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February 20th, 2012 by Ashley Plauche

Walking the Halls of Congress

Homecare Advocate Blog: Walking the Halls of Congress

How appropriate for Homecare Advocate to report back on our recent trip to Washington DC as we celebrate President’s Day!   George Washington would be proud of the hundreds of people who came from across the country to petition their elected representatives about homecare issues.

Here’s the latest update on our efforts to eliminate the poorly designed auction program that jeopardizes Medicare beneficiary access to quality goods and restricts their ability to choose their provider.

Homecare Advocate Blog: Walking the Halls of Congress

We met with our elected officials to discuss replacing this dangerous program with an economist-backed Market Pricing Program (MPP) that will ensure true savings for the taxpayer without threatening beneficiary harm or access issues to quality goods and services from reputable providers.

What is MPP?

MPP is a reflection of Congress’ goal to create a market-driven health care system with less government-controlled prices. However, unlike the current “Competitive Bidding” program, it has integrity, accountability, transparency, and oversight while ensuring healthy competition among HME companies and real, sharp prices for competitively bid products.  It affects the same product categories as the current program, and would have a national roll-out in July 2013.  Bids will be binding, and the bid price is based off of the clearing price (not arbitrary price-setting as is currently done).  Additional information on the operating principles of MPP may be found here.

Most importantly, MPP resolves the issues that 244 leading economists from around the world have found with the current “Competitive Bidding” program.

How Can MPP Become Law?

Bills are scored by the Congressional Budget Office (CBO) to help lawmakers know the cost of implementing the bill.  The homecare industry understands the need for any bill to be budget-neutral in this economic environment, and we believe that MPP will score close to neutral as-is.  However, we are committed to making MPP a budget-neutral alternative to the anti-competitive auction program and will make the necessary adjustments to ensure it can be implemented without costing taxpayers additional money.

There will be limited opportunities to bring MPP to a vote this year with the upcoming election, so it is vital that the Congressional Budget Office scores MPP quickly.  Round Two of Competitive Bidding will affect about half of Medicare beneficiaries throughout the country, and homecare equipment companies are already preparing their bids.  All four metropolitan areas in Tennessee will be included.

Now that our industry has come up with a viable replacement program, we look to our elected officials to be champions for patients and providers. To help, they need to:

  • Contact their colleagues in House Ways & Means and Senate Finance committees
  • Urge their colleagues to request the score from the Congressional Budget Office
  • Support the replacement of Competitive Bidding with the Market Pricing Program

What Can I Do to Help?

Thanks for all of the groundwork help, fellow advocates!

::AWP::

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December 13th, 2011 by Ashley Plauche

Going Old School

Homecare Advocate: Going Old School (Health Care)Many of us look back on the past and recall with warm fuzzies the “good ole’ days”.  The streets were filled with children playing and delicious smells of homemade meals fragranced the air from neighboring kitchen windows.  However, when it comes to medical care, aren’t we glad to have the medical advancements over the last 50 years!  Without medical research and development, we would have still thought that cigarettes aren’t harmful, that women can drink alcohol while pregnant, and that the only way to correct vision problems is with glasses (sorry contacts and Lasik, you weren’t discovered yet).

So maybe we want the best of both worlds. We want the sense of community and family from decades past with the cutting edge technology to improve our quality of life and enable us to live a fuller life, longer.  We want to make our own decisions, armed with the latest information and innovative options.  We look for technology that will enable us to remain in our homes, independent, and with our families.  As discoveries are made, technology changes, and health care options evolve, aren’t we glad that we’re able to make our health care decisions taking this into account?

Unfortunately for Medicare and Medicaid beneficiaries throughout the country, the federal government has developed a program that stifles home medical equipment innovation at an economic loss of $50 billion dollars according to a study by the Pacific Research Institute.  This is not what our weak economy needs, and even worse–this is counterintuitive to the needs of our nation’s elderly and disabled.  The study further adds to the complications of this federal program, forewarning of “shortages of critical medical equipment — and future patients will be deprived of the next generation of cutting-edge healthcare tools” as reported in Forbes Magazine.

What is this terrible federal program that will cause such economic, health, and technological development harm?

For the past several months, Homecare Advocate has been updating you on the developments of this anti-competitive auction program, dubiously titled “Competitive Bidding”.  It has alarmed leading economists from around the world, as CMS’ unconventional rules “undermine the market forces that make typical auctions effective-and economically efficient” Forbes reports.  Numerous other independent studies point to the same results: a disastrous program that fails beneficiaries, disincentivizes manufacturers to invest in research and development, and results in increased preventable hospital and facility admissions. It isn’t just your choice in new technology that is cut–it’s also your choice in who provides your care.  With this program, up to 90% of the established home medical equipment companies you’ve grown to rely on in your community will be eliminated from this program, forcing most to close their doors for good.

So what can you do?

Don’t stay in the Dark Ages. Learn about this program and how it will affect you.  Ask your home medical equipment provider for more information if you’d like, or you can learn more online here and here.  Contact your elected federal representative and let him or her know that you are one of their constituents and are concerned about how the Competitive Bidding for DMEPOS program will detrimentally affect you.  Ask that instead of this ill-conceived program, your representative support the “Market Pricing Program for Home Medical Equipment” instead.  This program, also called “MPP”, will enable Congress to find real savings for health care while stimulating technological advancements and preserving your provider choices.  Call the Congress switchboard to be connected to your representative at 202-224-3121.

We desperately need health care innovation if we are to care for our nation’s growing senior population. By 2030, 1 in every 5 Americans will be 65 and older.  We cannot afford to rely on 2011 technology 15 years from now.  The technology of today will not be sufficient for tomorrow, and the consequence for ignoring that could be greater than we could ever expect.  Sure, we want efficient government spending, but no amount of money will buy results if you cut out the benefit of quality care and improved delivery mechanisms.  There is more to health care than a price tag.  We cannot afford to cut out the value of the services that make us healthy, independent, and connected to the world around us.

::AWP::

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November 21st, 2011 by Ashley Plauche

Disability Groups Write Letter to Super Committee About Homecare

Dear Joint Select Committee Members and Staff:

The Healthcare at Home Initiative is a broad alliance of organizations representing disability groups, consumer advocates, family caregivers, and companies that provide medical care and equipment in the home.  We urge you to reject budget cuts that will restrict access to the home-based services and supports needed by millions of Medicare and Medicaid beneficiaries.

We understand that federal spending growth must be controlled.  Home-based services and supports are part of the answer to providing more cost-effective care that will help the nation meet its healthcare financing challenge.

Reduced access to home-based services, support, and equipment ultimately will cost taxpayers more money as beneficiaries are forced to make preventable emergency room and hospital visits to meet their healthcare needs.  In addition, the tremendous savings achieved through home-based care are multiplied dramatically through care provided by family members in the home.

While not a panacea, home-based care is a highly cost-effective part of our healthcare system that fosters quality of life and helps millions of seniors and people with disabilities to live independently in their own homes. Americans overwhelmingly report that the home is their preferred setting for receiving care.

As Americans live longer and face more chronic conditions in their senior years, it’s vitally important to strengthen policies that preserve access to the services, care, and supports these populations need.

Sincerely,

Alzheimer’s Foundation of America
American Association for Homecare
American Association of People with Disabilities
American Sleep Apnea Association
Christopher & Dana Reeve Foundation
International Ventilator Users Network
National Alliance for Caregiving
National Association for Home Care & Hospice
National Association for the Support of Long Term Care
National Emphysema/COPD Association
Paralyzed Veterans of America
Post-Polio Health International

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September 13th, 2011 by Ashley Plauche

Controversy Heats Over Auction Program

Homecare Advocate has been covering issues related to the controversial bidding program that will detrimentally affect seniors and destroy the homecare equipment supplier network throughout our country.  Today, The Tennessean published an article highlighting concerns from the supplier community on their ability to withstand the low-ball bid pricing that occurs in this contentious program. 244 economists have weighed in on this program, predicting system-wide failure and unsustainable pricing that is manipulated by the government.  End result?  Bad policy for seniors and for the thousands of mom-and-pop homecare equipment supply companies throughout the country.

Jesse Schwartz, an economics professor at Kennesaw State University, was interviewed by The Tennessean.  He explains that the program is ill-designed by encouraging low-ball bids that companies are not bound to.  “That’s a big problem because Medicare might not be able to meet demand because there won’t be enough suppliers.”  Schwartz joined hundreds of his esteemed colleagues in June writing a letter to President Barack Obama strongly warning about the flaws in the bid program and the serious harm it will bring.  In the letter to the President, the economics experts implore the White House Administration to bring effective reform and to abandon the flawed principles of the current program. “Indeed, the current program is the antithesis of science and contradicts all that is known about proper market design.”

Many homecare equipment companies agree with these economists.  Lambert’s owner, Randy Wolfe, was interviewed by The Tennessean and told the reporter, “I don’t mind being in a program where products are competitively bid or auctioned; we just don’t want to have to auction off our companies.”  And that is exactly what the current program will do.  Current estimates show that 42% of non-contracted companies will go out of business with over 80,000 people losing their jobs by 2014. 

To lose a bid is the kiss of death for many companies, but several companies in this first round of 9 areas have gone out of business even when they WIN contracts. Meet Rob Brant, former co-owner and president of City Medical Services in Miami, Florida.  His company aggressively bid and won the contract to supply oxygen to Medicare beneficiaries in the Miami metro-area.  Though he also bid on the other product categories within his normal scope of business, he did not win anything else.  He laid off half of his staff and reduced the store size, but even with drastic measures his company still lost $25,000/month as a “bid winner”.  Operating at an unsustainable rate, he had to make the decision to close his business.  Rob’s story is hauntingly familiar as other companies risked and lost everything to participate in the Competitive Bidding Program.

Here is Congressman Heath Schuler speaking in with the Subcommittee on Small Business about the disastrous Competitive Bidding program back in 2009.

Years later, the Centers for Medicare & Medicaid Services have failed to address these very issues.  Auction expert Jesse Schwartz stands alongside his esteemed colleagues in pushing for complete reform of this egregious program, and patient advocacy groups across the country are fighting to repeal it.

Unless swift action is taken, the significant majority of seniors in the United States will be affected by the auction program’s second round rollout, due to take effect in 2013.  The Tennessean reports that all four major cities in Tennessee will be included, making Tennessee disproportionally targeted for the second round (with only large states like California and Ohio having more congressionally bid areas).  Call your representatives and let them know that you do not want this program coming to your town, taking away jobs, putting small businesses out of business, and harming Medicare beneficiaries.

::AWP::

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August 22nd, 2011 by Ashley Plauche

Changes in Medicare HME Benefit

The Centers for Medicare & Medicaid Services (CMS) is implementing a program nationwide that will severely impact your Home Medical Equipment (HME) benefit in serious ways. We all would like to see smarter government spending, but this program, ironically titled “Competitive Bidding”, deviated significantly from what Congress sought to achieve (market-driven prices and healthy competition from a vast network of HME companies). Instead, this program achieves none of those things due it its serious design flaws that artificially lower prices to unsustainable rates, arbitrarily pick “winners” and “losers” without transparency, increase expenditures in Part A of Medicare, and jeopardize seniors’ access to quality care from their chosen home medical equipment company.

With this program, a small number of suppliers with the cheapest bids (and little regard to quality, service, experience, financial health, or presence in the community) win the exclusive ability to sell durable medical equipment to Medicare beneficiaries. Closer inspection to this program reveals a poor design with significant detrimental consequences; therefore patient advocacy groups, economists, auction experts, and homecare equipment companies have challenged CMS and Congress to repeal this particular program before irreversible harm occurs.

The current program is fraught with serious and consequential problems that will wreak havoc on elderly and disabled Americans and small businesses like Lambert’s throughout our great country. The controversy over this program is growing, and on Friday, CMS announced that all 4 of Tennessee’s major cities and surrounding towns will be on the chopping block in early 2013. This will affect all of Lambert’s patients living in Knoxville, Lenoir City, Maryville/Alcoa, Oak Ridge, Powell, Clinton, Loudon, Townsend, Corryton, and 17 other cities close by.

Key issues with this program design include: lack of long-term sustainability, lack of transparency, a flawed pricing rule with non-binding bids, endangerment of seniors, and creation of mass genocide in the Home Medical Equipment Industry by eliminating 90% of companies like Lambert’s nationwide. A failed program of this magnitude will destroy the home medical equipment supplier network for years to come, with an estimated 200+ companies closing and direct job losses of over 2,100 in Tennessee alone.

Want more information?  Read these Myths of Medicare’s Competitive Bid Program.

HOW DOES THIS IMPACT YOU?
A study conducted by Dobson & DaVanzo revealed:

  • Diminished freedom of choice in your provider,
  • Limited options in types of equipment and brands available,
  • Access issues to quality equipment and services,
  • Delayed response time in receiving goods/services,
  • Increase in emergency room visits and delays with discharge,
  • Stifled technological innovation for equipment,
  • Disruption in long-term relationships with your provider & continuity of care issues

**Many private insurance companies follow Medicare guidelines, so it is important that you learn about this and how it could impact you even if you do not have Medicare.**

WHO IS AGAINST THIS?
Patient advocacy groups stand united with economists and auction researchers against this ill-conceived program. It hurts people, it hurts small (and even large) business, and it will negatively affect the economy, with predictions of reduced investment of 12-15% annually ($3.1 billion between 2011 & 2020) in the homecare equipment industry.

244 of our country’s most prestigious economists from Princeton, Harvard, Yale, UCLA, Stanford, and more have joined together in 2011 in protest of this program, citing that it is plagued with “bureaucratic inertia” and that CMS’ failure to resolve the serious and consequential problems with this program are “especially distressing and unreasonable”. In 2010, 167 of these individuals wrote the Chairman of the Subcommittee on Health about the four main design problems of this program, stating “implementation of the current design will result in a failed government program…The current auction program has flaws that need to be fixed before it can achieve the objectives of low cost and high quality“. The Chairman promptly took this letter to CMS, asking how they would resolve it. CMS blindly dismissed these serious concerns and assert that CMS as a bureaucratic department knows more than these esteemed experts in auctions and economic impact. The New York Times Freakonomics Blog by Ian Ayers and Peter Cramton criticized CMS, stating, “Any expert would be able to quickly identify the fatal flaws in the Medicare competitive bidding program. We suspect the problem is that CMS initially did not realize that auction expertise was required, and once they spent millions of dollars developing a failed approach, they stuck with it rather than admit mistakes were made“.

Patient advocacy groups against this bid program include:
The ALS Association
American Association for People with Disabilities
Cerebral Palsy Association of Ohio
Muscular Dystrophy Association
National Association for Home Care & Hospice
National Council on Independent Living
National Emphysema/COPD Association
National Spinal Cord Injury Association
United Spinal Association
…and more…

WHAT CAN I DO?
Contact your elected representatives and tell them how:

  • You do not want Competitive Bidding for HME in your town,
  • You want freedom to choose your home medical equipment company, not bureaucratic employees in Washington,
  • A radical reduction in HME companies through the Competitive Bidding Program hurts the economy and will cause massive job loss,
  • Continued cuts to homecare benefits could force suppliers not to carry the same quality brands of equipment that you need to maintain your activities of daily living,
  • You do not want to be forced to use different companies for each different product you need

I’ll leave you with a quote from Jerald Winakur, MD, FACP, CMD:

“CMS has developed a hodge-podge response to the needs of our citizenry… By its actions, Medicare stifles innovation, discourages physician participation in the program, and–most egregiously–restricts the autonomy of elderly and disabled citizens, the very ones it is the mission of CMS to help.  And, paradoxically, CMS ends up spending more money, not less, in the long run.  This is shameful behavior that deserves the transparent light of day shone brightly upon it.”

::AWP::

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August 6th, 2011 by Ashley Plauche

The Debt Debate

I doubt many, if any, were spared the widespread coverage of the debt debate that cumulated in legislation passed with just hours to spare before the United States defaulted.  At the core of this discussion is the knowledge that our country is on an unsustainable fiscal path and the question about how to fix it.

As part of the legislation that passed earlier this week, a super-committee of 12 members of Congress have been appointed the daunting task of divvying up $1.5 trillion of cuts over 10 years to many federal programs, and unless their proposal passes the House and Senate and is accepted by the White House by year end, sweeping cuts will automatically take place with an automatic 2% cut to Medicare provider payments.  Though the White House intends to keep these cuts from affecting the 100 million Medicare and Medicaid beneficiaries, many believe that such cuts would trickle down to the patients as well.

What could these cuts come in the form of? Though it is just speculation at this point, we could see cuts in Medigap insurance, high-earning seniors paying higher premiums for Medicare, vouchers to purchase a private plan, or even Medicaid being turned into a block grant program.  It will undoubtedly also cut provider reimbursement for health care services.  Many, like physicians and home medical equipment providers, worry that any additional cuts will create undue financial hardships on their ability to take care of our nation’s most sick and vulnerable.  Home medical equipment, for example, has already had reimbursement cuts of 50% in oxygen alone over the past 12 years. It seems incredibly short-sighted for the government to attack the homecare industry whose utilization prevents higher costs in hospitalization, institutionalization, and readmissions.

Check out this Medicare spending chart on spending over the past several years done by the Centers for Medicare & Medicaid Services (CMS):

Medicare Spending Chart

















Do you see that little green line at the bottom?  The flat-lined one with very little growth if any at all?   That’s home medical equipment, the industry responsible for preventing expensive increases in Part A Medicare through increased hospital stays and living in nursing homes.  To continue cutting be it through the debt discussion (or the ill-conceived anti-competitive auction program) just doesn’t make sense.
Government officials look to Medicare and Medicaid spending and see significant costs. In fact, today it accounts for approximately 23% of federal spending. The increase in Medicaid can be contributed to the downturn in the economy and the rise in unemployed who do not have private health insurance plans. For Medicare, this is partially due to our country’ s aging population and also due to a medical model that doesn’t fully utilize the cost-effective option of homecare.

It’s apparent that the surge is partially due to the increase in utilization. Older, sicker, poorer. And we need to be doing something to address the needs of our changing demographics of our nation instead assuming that we can expect more for less from providers.  We need a solvent way to keep options for Medicare and Medicaid beneficiaries long-term.  Running the needed providers out of business is not one of them.  It is the concern of many in the health care provider community that a decrease in reimbursement will only lead to a decrease in services being able to be offered, which detrimentally affects you as their patient.


“Although there may be room for broader reform in Medicare, we’ve gotten so focused on rhetoric about entitlement reform, what’s often lost is that the problem is overall health care spending.”

–Judy Feder, Senior Fellow at The Urban Institute

::AWP::

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July 2nd, 2011 by Ashley Plauche

Hello Congressman, It’s Me

We are days away from celebrating Independence Day, and I couldn’t help but to think of how one of the most patriotic acts we can exercise as Americans is our right and responsibility to speak with our government representatives about issues that impact us.  Our ancestors fought for independence and democracy, and our ability to vote and access elected officials are critical for making our country by the people, for the people.  It is important that those representing you hear your thoughts and concerns as they form their opinions on legislation that will impact your life and community.  Do you know who your elected officials are and how to reach them?

ELECTED OFFICIALS

Community

Remember the kid in your neighborhood that pledged to grow up and become President?  Well, he or she may not have met that lofty goal, but that person could very well be involved in your local political scene today.  Let’s take a look at your community and build upward toward a national perspective.  Your city council performs duties of the legislative branch, including the formation of legislative laws.  Your mayor, on the other hand, is a part of the executive branch and is responsible for enforcing those laws.  Oftentimes, you city council will focus on things such as the city’s goals and major projects.  These projects may include a variety of things, such as making your downtown more handicap-accessible.  You can find more information about your city’s elected representatives online, just as Knoxvillians can find information on the City of Knoxville Web site.

State

It is often the case for our state officials to have previously served in the local community before moving to the state, as is the case with Governor Haslam of Tennessee who was previously Knoxville’s mayor.  It is at the state level where statewide issues are addressed.  Your governor performs the duties of the executive branch while members of the state House of Representatives and Senate execute the legislative branch duties such as determining state budgets, taxation on items, how your state Medicaid program will operate, and what assistance will be available through various state programs.  In Tennessee, for instance, former Governor Bredesen signed into law the CHOICES program which provides long-term  care alternatives to nursing homes for disabled and elderly Tennesseans.   To find your state officials, you can either go to your state’s Web site or visit this Web site that will give you state-specific contact information.

Country

Finally, for national issues, you have a federal Member of the House of Representatives for your district and two federal Senators for your state.  They work to represent you in Washington DC, and they enact legislation that shapes our entire country.  Each member of the 435 Members of Congress has a personal Web site that will let you know how to contact him/her in Washington and in his/her district office(s).  President Obama and Vice President Biden are, of course, part of the executive branch at a national level and can be reached via their online contact form.  It is oftentimes the national issues that gain media attention, particularly health care reform, Medicare and Social Security, Veterans Affairs, and more.

So what does this mean for you?

Let’s say that you want to talk to someone about the importance of homecare and how you want your access to homecare equipment and services to be protected.  This is often both a state and a federal issue.  Now that you know your elected representatives, you can contact their office and let that representative know where you stand and how you hope that he/she will vote when this issue comes up.  You start by introducing yourself and where you live, and then you state your brief talking points.  Examples of talking points for homecare include:

Homecare is part of the answer to our rising costs in health care;

Homecare offers an affordable alternative to institutional care;

Homecare is patient-preferred;

Homecare results in better patient outcomes;

Homecare allows our country to benefit from the loving hours donated by informal (family) caregivers to take care of the sick, elderly, and disabled population instead of paying for it through government services;

Homecare allows the patient and his/her family to have a higher quality of life;

Over 8 million Americans are benefiting from homecare services in the US today, including those with chronic obstructive pulmonary disease (COPD), multiple sclerosis, Lou Gehrig’s disease, spinal cord injuries, congestive heart failure, diabetes, and more;

Homecare reduces the length of hospital stays (which are very expensive);

Homecare keeps families together;

Homecare increases independence;

Homecare should be protected as a vitally important option for seniors and people with disablities.

I’d love to hear your experiences talking to your elected officials about homecare issues!  Please feel free to share them as a comment, and we may pick one of your stories for a future Faces of Homecare post! I wish you all a blessed, safe fourth of July and leave you with this quote from Thomas Jefferson: “Governments are instituted among Men, deriving their just Powers from the Consent of the Governed.”

Me and Other Homecare Equipment Providers Speaking with Rep. Jimmy Duncan About Homecare
Me and Others Meeting Rep. Duncan of TN to Discuss Homecare

::AWP::

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