Another Medtrade and another opportunity to reflect on the curious mix of optimism and alarm that is home care. For Medicaid recipients and the providers who rely on Medicaid for reimbursement, the first alarm comes from Missouri where Senate Bill 539 eliminated the legal requirement to fund DME providers. According to Brady Vestal of Citizen’s Memorial Home Medical Equipment, Bolivar, Mo, “the recently announced House plan to restore funding for basic DME services accounts for 58% of DME expenditures—including diabetic supplies, manual and power wheelchairs, oxygen/respiratory, prosthetic equipment, and ostomy supplies.” Left out would be hospital beds, canes, crutches, walkers, and everything else.

After testifying before a state House Committee in Jefferson City, Mo, Vestal laments that HME providers so far have been unable to get lawmakers to understand the value of HME products and services. “As providers, we know it makes little sense for Missouri’s Medicaid prescription drug plan to pay for respiratory meds but not pay for the nebulizer that delivers those meds,” says Vestal. “However, legi-slators, for the most part, do not get it!”

Cara Bachenheimer, JD, echoed Vestal’s concerns in her Medtrade presentation in Las Vegas. “The fear is that if Missouri gets away with it, it will set the trend,” says Bachenheimer, VP of government relations for Invacare Corp. “Why is Medicaid a target? Primarily because state expenses for these programs have grown astronomically. Also, forgive my cynicism, but it [targeting Medicaid] is easier for policymakers—at least in part—because beneficiaries are part of a disenfranchised community.”

Bachenheimer says that providers can work effectively with Medicaid constituencies, consumer groups, disability rights organizations, and even the media. “It does not take a lot of consumers, just one or two who are vocal, credible, and articulate,” says Bachenheimer.

Not surprisingly, competitive bidding (CB) also ranked high on the list of concerns for Medtrade attendees. In front of a packed house, John Gal-lagher and Dave Kazynski outlined ways that CB could be challenged and redirected. For independent providers who thought they could weather CB as it now stands, Gallagher (director of government relations for the Van G. Miller [VGM] Group) pointed out that CB requires the rebid of contracts “not to exceed every 3 years.” To this, Gallagher asked, “The second time around on rebid, can you cut reimbursement 20% again? Can you survive that?”

With the help of Kenneth Brown, PhD, University of Northern Iowa, Cedar Falls, Gallagher pointed to a VGM-sponsored study that gauged the impact of Federal Employees Health Benefits Program (FEHBP) cuts on CB savings from the two demonstration sites. After considering the impact of FEHBP cuts, and its administrative expenses, Brown calculated a loss to Medicare of more than $500,000. “We want more information on the true costs of the demonstration project and how many patients were ‘cost-shifted’ to hospitals,” says Gallagher. “What happens when patients are transferred to hospitals and costs go way up? If you are a member of Congress, why would you want to do that?”

Kazynski, president of VGM’s Homelink Division and a member of the program advisory and oversight committee (PAOC), pointed out that PAOC members have been bringing up the importance of quality standards and CMS has responded by allocating more time and money to develop them. Kazynski outlined items still up for discussion including: what standards do winning bidders have to meet and will dealers be allowed to form networks?

Both Kazynski and Gallagher stressed the need for providers to motivate members of Congress to demand that CMS finish the remaining three CB demonstration projects mandated by the Balanced Budget Amendment of 1997. Until then, CB could at least be delayed to allow these additional sites to validate CB’s supposed true savings potential.

With nationwide CB set to go into effect January 1, 2007, for 10 of the largest metropolitan statistical areas, these concerns—and many others—are of vital importance. As you grapple with uncertainty, take solace in knowing you are part of the solution. As always, the key is to make policymakers and payors see this fundamental truth.

Greg Thompson
gthompson@ascendmedia.com