The American Association for Homecare expressed alarm about provisions in the new health reform law that will harm homecare patients and providers. The cumulative impact of the provisions aimed at the home medical equipment sector will reduce the ability to provide the level of services that homecare patients and physicians expect in Medicare.
“Unfortunately, this health reform bill contains several provisions that will hurt homecare providers and patients,” said Tyler J. Wilson, president of the American Association for Homecare. “We will continue to work with Congress in the weeks and months ahead to correct these problems.”
The home medical sector is paying a disproportionate price in terms of funding healthcare reform. For example, the new health reform law:
• Expands Round Two of the misguided “competitive” bidding for durable medical equipment and accelerates implementation of the pricing timetable.
• Eliminates the first-month purchase option for standard power wheelchairs.
• Imposes an excise tax on medical device manufactures ($20 billion over 10 years).
• Eliminates the two percent increase for Round One bidded items in 2014.
• Requires a face-to-face exam for all home medical equipment items and services.
• Includes a yet to be defined “productivity adjustment” that would lower future CPI-Urban payment updates to the home medical equipment fee schedule which will lower the annual HME update by about one percentage point annually.
Specific Provisions that Harm Homecare
“The bill accelerates the controversial ‘competitive’ bidding program for durable medical equipment, which simply creates a race to the bottom in terms of quality of care for Medicare seniors and people with disabilities,” said Wilson. “This bid program will actually reduce competition by putting most providers out of business, even if they agree to rock-bottom reimbursement rates.”
The Association, along with many consumer and disability groups, supports H.R. 3790, a bipartisan bill to eliminate the bidding program and replace it with a fiscally responsible alternative that reduces Medicare spending for durable medical equipment and services. At the same time, the bill preserves the ability of qualified medical equipment and service providers to continue serving Medicare beneficiaries. H.R. 3790 currently has 184 cosponsors and has been endorsed by the ALS Association, the American Association of People with Disabilities, International Ventilator Users Network, Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, and Post-Polio Health International.
At a time when the government is working to create jobs, the bidding program is a job killer. In the first round of the program in 2008, up to 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items. The way this program is set up triggers a race to the bottom in terms of quality. And because losing the bid means going out of business, providers must engage in suicide bidding that coerces them to bid at economically unsustainable rates. This will increase Medicare spending in hospitals and ER visits.
The healthcare bill also eliminates the option that allows a Medicare beneficiary to purchase a power wheelchair in the first month the product is prescribed. The elimination of the first-month purchase option will make it difficult for patients to have their power wheelchairs customized to their individual needs since providers will have difficulty covering the overhead and wheelchair costs up front, but receive payment over a 13-month period. Instead, patients will be forced to rent ill-fitting wheelchairs that can lead to pain, pressure sores, and loss of mobility.
“While Congress may be happy with the very small cost reduction in Medicare, this short-sighted policy would come at an alarmingly high cost to Americans’ quality of life,” said Paul Tobin, President of the United Spinal Association.
A wide range of advocacy organizations support preserving the first-month purchase option, including the ALS Association, American Association of People with Disabilities, Association of Program for Rural Independent Living, Consortium for Citizens with Disabilities, Easter Seals, Independence through Enhancement of Medicare and Medicaid Coalition, National Council on Independent Living, National Spinal Cord Injury Association, and Paralyzed Veterans of America.
Power wheelchairs—unlike most standard manual wheelchairs, which are intended for temporary use—are prescribed to those with lifelong medical needs and therefore require a high degree of customization to ensure the individual’s quality of life, mobility and independence. Nearly all beneficiaries elect the purchase option because they live with long-term, debilitating conditions that require customized equipment to meet their specific life-long needs.
Finally, the Association opposes the excise tax on medical devices. The tax will have a negative impact on manufacturers of home medical equipment whose devices allow patients to recover from illness or facilitate patients’ ability to remain in their homes. The American Association for Homecare believes that the tax should not be applied to home medical equipment. It is very unlikely that expanded insurance coverage will result in a windfall for home medical device manufacturers because these items are predominantly provided to Medicare beneficiaries for use in the patient’s home. The tax will cost American jobs and will cut research and development for new technologies that contribute to cost-effective care at home.
The home is already the most cost-effective setting for post-acute care. As more people receive good equipment and services at home, Americans will spend less on longer hospital says, emergency room visits, and nursing home admissions. Home medical equipment is an important part of the solution to the nation’s healthcare funding crisis and represents less than two percent of total Medicare spending.
Tuesday, March 23, 2010
Monday, March 22, 2010
Current Healthcare Bill Forces Patients to Rent Ill-Fitting Wheelchairs that Can Lead to Pain, Skin Sores and Loss of Mobility
The American Association for Homecare expressed dismay about the unwarranted, disproportionate, and harmful impact of the health reform bill on homecare patients and providers. The health reform bill passed by the House last night
Last night, the House of Representatives passed the sweeping health care reform legislation that had been passed by the Senate on December 24, 2009. This bill will now be signed into law by the president as early as tomorrow. The House passed the Senate bill (H.R. 3590) by a vote of 219-212 last night. The bill contains several negative provisions that will hurt HME.
“Unfortunately, this health reform bill contains several provisions that will disproportionately hurt homecare providers and homecare patients,” said Tyler Wilson, president of the American Association for Homecare.
“The bill accelerates the controversial ‘competitive’ bidding program for durable medical equipment, which simply creates a race to the bottom in term of quality of care for Medicare seniors and people with disabilities. The misguided bid program will actually reduce competition by putting most providers out of business, even if they agree to rock-bottom reimbursements. The healthcare bill also eliminates the option that Medicare beneficiaries currently have to purchase power wheelchairs as soon as needed instead of renting them.”
Current policy allows patients to purchase power wheelchairs in the first month the product is prescribed. If the health care reform bill passes unchanged and the first-month purchase option is eliminated, it will be very difficult for patients to have their power wheelchairs customized to their individual needs. Instead, patients will be forced to rent ill-fitting wheelchairs that can lead to pain, skin sores, loss of mobility and freedom.
“If Congress passes healthcare unchanged, power wheelchair users will suffer,” said Paul Tobin, President of the United Spinal Association. “While Congress may be happy with the very small cost reduction in Medicare, this short-sighted policy would come at an alarmingly high cost to Americans’ quality of life.”
A wide range of advocacy organizations support preserving the first-month purchase option, including:
The ALS Association,
American Association of People with Disabilities,
Association of Program for Rural Independent Living,
Consortium for Citizens with Disabilities, Easter Seals,
ITEM Coalition (Independence through Enhancement of Medicare and Medicaid),
Muscular Dystrophy Association,
National Council on Independent Living,
National Spinal Cord Injury Association,
Paralyzed Veterans of America, and
United Spinal Association.
Power wheelchairs—unlike most standard wheelchairs, intended for temporary use—are often prescribed to those with lifelong medical needs and therefore require a high degree of customization to ensure the individual’s quality of life, mobility and independence. Nearly all beneficiaries elect the purchase option because they live with long-term, debilitating conditions that require customized equipment to meet their specific life-long needs. Medical consequences of poor-fitting power wheelchairs include pressure wounds that are prone to deadly infection, increased pain, and decreased mobility. Those results often result in higher costs in the form of increased care, hospital stays, or admission to nursing facilities.
“Forcing the rental of custom-configured power wheelchairs will severely reduce patient access because many providers are unable to finance the costs associated with renting,” said Tobin. “The additional cost to Medicare of paying for the injuries resulting from poor-fitting power wheelchairs will more than cancel out any financial gains of implementing this change in policy.”
Last night, the House of Representatives passed the sweeping health care reform legislation that had been passed by the Senate on December 24, 2009. This bill will now be signed into law by the president as early as tomorrow. The House passed the Senate bill (H.R. 3590) by a vote of 219-212 last night. The bill contains several negative provisions that will hurt HME.
“Unfortunately, this health reform bill contains several provisions that will disproportionately hurt homecare providers and homecare patients,” said Tyler Wilson, president of the American Association for Homecare.
“The bill accelerates the controversial ‘competitive’ bidding program for durable medical equipment, which simply creates a race to the bottom in term of quality of care for Medicare seniors and people with disabilities. The misguided bid program will actually reduce competition by putting most providers out of business, even if they agree to rock-bottom reimbursements. The healthcare bill also eliminates the option that Medicare beneficiaries currently have to purchase power wheelchairs as soon as needed instead of renting them.”
Current policy allows patients to purchase power wheelchairs in the first month the product is prescribed. If the health care reform bill passes unchanged and the first-month purchase option is eliminated, it will be very difficult for patients to have their power wheelchairs customized to their individual needs. Instead, patients will be forced to rent ill-fitting wheelchairs that can lead to pain, skin sores, loss of mobility and freedom.
“If Congress passes healthcare unchanged, power wheelchair users will suffer,” said Paul Tobin, President of the United Spinal Association. “While Congress may be happy with the very small cost reduction in Medicare, this short-sighted policy would come at an alarmingly high cost to Americans’ quality of life.”
A wide range of advocacy organizations support preserving the first-month purchase option, including:
The ALS Association,
American Association of People with Disabilities,
Association of Program for Rural Independent Living,
Consortium for Citizens with Disabilities, Easter Seals,
ITEM Coalition (Independence through Enhancement of Medicare and Medicaid),
Muscular Dystrophy Association,
National Council on Independent Living,
National Spinal Cord Injury Association,
Paralyzed Veterans of America, and
United Spinal Association.
Power wheelchairs—unlike most standard wheelchairs, intended for temporary use—are often prescribed to those with lifelong medical needs and therefore require a high degree of customization to ensure the individual’s quality of life, mobility and independence. Nearly all beneficiaries elect the purchase option because they live with long-term, debilitating conditions that require customized equipment to meet their specific life-long needs. Medical consequences of poor-fitting power wheelchairs include pressure wounds that are prone to deadly infection, increased pain, and decreased mobility. Those results often result in higher costs in the form of increased care, hospital stays, or admission to nursing facilities.
“Forcing the rental of custom-configured power wheelchairs will severely reduce patient access because many providers are unable to finance the costs associated with renting,” said Tobin. “The additional cost to Medicare of paying for the injuries resulting from poor-fitting power wheelchairs will more than cancel out any financial gains of implementing this change in policy.”
Tuesday, March 16, 2010
Myths and Realities about the Medicare “Competitive” Bidding Program for Home Medical Equipment and Services
Medicare has been touting the merits of the “competitive” bidding program for durable, or home medical equipment and services (HME) to convince Congress that the program is good for seniors. Unfortunately, proponents have conveyed misleading information and cherry-picked facts that exaggerate the benefits and ignore the shortcomings of the program.
MYTH #1: The bidding program is good for beneficiaries because it will significantly reduce cost-sharing requirements.
REALITY: Patient copayments for home medical equipment have fallen dramatically for many years along with decreasing home medical equipment reimbursement rates. A bipartisan bill in the House, H.R. 3790, would eliminate the bidding program in a fiscally responsible manner by reducing home medical reimbursements to offset savings that the bid program would have realized. So the effect of that bill, which has 179 cosponsors so far, would be a further reduction in copayments for Medicare patients. Moreover, most beneficiaries have Medigap policies that cover copayments, so insurance companies will be the primary beneficiary of the lower copayments. More importantly, low copayments come at a great cost in terms of reduced access and service. The bidding program will trigger a race to the bottom in terms of care for seniors and people with disabilities. The bid program will ultimately increase doctor visits, hospital stays, and nursing home admissions, which in turn will increase copayments and other costs for patients and for Medicare.
Organizations that support the elimination of Medicare’s competitive bidding program for durable medical equipment include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, and Post-Polio Health International.
MYTH #2: The bidding program will eliminate fraud in the durable medical equipment sector.
REALITY: To characterize the bidding program as an anti-fraud mechanism is extremely misleading. The real solution to keeping criminals out of Medicare is better screening, real-time claims audits, and better enforcement mechanisms for Medicare. The American Association for Homecare has proposed an aggressive 13-point plan to combat fraud (www.aahomecare.org/stopfraud) and many of those provisions are included in two bills in Congress. The Association endorses Sen. George LeMieux’s anti-fraud legislation, The Prevent Health Care Fraud Act of 2009 (S. 2128), and its companion bill in the House, H.R. 4222. Also two new requirements that took effect in October 2009 – accreditation and surety bonds for home medical equipment providers – will go far toward eliminating fraud.
MYTH #3: The bidding program is good for business because it creates a more competitive environment.
REALITY: The program requires “suicide bidding” that coerces providers to bid at unsustainable Medicare reimbursement rates. At a time when the government is working to create jobs, the bidding pogrom is a job killer. In the first round of the program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items, even if they had agreed to the lower Medicare rates.
MYTH #4: Providers will be competing on quality and price.
REALITY: The “competitive” bidding program will, in fact, ration care. Home medical equipment providers already compete on the basis of quality in order to help in the hospital discharge process, which moves patients into cost-effective, post-acute care at home. The way this bidding program is set up triggers a race to the bottom in terms of quality and because losing the bid means going out of business, providers must engage in suicide bidding that coerces them to bid at economically unsustainable rates. This will increase Medicare spending in hospitals and ER visits.
MYTH #5: The bidding program will make healthcare more cost-effective.
REALITY: The home is already the most cost-effective setting for post-acute care. As more people receive good equipment and services at home, we will spend less on longer hospital says, emergency room visits, and nursing home admissions. Home medical equipment is an important part of the solution to the nation’s healthcare funding crisis. Home medical equipment represents less than two percent of Medicare spending. So while this bidding program may further reduce reimbursement rates for home medical equipment, ultimately, it will increase Medicare and Medicaid spending for hospitals, physicians, nursing homes, and emergency treatments.
MYTH #1: The bidding program is good for beneficiaries because it will significantly reduce cost-sharing requirements.
REALITY: Patient copayments for home medical equipment have fallen dramatically for many years along with decreasing home medical equipment reimbursement rates. A bipartisan bill in the House, H.R. 3790, would eliminate the bidding program in a fiscally responsible manner by reducing home medical reimbursements to offset savings that the bid program would have realized. So the effect of that bill, which has 179 cosponsors so far, would be a further reduction in copayments for Medicare patients. Moreover, most beneficiaries have Medigap policies that cover copayments, so insurance companies will be the primary beneficiary of the lower copayments. More importantly, low copayments come at a great cost in terms of reduced access and service. The bidding program will trigger a race to the bottom in terms of care for seniors and people with disabilities. The bid program will ultimately increase doctor visits, hospital stays, and nursing home admissions, which in turn will increase copayments and other costs for patients and for Medicare.
Organizations that support the elimination of Medicare’s competitive bidding program for durable medical equipment include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, and Post-Polio Health International.
MYTH #2: The bidding program will eliminate fraud in the durable medical equipment sector.
REALITY: To characterize the bidding program as an anti-fraud mechanism is extremely misleading. The real solution to keeping criminals out of Medicare is better screening, real-time claims audits, and better enforcement mechanisms for Medicare. The American Association for Homecare has proposed an aggressive 13-point plan to combat fraud (www.aahomecare.org/stopfraud) and many of those provisions are included in two bills in Congress. The Association endorses Sen. George LeMieux’s anti-fraud legislation, The Prevent Health Care Fraud Act of 2009 (S. 2128), and its companion bill in the House, H.R. 4222. Also two new requirements that took effect in October 2009 – accreditation and surety bonds for home medical equipment providers – will go far toward eliminating fraud.
MYTH #3: The bidding program is good for business because it creates a more competitive environment.
REALITY: The program requires “suicide bidding” that coerces providers to bid at unsustainable Medicare reimbursement rates. At a time when the government is working to create jobs, the bidding pogrom is a job killer. In the first round of the program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items, even if they had agreed to the lower Medicare rates.
MYTH #4: Providers will be competing on quality and price.
REALITY: The “competitive” bidding program will, in fact, ration care. Home medical equipment providers already compete on the basis of quality in order to help in the hospital discharge process, which moves patients into cost-effective, post-acute care at home. The way this bidding program is set up triggers a race to the bottom in terms of quality and because losing the bid means going out of business, providers must engage in suicide bidding that coerces them to bid at economically unsustainable rates. This will increase Medicare spending in hospitals and ER visits.
MYTH #5: The bidding program will make healthcare more cost-effective.
REALITY: The home is already the most cost-effective setting for post-acute care. As more people receive good equipment and services at home, we will spend less on longer hospital says, emergency room visits, and nursing home admissions. Home medical equipment is an important part of the solution to the nation’s healthcare funding crisis. Home medical equipment represents less than two percent of Medicare spending. So while this bidding program may further reduce reimbursement rates for home medical equipment, ultimately, it will increase Medicare and Medicaid spending for hospitals, physicians, nursing homes, and emergency treatments.
Monday, March 15, 2010
Reps. Altmire and Shuler, Sen. Klobuchar Talk about Benefits of HME
Several members of Congress spoke at the AAHomecare Washington Legislative Conference, March 1-3. All spoke about the benefits and cost-effectiveness of homecare and its importance in our healthcare system.
“Homecare is a major part of the solution in terms of cost-effectiveness,” said Senator Amy Klobuchar (D-Minn.) during AAHomecare Washington Legislative Conference. And with explosive growth in our older population, “homecare is going to be vital,” she said. Sen. Klobuchar has also been instrumental in reducing the size of the proposed tax on medical devices, which was included in the Senate’s health reform proposal.
Congressman Heath Shuler (D-N.C.) spoke about his own grandfather’s requirement for oxygen after suffering a stroke. Shuler said, “His quality of life escalated unbelievably.” Shuler has been a steady champion for HME concerns, focusing especially on small-business implications. He was introduced at the conference by Heath Sutton, owner of Mountaineer Oxygen Services in Waynesville, N.C., whom Shuler credits with helping him to better understand the services required for Medicare beneficiaries who receive home medical equipment.
Similarly, Congressman Altmire recommended that HME providers remind lawmakers that HME is cost-effective, high-quality, and is preferred by patients. Altmire said his awareness about HME issues is due largely to the tireless efforts of Georgie Blackburn, of BLACKBURN’S, an HME provider in Western Pennsylvania.
“Homecare is a major part of the solution in terms of cost-effectiveness,” said Senator Amy Klobuchar (D-Minn.) during AAHomecare Washington Legislative Conference. And with explosive growth in our older population, “homecare is going to be vital,” she said. Sen. Klobuchar has also been instrumental in reducing the size of the proposed tax on medical devices, which was included in the Senate’s health reform proposal.
Congressman Heath Shuler (D-N.C.) spoke about his own grandfather’s requirement for oxygen after suffering a stroke. Shuler said, “His quality of life escalated unbelievably.” Shuler has been a steady champion for HME concerns, focusing especially on small-business implications. He was introduced at the conference by Heath Sutton, owner of Mountaineer Oxygen Services in Waynesville, N.C., whom Shuler credits with helping him to better understand the services required for Medicare beneficiaries who receive home medical equipment.
Similarly, Congressman Altmire recommended that HME providers remind lawmakers that HME is cost-effective, high-quality, and is preferred by patients. Altmire said his awareness about HME issues is due largely to the tireless efforts of Georgie Blackburn, of BLACKBURN’S, an HME provider in Western Pennsylvania.
Wednesday, March 10, 2010
2010 Washington Legislative Conference Recap
Thank you to everyone who attended the 2010 Washington Legislative Conference! We had over 270 attendees who charged Capitol Hill to fight for homecare.
During the conference, several moments were captured:
Director of CMS’ Center for Medicare Management, Jonathan Blum, receives tough questions from the luncheon audience.
Joe Petrolla, of Seeley Medical, asks questions during a WLC session.
There are several more photos, taken by Max Krupka, available online. Just follow these steps:
We were able to capture a few moments on video. Please visit our YouTube page to view those in HD: www.youtube.com/aahomecare
During the conference, several moments were captured:
Director of CMS’ Center for Medicare Management, Jonathan Blum, receives tough questions from the luncheon audience.
The North Carolina delegation listens in on a conference presentation.
The New England Medical Equipment Providers (NEMED) group discusses issue strategy before heading to Capitol Hill.
The New England Medical Equipment Providers (NEMED) group discusses issue strategy before heading to Capitol Hill.
The North Carolina delegation discusses issue strategy before heading to Capitol Hill.
Joe Petrolla, of Seeley Medical, asks questions during a WLC session.
There are several more photos, taken by Max Krupka, available online. Just follow these steps:
- Go to: www.photographicservices.bz/viewyourevent.html
- Find and click the link on the right that says "AAHC Washington Legislative Conference"
- Enter your email address and press 'Enter'.
- Enjoy!
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