There are certainly challenges in conveying the message that home care is an essential component in the continuum of care. However, during our recent visit to Capitol Hill at this year’s American Association for Homecare (AAHomecare) Legislative Conference, there were indications that policy makers are beginning to understand the message. Members of the California AAHomecare delegation met with Sen Barbara Boxer’s (D-Calif) legislative assistant (LA), Sen Dianne Feinstein’s (D-Calif) LA, as well as the LAs of Rep Randy “Duke” Cunningham (R-Calif) and Rep Susan Davis (D-Calif).

Lisa M. Getson

The LAs in this year’s Senate meetings appeared to be much more engaged in our issues. We discussed concerns related to competitive bidding, the need for comprehensive clinical standards, and the importance of allowing providers to fully respond to and adjust their businesses to 2004’s and 2005’s Medicare reimbursement reductions. We also covered issues related to the service fee for respiratory medications and trends in Medicaid/Medi-Cal program coverage.

Vernon R. Pertelle

Last year, Sen Feinstein’s aide made it clear that we lacked data to defend our position, and her boss was not interested in anecdotes. This year, it was obvious that the industry data we have compiled and presented has been effective in convincing her and her boss of the importance of home care. Last year, it was a tough sell to get Sen Feinstein to join the Congressional COPD Caucus. This year, her aide emphatically stated that the Senator is now a member of the COPD Caucus and was moved to join after learning about the high number of COPD patients in her home state.

Sen Boxer’s LA showed the same interest and enthusiasm as did the LAs of Cunningham and Davis—who are both members of the COPD Caucus. And we anticipate Sen Boxer will be joining soon. It was refreshing to see how our efforts over the past year have taken hold with members of Congress and clear that the data has had a positive effect on many legislators. However, despite the progress, challenges that face our industry remain and shifts in Medicare reimbursement patterns continue.

Cost-containment pressures, although needed, are the primary driving force behind retrenchment and the subsequent realignment of government. Such forces tend to impede the development of a comprehensive system for the provision of services in the home. The movements and shifts in reimbursement patterns can lead one to conclude that the same old features will continue to prevail instead of new and innovative delivery structures in the low cost environment—the home.

In other words, the in-home care industry will become more like the nursing home industry—highly regulated and perpetually plagued by questions concerning quality of care. Although government is attempting to diminish its task as the prime provider of health services (through fiscal retrenchment—managed care) and the public’s role as the dominant delivery system (social retrenchment, self-care), nevertheless, the government has been unable to retrench politically in spite of its present direction of cost containment and fiscal restraint. Consequently, the social welfare functions may continue to be performed in spite of cost restraint policies. As a result, another “no-care zone” is created and policy makers will continue to develop “crisis policy” such as intense demands to hold unit costs low.

Home care has expanded many of the options and emerged as a salient segment of our health service system. Yet, policy makers have not developed a comprehensive home care system, particularly one that defines a common policy for home care benefits and engenders the right kind of public-private partnership for the delivery of quality home care. However, if the level of receptivity we experienced during our recent visit is an indication of the willingness of policy makers to better understand the value of home care, there certainly is hope for the future.

Progress will only come by continuing to demonstrate our value through data and educating policy makers. As the framework for competitive bidding continues and standards are developed, we have seen an increased awareness and willingness of legislators to understand our industry. If this is an indication of home care’s validation, then again, there truly is hope. We urge everyone to become involved and remain active in the process—not just during a single conference, but on an ongoing basis.

Lisa M. Getson is executive vice president, Government Relations, Investor Services & Compliance, Apria Healthcare, Lake Forest, Calif. Vernon R. Pertelle, MBA, RRT, CCM, is national director of Respiratory/HME Services for Apria.