The two big provisions from MMA 2003 are rapidly coming to a head. CMS has published a proposed payment for respiratory medications that is the equivalent of an 89% reduction from current rates. That number will put most of us out of the respiratory medication business if we do not get something done quickly.

Tim Pontius, RRT

Through the efforts of a core group of Industry CEOs, the American Association for Homecare (AAHomecare) has been able to fund and subsidize a study by the Muse Group that establishes well-defined costs associated with the provision of these medications. More than 100 companies participated in our data collection efforts for the Muse Study. That is a decent number, but over 800 companies were contacted by Muse, so only about 12% participated.

Hours are being spent each week by AAHomecare staff and a few others setting up meetings with CMS, working with national physician associations to establish clinical support, and reviewing any data that will support our claims.

What about the Federal Employees Health Benefits Program (FEHBP)? The General Accounting Office (GAO) recently computed a comparison that showed we are paid about 15% less for oxygen patients under FEHBP vs traditional Medicare. Again, AAHomecare has been busy, contracting with Morrison Informatives to do a study of all the FEHBP plans to which our members currently provide services.

The results of the Morrison Informatics Study show the payments for oxygen under FEHBP are essentially the same as Medicare. The GAO will soon release a similar study. Our position will remain that we oppose any reduction to oxygen payments in 2005.

If that fails, we will continue to push hard for support of HR 4491. We do not expect this bill to come to a vote in this legislature, but we need every one of you to get your Congressman to sign on in support. Only 52 Congressmen have signed on as of September 13, and we need more than 200 if we are to have a good chance of getting FEHBP legislated out of MMA in the coming months. Did I mention that the GAO also supports competitive bidding and placing stationary oxygen systems into capped rental? Are you motivated to call your Congressman yet?

Oh yes, and we are actively working on submitting comments on the power wheelchair policy, competitive bidding concerns to the forthcoming PAOC advisory panel, and additional comments to CMS on the AWP/ASP pricing proposal.

If you think this sounds like a lot of problems, you are right. The year 2005 is a year where we will need to unify more than ever. The Budget Deficit Reduction Act may make the MMA of 2003 look like small potatoes when it comes to cutting costs out of home care. Bush or Kerry? It does not matter since Congress will need to put a dent in the federal deficit. Am I complaining? Definitely! But we can make a positive outcome if we work together. We have choices, and I choose to fight for my destiny.

We are just past the third anniversary of September 11. The world has changed dramatically and it remains our choice as to how we live our lives in the face of orange and red alerts. And what about our brethren in Florida? How many hurricanes do you have to endure before you qualify for a period of “stability?” Many of us have friends and acquaintances who are struggling with extended power outages, disrupted supply lines, continual stress of recurring hurricane systems, and enacting plans for maintaining critical services to patients in a catastrophic crisis. (How do you think Florida would be responding if competitive bidding were fully implemented?) I am betting that thousands of patients would be seeking help in hospitals because the few winning bidders would simply be overwhelmed. I am also betting that those tough-minded Florida companies are doing everything in their power to keep patients serviced today, and out of the hospitals. This is the spirit that Congress needs to see.

Tim Pontius, RRT, is chairman of the American Association for Homecare.