Tuesday, March 23, 2010

American Association for Homecare Alarmed by Provisions in Health Reform Law that Will Harm Homecare Patients and Providers

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.

1 comment:

Anonymous said...

Enough is enough. DME providers have taken hit after hit each year. DMEs take reimbursement cuts yearly, have increased costs due to new regulations such as accrediation and surety bonds, take reductions in oxygen reimbursements, have increased overhead due to more time spent to educate our doctors on proper documentation and PECOS that CMS tells us it is our job to do. Plus we are all holding our breaths not to be eliminated from doing business with their competitive bidding plan. Now it's the Healthcare Reform that will most definitely have the "kill factor" to DMEs. I sure hope CMS knows how to dispense medical equipment and products to their beneficiaries because there won't be any DMEs in existance after all this. It's time we, as DMEs, start the hollering just like the doctors have when they were faced with the 21% cuts and elected to no longer accept Medicare patients. In fact, our local TV has reported that less than 2% of our doctors will accept new Medicare patients. Have they not thought out this process? Let me summarize. Because of new taxes on manufactures that will be passed on to DMEs, our costs will increase. Our reimbursements will be decreased again for competitive bidding, our operational costs will increase due to trying to educate and collect proper face to face documentation from the 99.9% uneducated doctors who can't properly document medical necessity to CMS's standards, and our costs will increase for 1st month power wheel rental options due to additional billing and documentation requirements. So what will be the DMEs options? Close down their business? Look for ways to cut costs by reducting services such as emergency calls, cut deliveries to 1 day a week, provide very basic supplies to patients (ie reduce oxygen nasal canuals to per patient per every 6 months), cut phone services to 1 line, reduce hours of operations? Purchase sub-rated products at reduced rates that could possibly do a patient harm or not last through the reasonable useful life? Refuse all Medicare patients? Require Medicare patients to pay in addition to the allowable amount? Even with all the possible ways to help cut costs to try to stay alive, I am afraid that most DMEs will be looking for illegal ways to keep their existance--hence here we all are at the beginning again with fraud in Medicare--Basically nothing was accomplished. Didn't take a brain surgeon to figure this one out!!!