As last week wound down, Congress averted another threatened government shutdown, passing an appropriations bill funding federal operations through September 2012.
Meanwhile, Senate leadership worked on a separate agreement to extend the payroll tax holiday, extend unemployment insurance protections and prevent a 27 percent cut in Medicare physician reimbursement (the “doc fix”). Earlier in the week, the House passed a payroll tax/UI/doc fix bill by a vote of 234-193. As we reported to AAHomecare members on Saturday, the Senate voted 89-10 to approve their own short-term package that would extend a payroll tax holiday and prevent for two months a reimbursement reduction for Medicare physicians. We have learned from Capitol Hill sources that House Republican leadership will reject the Senate legislation, and additional negotiations will be required to reach an agreement acceptable to both the House and Senate.
In any event, it remains vital that HME providers contact their Representative and Senators and strongly urge them to contact their respective leadership to ask that the MPP proposal be included in the final doc fix bill that is sent to the President.
Use our Take Action Center to quickly send a message to your members of Congress.
A full, section-by-section breakdown of the Market Pricing Program is available to our members (login required). A brief summary of the MPP is available to everyone.
You can reach your Representative and Senators’ office by calling the Capitol switchboard at 202-224-3121. If you have any questions or feedback from House staff, please contact Jay Witter at jayw@aahomecare.org.
Monday, December 19, 2011
Monday, December 12, 2011
AAHomecare Urges Congress to Enact Market-Based Alternative to Medicare’s Bidding Program for Home Medical Equipment
Sustainable Market Pricing Program Corrects Flaws in Current Bidding Program, Preserves Access to Home-Based Care for Millions of Americans
The American Association for Homecare urges Congress to enact the Market Pricing Program (MPP), a reform of Medicare’s pricing system that is an alternative to the controversial bidding scheme for durable medical equipment and services.
“As it’s currently designed, Medicare’s bidding system reduces choice, access, and quality of care for seniors and people with disabilities who require home medical equipment and services,” said Tyler J. Wilson, president of the American Association for Homecare. “It also discourages competition and ultimately increases healthcare costs. Our proposal, the Market Pricing Program, corrects numerous flaws in the current bidding program and features a financially sustainable auction system.”
The bidding program implemented by the Centers for Medicare and Medicaid Services (CMS) has deep flaws, which were described in a letter to Congress signed by 244 top economists and auction experts. The current bidding system allows for non-binding bids – which encourage irresponsible bids and unsustainable prices and do nothing to ensure that winning bidders are actually qualified to provide the products and services to Medicare beneficiaries in the specified market areas. Since the bidding program was implemented on January 1, 2011, hundreds of Medicare patients have reported difficulty finding local equipment or service providers, delays in obtaining medically required equipment and services, and fewer choices when selecting equipment or providers.
The Market Pricing Program is based on recommendations by economists and auction experts in the field who have studied the current program. MPP features an auction system to establish market-based prices around the country and would require Medicare to make fundamental changes to ensure the long-term viability of the pricing program. Key components are:
The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community that serve the medical needs of millions of Americans who require oxygen systems, wheelchairs, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.
The American Association for Homecare urges Congress to enact the Market Pricing Program (MPP), a reform of Medicare’s pricing system that is an alternative to the controversial bidding scheme for durable medical equipment and services.
“As it’s currently designed, Medicare’s bidding system reduces choice, access, and quality of care for seniors and people with disabilities who require home medical equipment and services,” said Tyler J. Wilson, president of the American Association for Homecare. “It also discourages competition and ultimately increases healthcare costs. Our proposal, the Market Pricing Program, corrects numerous flaws in the current bidding program and features a financially sustainable auction system.”
The bidding program implemented by the Centers for Medicare and Medicaid Services (CMS) has deep flaws, which were described in a letter to Congress signed by 244 top economists and auction experts. The current bidding system allows for non-binding bids – which encourage irresponsible bids and unsustainable prices and do nothing to ensure that winning bidders are actually qualified to provide the products and services to Medicare beneficiaries in the specified market areas. Since the bidding program was implemented on January 1, 2011, hundreds of Medicare patients have reported difficulty finding local equipment or service providers, delays in obtaining medically required equipment and services, and fewer choices when selecting equipment or providers.
The Market Pricing Program is based on recommendations by economists and auction experts in the field who have studied the current program. MPP features an auction system to establish market-based prices around the country and would require Medicare to make fundamental changes to ensure the long-term viability of the pricing program. Key components are:
- The Market Pricing Program is designed to achieve an accurate market price.
- Bids are binding for the bidders and cash deposits are required to ensure that only serious homecare providers participate.
- The bid price is based on the clearing price, not the median price of winners.
- The program includes the same equipment and services as the current bidding system and would be implemented across the country during the same timeframe.
- Two product categories per market area would be bid. Eight additional product categories in that same area would have prices reduced based on auctions conducted simultaneously in comparable geographic areas.
- Bid areas are smaller geographically than the currently used bidding units (metropolitan statistical areas) and are more homogeneous.
The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community that serve the medical needs of millions of Americans who require oxygen systems, wheelchairs, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.
Wednesday, November 23, 2011
The Holidays Highlight the Value of Home-Based Health Care
WASHINGTON, November 23, 2011 ------ Millions of Americans will be able to share Thanksgiving and other holidays with seniors and people with disabilities who are able to live safely and independently in the comfort of their own homes, thanks to home medical equipment, services, and supports.
Homecare also provides tremendous value to more than eight million Americans who require some type of care in the home, says the American Association for Homecare. Home medical equipment and services can be provided and maintained for just dollars a day, which is why homecare is a cost effective alternative to institutional care and is an important part of the solution to our nation’s healthcare financing challenge.
Facts about Homecare
The American Association for Homecare celebrates the thousands of dedicated professionals and family caregivers who provide the equipment, services, and supports that enable seniors and people living with disabilities to remain in the care setting that most prefer – their own homes.
The American Association for Homecare represents providers of durable medical equipment and services who meet the healthcare needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and mobility assistive technologies, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members provide homecare in all 50 states.
Contact:
Michael Reinemer, 703-535-1881, michaelr@aahomecare.org
Tilly Gambill, 703-535-1896, tillyg@aahomecare.org
Homecare also provides tremendous value to more than eight million Americans who require some type of care in the home, says the American Association for Homecare. Home medical equipment and services can be provided and maintained for just dollars a day, which is why homecare is a cost effective alternative to institutional care and is an important part of the solution to our nation’s healthcare financing challenge.
Facts about Homecare
- More than eight million Americans depend on medical equipment and services at home which treats conditions such as multiple sclerosis, Lou Gehrig’s disease, spinal cord injuries, severe lung disease such as chronic obstructive pulmonary disease (COPD), congestive heart failure, sleep apnea, and diabetes. Virtually every type of health care short of surgery can be successfully delivered in the home. Seniors and people with disabilities receive medically prescribed oxygen therapy, wheelchairs, hospital beds, drug infusion therapy, hospice care, walkers, and other medical services, supplies, and equipment at home.
- Americans would rather receive care at home according to surveys by AARP and other organizations. Moreover, a 2011 Harris Interactive survey about spending priorities for health care found that 79 percent of Americans believe the federal government should strengthen patient access to home medical equipment and services and 61 percent favor investment in community- or home-based care to improve cost-effective health care.
- Providers of home medical equipment and services help prevent ER visits and hospitalization and enable hospitals to discharge patients on a timely basis to post-acute care at home, which reduces length of hospital stays and lowers spending in the healthcare system. The home is the most cost-effective setting for many types of medical care including long-term care and is part of the solution for lowering health costs. In an October 20, 2010 New England Journal of Medicine article, Steven H. Landers, M.D., cites home oxygen as an example of advancement in portable medical technology and cites parenteral nutrition (tube feeding) and infusion as examples of home-based care that are cheaper than and as equally effective as institutional care.
- Home medical equipment providers serve as first responders to ensure that people receiving homecare are safe in emergencies such as Hurricane Irene or ice storms where power is lost for days at a time. A power outage can be deadly for a person who requires a ventilator or an oxygen concentrator that treats lung diseases or chronic heart failure. During a power outage or evacuation, having an adequate back-up supply of battery power or oxygen is essential to the health of the device users. In a catastrophic pandemic flu, home-based care will play a large role in treating flu victims since patients will quickly overwhelm hospitals.
The American Association for Homecare celebrates the thousands of dedicated professionals and family caregivers who provide the equipment, services, and supports that enable seniors and people living with disabilities to remain in the care setting that most prefer – their own homes.
The American Association for Homecare represents providers of durable medical equipment and services who meet the healthcare needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and mobility assistive technologies, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members provide homecare in all 50 states.
Contact:
Michael Reinemer, 703-535-1881, michaelr@aahomecare.org
Tilly Gambill, 703-535-1896, tillyg@aahomecare.org
Wednesday, November 16, 2011
Misleading Medicare Data on Improper Payments for Home Medical Equipment Paints False Picture
The American Association for Homecare expressed dismay today that the Centers for Medicare and Medicaid Services’ (CMS) calculated a 61 percent improper payment rate for the home medical equipment sector for 2011. The 61 percent improper payment rate is significantly higher than the overall Medicare fee-for-service error rate, which is 8.6 percent for 2011.
Even though the improper payment rate is not a calculation of fraud, the rate is misunderstood and it casts an unwarranted cloud over the entire home medical equipment sector.
“The 61 percent error rate is preposterous,” said Tyler Wilson, president of the American Association for Homecare. “More than anything, the improper payment rate for HME reflects badly on Medicare. It highlights the inconsistent guidance provided by CMS and the subjective audit reviews by the Agency’s contractors. Without significant changes to the medical review process, the millions of Medicare beneficiaries who require home medical equipment will not receive what their physicians order. The agency must better educate physicians about documentation requirements and help to improve compliance without placing needless burdens on providers of home medical equipment.”
The Association has worked with CMS to lower the error rate through greater consistency in audit requests, Medicare coverage criteria, and education of both home medical equipment providers and physicians. However, the Association’s recommendations to the agency for reducing the error rate have been ignored.
CMS is required by law to estimate and report the improper payment rate through a random sampling of claims conducted by the Comprehensive Error Rate Testing (CERT) audit contractor. The CERT contractor evaluates claims to determine whether they were properly paid according to Medicare coverage, coding, and billing rules.
The American Association for Homecare represents providers of durable medical equipment. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association’s members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org.
Even though the improper payment rate is not a calculation of fraud, the rate is misunderstood and it casts an unwarranted cloud over the entire home medical equipment sector.
“The 61 percent error rate is preposterous,” said Tyler Wilson, president of the American Association for Homecare. “More than anything, the improper payment rate for HME reflects badly on Medicare. It highlights the inconsistent guidance provided by CMS and the subjective audit reviews by the Agency’s contractors. Without significant changes to the medical review process, the millions of Medicare beneficiaries who require home medical equipment will not receive what their physicians order. The agency must better educate physicians about documentation requirements and help to improve compliance without placing needless burdens on providers of home medical equipment.”
The Association has worked with CMS to lower the error rate through greater consistency in audit requests, Medicare coverage criteria, and education of both home medical equipment providers and physicians. However, the Association’s recommendations to the agency for reducing the error rate have been ignored.
CMS is required by law to estimate and report the improper payment rate through a random sampling of claims conducted by the Comprehensive Error Rate Testing (CERT) audit contractor. The CERT contractor evaluates claims to determine whether they were properly paid according to Medicare coverage, coding, and billing rules.
The American Association for Homecare represents providers of durable medical equipment. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association’s members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org.
Friday, November 11, 2011
AAHomecare Supports Key Anti-Fraud Bill Introduced in House
The American Association for Homecare (AAHomecare) is pleased that Representative Peter Roskam (R-Ill.) introduced an important bill yesterday designed to reduce fraud and improper payments in Medicare.
The Fighting Fraud and Abuse to Save Taxpayer Dollars Act, or FAST Act, H.R. 3399, would strengthen Medicare by shifting Medicare's "pay-and-chase" payment system to one that is modeled after credit card industry fraud-prevention tactics, utilizing predictive modeling technology to prevent paying fraudulent Medicare claims. The legislation also contains a provision, supported by AAHomecare, which would require an electronic prior authorization process for standard power wheelchairs in Medicare. This provision requires physicians to use a clinical medical necessity template to document the medical need for a power wheelchair. The Association believes that this physician template is a critical tool needed to reduce improper payments due to documentation errors.
AAHomecare has long fought against Medicare fraud. The Association has worked with Congress and the Administration to implement a number of key components of its 13 point anti-fraud plan. Visit www.aahomecare.org/stopfraud to see the plan. Last year, AAHomecare supported H.R. 5546, introduced by Rep. Roskam, which would have improved the tools and resources available to prevent fraud and abuse in Medicare through the use of predictive modeling technologies.
The Association welcomes the opportunity to work with Rep. Roskam on this important bill as it moves through the legislative process.
The Fighting Fraud and Abuse to Save Taxpayer Dollars Act, or FAST Act, H.R. 3399, would strengthen Medicare by shifting Medicare's "pay-and-chase" payment system to one that is modeled after credit card industry fraud-prevention tactics, utilizing predictive modeling technology to prevent paying fraudulent Medicare claims. The legislation also contains a provision, supported by AAHomecare, which would require an electronic prior authorization process for standard power wheelchairs in Medicare. This provision requires physicians to use a clinical medical necessity template to document the medical need for a power wheelchair. The Association believes that this physician template is a critical tool needed to reduce improper payments due to documentation errors.
AAHomecare has long fought against Medicare fraud. The Association has worked with Congress and the Administration to implement a number of key components of its 13 point anti-fraud plan. Visit www.aahomecare.org/stopfraud to see the plan. Last year, AAHomecare supported H.R. 5546, introduced by Rep. Roskam, which would have improved the tools and resources available to prevent fraud and abuse in Medicare through the use of predictive modeling technologies.
The Association welcomes the opportunity to work with Rep. Roskam on this important bill as it moves through the legislative process.
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