, the correspondent, at 310-571-2000 (William.lajeunesse@foxnews.com).

Deseret News Quotes Leavitt Saying He Was “Politically Stoned” Over Bidding Program

The Deseret News in Salt Lake City, Utah, printed an editorial by Marjorie Cortez (“Fear of Government Hinders Healthcare Reform,” Sept. 29) which severely misrepresents the facts regarding the Medicare bidding program for home medical equipment. The American Association for Homecare has responded with the following Letter to the Editor.

"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.