To many in the home care field, Senator Mike Crapo (R-Idaho) is a legislator who “gets it.” He spoke at this year’s American Association for Homecare Washington Legislative Conference and founded the Congressional Chronic Obstructive Pulmonary disease (COPD) Caucus. Crapo is in his first Senate term and is up for reelection this November, but he took time out to answer some key questions from Dealer/Provider.

Dealer/Provider: Why did you start the COPD Caucus and what are your goals for the Caucus?

Crapo: In November of last year, I participated in the First National Chronic Obstructive Pulmonary Disease (COPD) Conference in Arlington, Va. Two of my brothers are pulmonologists, which motivated the conference to sponsor a “Crapo Brothers” panel. My brothers James and Robert spoke from their own expertise on the medical challenges of diagnosis and treatment for COPD; I talked about legislative challenges faced for COPD. which is the fourth largest killer in the United States, and yet faces policy and funding struggles.

During the panel, I also mentioned the idea to start a Congressional Caucus on COPD, and it just took off from there. Sen Blanche Lincoln (D-Ark), and Representatives Cliff Stearns (R-Fla) and John Lewis (D-Ga) joined with me to formally establish the Caucus in March of this year.

Some caucuses on Capitol Hill are not very active, but I am determined to keep the COPD Caucus active. The caucus has developed good working partnerships with the American Lung Association, the National Association for Medical Direction of Respiratory Care, the US COPD Coalition, the Alpha-1 Association, the American College of Chest Physicians, AAHomecare, several medical device manufacturers, and many others.

Right now, the Caucus is working with the Centers for Disease Control and Prevention and the National Institutes of Health to collect more data on COPD across the nation—and lobbying CMS to set national reimbursement guidelines for pulmonary rehabilitation. On September 23, we are sponsoring an extensive briefing on the new Federal Aviation Administration-proposed rule to allow oxygen concentrators on airplanes.

Dealer/Provider: To many HME providers, it appears that they are always the ones who take the brunt of reimbursement cuts? Is this a fair assessment? If so, why is HME so often singled out for Medicare savings?

Crapo: The payment system employed by Medicare makes HME providers relatively easy targets for reimbursement reductions—as are all health care providers. The inherent flaw with Medicare’s reimbursement formula is that it considers home health care services, and other health services, as a commodity-based business rather than a patient care-based business. For example, with inhalation therapies provided in the home, we ought to look at the service component for reimbursement of that therapy. It is not just a commodity. This is the underlying concept that needs to change because in the end, Medicare beneficiaries are clearly the ones who stand to lose the most. The current system creates a serious access problem for patients through the reimbursement for home care.

Dealer/Provider: Many professionals in the home care industry believe that their voice is not heard in Washington and that groups such as AAHomecare are not consulted enough on major legislative questions that affect home care. Is this a fair allegation?

Crapo: Many legislators are still not fully aware that by providing these services in the home, we are keeping patients out of hospitals. Regular home service treatments are vastly less expensive than acute inpatient episodes. Also, it is critical to appreciate patients’ strong desire to be treated in the home, and it often helps in their recovery. We need to make these simple points more obvious, and by doing so realign how home care is often viewed. AAHomecare and Kay Cox’s team are a force on Capitol Hill, and are extraordinarily active in the regulatory and policy-making side of operations.

Dealer/Provider: Do you think competitive bidding is a good idea for home care?

Crapo: Competitive bidding is a means to an end—the end obviously being patient care. The critical question is what is the effect on that end? Is the quality and effectiveness of patient care better, worse, or the same under a competitive bidding model? Nationwide consensus, of course, is not out yet, but from the limited trials we have performed, competitive bidding may not be the panacea some have dreamed it up to be. We will be looking very closely at the midstage results after it is implemented.

Dealer/Provider: Regions in Texas have been rocked by the “Wheeler-Dealer” scandals that exposed fraud and abuse in rehab/mobility billings to CMS. Does fallout from this scandal still affect the opinions of legislators?

Crapo: Most legislators know that fraud and abuse are often a problem with government programs, but most of the time such incidents are isolated and should not tarnish whole industry sectors. Medicare’s billing requirements are onerous and complex, and simple accounting or coding mistakes should not necessarily be treated as criminal acts. The Senate Committee on Finance held a hearing on the CMS Power Wheelchair Program back in April, and I think Kay Cox did a great job representing the views of industry.

Dealer/Provider: Medicare Modernization Act (MMA)-mandated Federal Employees Health Benefits Program (FEHBP) cuts are scheduled to take place in January 2005. Cuts will lower reimbursement to FEHBP levels for oxygen, manual wheelchairs, power wheelchairs, nebulizers, diabetic supplies, and air mattresses. Reps David Hobson (R-Ohio) and Harold Ford (D-Tenn) have introduced HR 4491 to repeal those scheduled reimbursement cuts. If the opportunity arises, will you support companion legislation in the Senate?

Crapo: The Hobson bill repeals section 302(c)(2) of the MMA, which we passed last year. This provision is certainly problematic. These cuts did not seem to be fully vetted before passing the bill, and it certainly will carry repercussions of access for patients. The Hobson-Ford bill is a good one that should be at the top of the list as we reexamine MMA.

Dealer/Provider: Many HME providers are dismayed by the government practice of comparing home care reimbursement rates to Veterans Administration guidelines or FEHBP rates (which they believe is like comparing apples and oranges). Why are legislators so fond of making these comparisons?

Crapo: The FEHBP program and Veteran’s Health program are nearly as complex as Medicare. It takes real institutional knowledge to be able to communicate the intricacies of these programs, so some legislators may not have a full understanding of the complexities to understand that comparing the pricing of the 200-odd FEHBP plans—with their different demographic populations than Medicare’s—may not be the most balanced comparison.

Dealer/Provider: HME providers are inundated with requests to contact their Senators and Representatives regarding home care issues, but many believe their voices are not heard. Do these calls and letters have an effect on your policy decisions?

Crapo: Absolutely. Correspon-dence from folks in the field is integral for Congressional offices to stay abreast of what is going on. Inviting members of Congress and their staff to see your facilities firsthand and understand your business model is also helpful. National organizations, such as AAHomecare, are also excellent at disseminating the latest industry news to Capitol Hill. I would encourage you to start at your local level with the state offices for your Senators and Representatives.

Dealer/Provider: Have you or your family members had personal experience with home care? If so, how has that shaped your views on home care?

Crapo: During the last month of my mother’s life, she received hospice care at home, which assisted my family greatly in dealing with the illness. With medical professionals in the family, I also hear regularly about the home care industry’s innovations and concerns.

Q&A conducted by Greg Thompson, editor of Dealer/Provider.