Discussion Forum

From: Home Care Magazine

WASHINGTON — Rumors of HME cuts turned real last week as government officials continued to shuffle ideas around on the nation’s financial predicament. According to a leaked document, allegedly part of Vice President Joe Biden’s debt ceiling talks, three cost-cutting ideas targeting HME are on the table:

• Applying Medicare competitive bidding rates for DME to Medicaid in states where the program is implemented, which would save $5 billion over 10 years;
• Initiating a Medicare prepayment review of power wheelchairs, estimated to save $200 million over 10 years; and
• Reducing Medicare reimbursement for diabetic strips sold in pharmacies.

“The threat is real,” said John Gallagher, vice president of government relations for Waterloo, Iowa-based VGM Group. “This one has legs because if it is from Biden’s group; it has been kicked around.”

When it comes to cutting health care as part of the budget discussions, “just about everything is on the table,” said Michael Reinemer, vice president, communications and policy, for the American Association for Homecare. “Virtually everybody is at risk.” While some health sectors “are facing much more drastic cuts,” he said, “that doesn’t make it any better for us.”

With the situation changing daily, Gallagher said he believes that “like everything else, this is going to be an 11th hour finish, and everything and the kitchen sink will be thrown in as an offset … We’ll see if [the HME cost-cutting measures] see the light of day or just move in another direction.”

Both VGM and AAHomecare issued action calls to lobby against more cuts to home care in any plan that emerges.

“Our message to the Hill is clear: No more cuts to home care!” emphasized Jay Witter, AAHomecare senior director of government affairs. “The nation’s debt problems cannot be solved by making further cuts to the most cost-effective form of health care — home care.”

That could be a hard sell, stakeholders acknowledged, especially in light of such bad publicity as a new Office of Inspector General report on power wheelchairs and a succeeding article in USA Today.

The July 7 OIG report maintained that 61 percent of PWCs provided by Medicare during the first half of 2007 were unnecessary. USA Today followed the report with a July 13 article saying that Medicare will triple its number of fraud-fighting strike forces from seven to 20 to catch the “scammers.”

The report and the article incensed industry stakeholders. AAHomecare called the OIG report “misleading.”

“Their report clearly indicated that medical necessity was actually only questioned on 9 percent of the claims,” the association said in a “Mobility Matters” issue July 14. “The fact that the OIG concluded that information was missing in 52 percent of claims underscores that the government needs to fix the documentation process for determining the medical necessity for power wheelchairs.”

CMS needs to do more to educate its physicians, AAHomecare said. It suggested creating a mandatory template for physicians to use in documenting medical necessity for power wheelchairs.

As to the newspaper article, Gallagher said, “How do we respond to USA Today? We can’t. They aren’t going to listen to us, we aren’t going to get equal time. The damage is done.”

Despite such stumbling blocks, he said, it is critical that providers and other stakeholders “create a lot of noise” against any HME cuts.

How to do that? The hospital lobby alone is spending $1 million per week campaigning against possible cuts in that sector, a figure the HME industry can’t begin to match.

“There are many other groups clamoring to get their message of ‘no cuts’ in front of members of Congress,” said Witter. “But regardless of what others are doing, we must remember there is no one else fighting for home care. It is up to us to make our message heard on Capitol Hill, and the most effective way to do that is to call your members of Congress.”

HME has a “unique and powerful advantage” that other health care sectors don’t have, Reinemer said, and that’s what stakeholders need to use to get the message across. “What we may lack in terms of budget we can make up for in terms of real-life stories,” he said. “People just have to put a human face on this issue …

“I think you have to stick with the basics. Everybody believes that what you want to do is get people out of hospitals and nursing homes if possible. It’s vastly more cost effective. And it is preferred by patients. And it is clinically effective.

“We just have to keep our nose to the grindstone,” Reinemer said. “This won’t be the last battle.”