Peter Thomas
During a roundtable discussion on Capitol Hill on Tuesday, Peter Thomas, co-chair of the Consortium for Citizens with Disabilities’ Health Task Force and the general counsel for the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), spoke about the cost-effective role that homecare can play in the reform of the U.S. healthcare system. The roundtable also addressed the controversial competitive bidding program for home medical equipment (HME) and services. The American Association for Homecare hosted the event, which was attended by congressional staff and media.
Former Senate Majority Leader Tom Daschle and “Blue Dog Democrat” Rep. Jason Altmire (D-PA) joined the discussion, as did Georgetta Blackburn, vice president for government relations at Blackburn’s, a home medical provider in Tarentum, Pennsylvania. Tyler Wilson, president of the American Association for Homecare, moderated the discussion.
Thomas said, “Disability groups have long opposed competitive bidding for DMEPOS [durable medical equipment, prosthetics, orthotics, and supplies]. There is real concern about limitations on choice of provider. In many instances these are beneficiaries with long-standing relationships with providers…. Those relationships get fractured under competitive bidding…. We’re very concerned that service is going to go out the window, that quality is going to decrease, and that patient choice is going to become compromised. There are other ways to get at overpayment in the DMEPOS fee schedule. We think that competitive bidding is not the way to do it.”
Daschle noted, “We can provide low-cost good quality access in part through home healthcare. Home health is by far the most effective way to start producing wellness promotion and primary care….” Referring to the difference between the $7 per day cost of oxygen therapy to more than $5,000 per day for hospitalization under Medicare, Daschle said the difference “shows clearly how much of a panacea home healthcare can be…. My mother’s quality of life is a hundred times better given the fact that she can live at home rather than be institutionalized at 86. Her quality of life is proof positive that we can help improve quality, lower costs, and provide greater access if we put the emphasis where it belongs: at the base of the pyramid with good home healthcare.”
Altmire, a fiscally conservative Democrat in Congress, spoke about the role of home medical services and equipment in healthcare reform. “We’re going to preserve what works in our current system, first and foremost, and one of the things that works best in the current system is homecare. And if you look at what the goals are for healthcare reform, homecare touches on every one of them. When you think about wellness and prevention…that can be done in the home better than anywhere else. There’s no more cost-effective setting than in the home.”
Altmire referred to findings from hearings on competitive bidding in the House Small Business Subcommittee on Investigations and Oversight, which he chairs. “What we found is when you have a regulation in place that’s putting cost over quality, that’s not only going to impact the beneficiary, and we all know how that works, it’s also going to affect the small businesses that are staples to our communities in the durable medical equipment field.”
“Homecare must be supported as a vital component of the healthcare system and recognized as a critical benefit under Medicare,” Wilson said. “When the Office of Inspector General at HHS notes that a piece of equipment can be purchased over the Internet at a lower cost than at the Medicare rate, it presents a false analogy and demonstrates a fundamental misunderstanding of the benefit. Quality homecare and accessible homecare is not merely about equipment. That is not what Medicare beneficiaries want, nor is it the recipe for providing a standard of healthcare that everyone expects. Services include 24-hour on-call service; patient evaluation and education, caregiver education regarding equipment maintenance and safety and infection control; monitoring visits assessing patient compliance with the physician plan of care; ongoing maintenance of the home medical equipment; and ongoing provision of related supplies and back-up systems as needed.”
