Home Health & Hospice Week

President's 2007 budget brings more bad news for home care.

The 2006 budget reconciliation bill passed and that won't do HME suppliers any favors. The upside is there's still time to regroup before the bill's impact hits suppliers' pocketbooks.

The home medical equipment industry fought the bill (S. 1932), which included provisions moving oxygen to a capped rental after 36 months and limiting other capped rental payments to 13 months. Congress passed the bill Feb. 1, with a final tally of 216-214 ...quot; an incredibly close margin.

"It's a disaster," says Mike Hamilton of the Alabama Durable Medical Equipment Association and the Georgia Association of Medical Equipment Services. Moving oxygen equipment to capped rental was ill-conceived and ill-advised--it needs to be changed, he says. Patients taking ownership of oxygen equipment creates the frightening potential for a dangerous used oxygen equipment market, Hamilton cautions.

To combat legislation like this, HME needs to be a stronger, more vocal presence on Capitol Hill, experts urge.

HME needs to turn up the heat with its lobbying efforts, says attorney Jeff Baird with Brown & Fortunato in Amarillo, TX. The industry as a whole "needs to become more aggressive and outspoken on the Hill than it has in the past," he says.

HME is a relatively young industry compared to physicians and pharmacy and doesn't have a long-established voice like the American Medical Association or the National Community Pharmacists Association, observes Baird. "We as an industry have our work cut out for us to educate the folks on Capitol Hill," he says. Most politicians "wouldn't know an HME from a kumquat; at least politicians know what doctors do."

A glimmer of hope: Alabama and Georgia association members joined other state associations and the American Association For Homecare in expressing their concerns about the bill to congressional representatives before the final vote, Hamilton reports. Response was fairly positive, with most representatives agreeing to consider supporting legislation to help change the HME portions of the bill.

Industry Regroups For Next Phase

AAHomecare is considering near-term and longer-term steps to address the issues raised by the bill's passage, the trade group says in a release.

Waiting for national agreement about which course of action to take is the best plan, says Hamilton. "It would be counter-productive to have multiple attempted changes underway and have people fighting over which one to support."

But some HME folks feel the need to run off and do battle while the issue is still fresh in everybody's mind, says Hamilton. "It's not going to change next week," he advises. Even with the 13-month capped rental changes, the industry won't feel the effects for over a year when those rental periods come to an end. "So, we've got some time to make some changes before it actually impacts anyone's pocket book," he says.

The industry has time to reverse this legislation and to push the Hobson-Tanner bill, says Baird. The bill (H.R. 3559) introduced by Reps. David Hobson (R-OH) and John Tanner (D-TN) modifies many of the competitive bidding requirements for home care that were included in the Medicare Modernization Act of 2003.

HME suppliers need to keep enthusiasm high and their level of concern up, but not excessively, advises Hamilton. "[We need to] improve grass roots lobbying capability while we're coming up with a national plan."

President's Budget Deals Another Blow

On the heels of the 2006 budget bill disappointment comes the fact that President Bush's fiscal year 2007 budget proposal holds more bad news for HME.

The budget, released Feb. 6, proposes capping oxygen equipment rental at 13 months, down from the 36-month cap suppliers won in the 2006 budget reconciliation bill. The budget also includes an adjustment to payments for short-term power wheelchair use based on actual time used.

"Continuing cuts to home care erode" its cost-effective infrastructure, AAHomecare chair Tom Ryan says in a release.