Home Health & Hospice Week

The universal health care legislation winding its way through Congress may be good news for uninsured Americans, but it's not looking good for home care providers. The House of Representatives on Nov. 7 narrowly passed a health care reform bill (H.R. 3962) that would cut about $55 billion from Medicare home health agency payments over the next 10 years, notes the National Association for Home Care & Hospice. Another $8 billion is targeted from hospice payments.

"We cannot tolerate a level of cuts that results in our inability to serve the Medicare patients who are so sick with multiple chronic diseases that they cannot leave home without assistance and require physician-ordered, skilled nursing or physical therapy services," NAHC insists.

"The Visiting Nurse Associations of America is extremely disappointed with the level of across-the-board cuts included in the House health reform bill," the trade group says. VNAA"supports a targeted approach to applying home health cuts to preserve services for vulnerable patients, rather than across-the-board cuts to all providers," it says.

The cuts "will severely impact safety net home health agencies' ability to care for vulnerable patients who are typically low-income and have medically complex needs," VNAAPresident and CEO Andy Carter says in a release.

The bill is also mostly bad news for durable medical equipment suppliers, notes the National Association of Independent Medical Equipment Suppliers. But it doesn't address the industry's two most pressing concerns: the oxygen cap and competitive bidding.

What's next: Now all eyes are on the Senate as Democratic leaders there try to push through their own health care reform legislation. Observers predict a tough road ahead in the Senate for a reform package, but pressure from President Obama may spur senators to take action on the issue.

The home care provisions of a Senate bill are still up in the air. Industry observers hope a Senate bill would be kinder to home care payment, but it may end up being just as harsh as the House bill as lawmakers look for ways to pay for reform.

Even if the Senate can manage to pass a reform bill in the next few weeks, the House and Senate would have to reconcile their two versions and approve the resulting compromise bill before sending it to the president. That would put passage of a reform bill in late 2009 at the earliest, NAHC notes.

Even though the House bill and potential Senate version contain steep home care cuts, providers shouldn't lose hope, the trade group insists. "The outlook for the home care and hospice community is excellent," NAHC says. "There is a great deal of discussion on Capitol Hill about the home care community being saddled with unfair and disproportionate cuts."

Do this: Home care providers should emphasize to their representatives the cost-saving nature of home care overall, advises NAHC, which is planning a "March on Washington" lobby effort in December.