Twenty-six million americans—largely female and near retirement age—toil in the role of unpaid caregiver to a spouse or adult child suffering from a chronic disabling condition. “The Albert Einstein College of Medicine in a study 2 or 3 years ago came up with that profile and determined that unpaid caregivers provide health-related services carrying a value of $196 billion annually,” says David T. Williams, executive director for the Re/hab Technology Council and director of government relations for Invacare, Elyria, Ohio. “That’s a huge savings to the system.”

The caregivers’ gift is even greater when you consider that, for many, the lifts and other assistance tools that would make their job safer and easier are unavailable because Medicare will not cover the cost of this type of HME. Williams considers this “penny-wise, pound-foolish” thinking. “What then happens in many instances is the caregiver ends up injuring her back while transferring her husband in and out of his wheelchair or bed,” he says. “So instead of receiving all that value in unpaid services, the system ends up with two beneficiaries—the ailing husband and the injured wife, both of whom must be admitted to an institution.”

Suzanne Geffen Mintz, president and cofounder of the National Family Caregivers Association, headquartered in Kensington, Md, says her organization sponsored a membership study that found that 41% of respondents experienced back problems while engaged in the administration of care to a loved one. “Clearly, family caregiving has a physical impact on the health of those who serve in that capacity,” Mintz says. “The work of family caregiving places people at risk who otherwise wouldn’t be were it not for them taking on this job.”

However, a legislative solution is in the works. The Caregiver Safety and Well-being Act (CSWBA)—which would require Medicare to pay for equipment, like lifts, that make the family caregivers’ job safer—may be introduced in Congress later this year if the act’s sponsors can attach it to an appropriate piece of legislation. Because home care is only about 2% of Medicare’s budget, CSWBA is too small an issue to receive the support necessary to pass Congress on its own, Williams explains.

NEW MARKETS COULD OPEN
If Congress enacts CSWBA, Williams (left) speculates that Medicare might make $25 million to $40 million available each year to pay for products a caregiver would use. For dealers who have never before offered lifts, CSWBA would open up an entirely new market, he predicts. “Many caregivers—and patients, too—who could benefit from use of lifts currently stay away from the product simply because it is beyond their budgetary means and isn’t a covered benefit,” he says. “That would change overnight if reimbursement were available.”

The ability to sell formerly non-reimbursable products, like lifts, would let HME dealers attract new customers. “And, if they can bring these new customers into the shop, they will have the opportunity to stimulate sales of related and unrelated products on both the basis of planned purchases and impulse buying,” Williams says. “Take beds, for instance. Currently, Medicare only pays for a semi-electric bed. However, a fully-electric bed in combination with a lift would make it even easier for caregivers to transfer patients into a wheelchair, not to mention make it easier to provide in-bed bathing, rolling, and positioning. Under CSWBA, fully-electric beds would be covered. That means dealers could expect to sell more of them.”

It is too soon to know how well Medicare will reimburse for lifts if CSWBA is enacted, but HME dealers should be cautious of expecting too much, says Steve Knoll, president of Knoll Patient Supply in Topeka, Kan. “Based on past experience with this kind of thing, I’d have to say I would not be surprised if the reimbursement were something less than adequate,” he says. “Stingy is the word I probably would use to describe what we can expect.”

Still, even a small reimbursement could prove a boon to Knoll’s business. “If a payor will cover the cost, then more people will be able to have access to that type of equipment,” he says.

Most HME dealers can expect lift sales to increase by about 5% annually if CSWBA passes, Williams says, but it will be a gradual process rather than an overnight jump in sales. “It’s going to take time for consumers to become aware that these items are even available and reimbursable,” he says.

Knoll disagrees. He believes there already exists considerable awareness of lifts—and plenty of pent-up demand just waiting for something like CSWBA to come along and uncork it. “You’d be surprised how many caregivers and patients know about lifts and wish they could have one,” he says. “They hear about lifts as a result of conversations about home care in general with physicians or other members of the health care team. Unfortunately, there’s too much misinformation out there, so caregivers and patients often are told that lifts are a covered item. You can imagine how disappointed they are when they come to talk to us about acquiring lifts and discover that these currently aren’t covered at all. Even so, it’s a product they continue to want and don’t forget about. That’s why I think there’s a good chance CSWBA could open a floodgate of inquiries to HME dealers.”

HCFA OPPOSES IT
As helpful as CSWBA would be to patients, their caregivers, and HME dealers, the proposed measure has a few ardent detractors. Front and center among them is the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), the federal agency that runs Medicare. “HCFA opposes CSWBA because it’s looking at the limited resources it has available to pay for health-related services and fears that something like CSWBA will prove to be an uncontrollable program that will destroy the balance it has worked so hard to achieve,” Williams says. “HCFA feels that if it starts giving benefits to caregivers, the line of Medicare’s responsibility will have been pushed outward beyond the patient and that will result in dramatically increased costs to the program.”

However, while CSWBA opponents are correct in saying the act will increase up-front costs, it will save even more money in the long run, Williams says. “Under CSWBA, Medicare would be able to pay a one-time charge of $1,000 for a lift to make transfers safer for the patient and caregiver alike,” he says. “Opponents of the measure seem to be taking the position that they would rather have the system stuck with a tab of $36,000 a year for the sick patient and the injured caregiver to stay in a nursing home.”

LONG ROAD AHEAD
Leading the charge for passage of CSWBA is the author and chief sponsor of the bill, Rep Sherrod Brown (D-Ohio). Brown is attempting to line up cosponsors on both sides of the aisle in the Republican-controlled House of Representatives. According to Williams, Brown might re-introduce the measure in September, but he cautions not to count on that.

“In the grand scheme of things, CSWBA qualifies as small potatoes,” he says. “As such, it isn’t likely to generate much interest as a stand-alone measure. To move, it will have to be attached to a major bill. But to pass, it will have to be attached to the right major bill, and therein lies the tricky part.”

CSWBA originally was introduced in the last session of Congress. It went nowhere because there was no major piece of legislation that CSWBA could be attached to during 2000, Williams says. “We’ve since then tweaked the bill in order to address some of the concerns we heard from HCFA, so we think we’ve got a stronger bill to submit this time.”

Still to come is a cost analysis by the Congressional Budget Office (CBO). This analysis could enhance or ruin the bill’s chances, depending on what the numbers show. “It’s possible the cost estimate could come out in a way that’s disadvantageous for the proponents’ side because the CBO will be relying heavily on HCFA for input,” Williams says.

When it comes time to actually debate and vote on CSWBA, the bill could run smack up against stiff opposition from lawmakers if passing a prescription-drug benefit is high on the agenda of the House or Senate leadership. “It would be unlikely that a new benefit like CSWBA would pass the same year that Congress authorizes a prescription-drug benefit,” Williams says. “Politically, it would be asking for too much at once. CSWBA is one of those bills that may have to be introduced three or four times before it gets passed. Or it may have to be broken up into pieces and adopted one small part at a time over a period of months or years.”

Prospects for ultimate passage this year or next? Too hard to say right now. “There are a million variables that could come into play and affect the outcome, one way or another,” Williams says. “But I’m confident that, eventually, CSWBA will find its way into law. It has to. The demographics will force it to happen. The country can’t afford to put all its elderly into facility-based care. If there’s going to be home care, then there has to be support for those family members and friends who are doing the most difficult and dangerous part of the work.”

Rich Smith is a contributing writer for Dealer/Provider.