Medicare’s looming changes to home health care to hurt many

From: The Bakersfield Californian

by Allen Kennedy

The Medicare program as we know it today is in the midst of many changes. For some individuals, the word Medicare brings to mind government assistance and provisions for physician visits, hospitalization or surgical procedures. However, for those who need assistance at home, it means so much more. For these individuals, Medicare has provisions for home-based medical equipment that allow them to be cared for by a home health nurse or family member and, in many cases, remain independent within their own home.

But these benefits will change in the coming months. A few weeks ago, Medicare announced that on July 1 substantial changes will come to the existing Medicare provisions as it relates to government-provided home care for 70 percent of the nation. These changes began in 2003, when the home medical equipment industry was informed that Medicare would begin to implement competitive bidding. Kern County was not part of the first-round bidding process; the only California area affected was Riverside County. But the round two bidding process will drastically affect Kern County.

Because of new regulations and government processes, many patients will no longer have the ability to choose a local supplier, and this will be a major blow to small business. Businesses that currently supply wheelchairs, walkers, hospital beds, special mattress systems, diabetic testing strips, oxygen, CPAP, enteral feeding, and wound therapy will all be negatively affected. Even more troubling is the fact that the consumer will have multiple suppliers within the home and many of these suppliers have no presence in the state of California. This will result in a lack of accessibility to equipment and supplies needed by the patient.

I currently own a local medical business that is 7 years old and we employ 13; my roots are in Bakersfield, where I have served Kern County residents for more than 35 years. However, even I am now looking at the possibility of having to cut my staff in half as we approach the looming deadline of July 1. The unrealistic cuts of 45 percent go beyond the profits of even large national firms, and to make things worse, in the second round of bidding only 867 companies have been offered 14,654 contracts nationally. Many local providers have not been offered a contract and will need to decide how to go forward without supplying Medicare patients as part of their business plan. For this reason, the Home Medical Equipment Industry continues to encourage House and Senate lawmakers to get answers from CMS about the second round of competitive bidding and is warning them that this will lead to an implosion of the country’s home care system.

The problem with the CMS bidding program is very clear and evident. Winning bidders were not bound to their bids — and I have never seen a government bidding program that was non-binding. The other issue is that the payment rate may be more or less than the amount that you bid. CMS has had no transparency during the bidding process with providers or Congress. Congress has been advised by 244 economists and action experts that this will severely damage patient access. There are 184 members of Congress and 30 patient and consumer groups that support fixing the CMS bidding program. There is an alternative that is budget-neutral known as the Market Pricing Program; this program has been developed by experts in the field of government actions. The MPP would address all of the critical problems while still setting fair market prices.

Almost all of our families have aging parents and those failing in health. For these individuals, basic home care equipment and services are necessary. Within my own family, medical equipment was necessary to allow family members to avoid placement within a skilled nursing facility. If Congress does not take action, beneficiaries will lose access to the high-quality products and services that keep them safe and secure in their homes. I along with other home medical equipment industry providers and a multitude of manufacturers urge Congress to stop this flawed bidding program scheduled to be implemented on July 1.

Allen Kennedy of Bakersfield has owned a local medical business for seven years. Community Voices is an expanded commentary of 650 to 700 words.