Home Health & Hospice Week

Avoiding a copay this year was a major victory, says William Dombi, vice president for law with the National Association for Home Care & Hospice's Center for Health Care Law. "We've come out well in comparison to where we were" when legislation first was proposed, Dombi says. "We had a very tough battle" to get the copay out of the pending bill, he adds.

Beating the copay this year "seemed to be an insurmountable goal," agrees Visiting Nurse Associations of America President and CEO Carolyn Markey in a message to members. The home care industry's grassroots efforts ultimately "was a force that could not be defeated," she says.

But that doesn't mean the legislation is a bed for roses for HHAs. "Reductions in the HHMBI will negatively affect VNAs' missions and disproportionately harm non-profit home health agencies," Markey says in a Nov. 18 letter to Senate Majority Leader Bill Frist (TN). The reduction "will further erode VNAs' ability to serve as safety-net providers in their communities by cutting into their miniscule budget margins or budgets already in the red."

The -0.8 reduction factor is a bit better than the originally proposed -0.9 one, allows John Beard, president of Alacare Home Health and Hospice based in Birmingham, AL. But for Alacare, the losses from three years of inflation cuts still will outweigh the gains from one year of a 5 percent rural add-on, Beard judges. Alacare does about 60 percent of its business in rural areas, he says.

Was the Copay Victory Worth the Price? 

The MBI reduction generally is thought to have come in lieu of the originally proposed copay. But the trade-off may not have been the smartest move in the long run, Beard worries.

The copay "appears to be an issue that will not go away based on the philosophy of some members of Congress that all services need a copay," Beard tells Eli. HHAs are receiving cuts that may mean "not having enough revenue to properly fund current patient care and address future needs," he says. And at the end of the day, copays may be imposed anyway.

But if this bill passes, another major Medicare package won't come along for at least another few years, Dombi predicts. And if lawmakers try to pass a copay in a year when there isn't something as distracting as the Medicare prescription drug bill to take attention away from the matter, it will be much more difficult to sneak it past Amer-ica's seniors.

When calculating their gains or losses, HHAs should remember to factor in the added overhead costs of collecting the copay, Dombi says. The paperwork and billing burden associated with a copay, which often may be uncollectible, can be steep.

Finally, once Congress gets its foot in the door with a modest copay (this year's proposal was 1.5 percent), lawmakers will be eager to ratchet it up to "match" other providers' larger copays, Dombi forecasts.

Most troubling in the long term are the bill's provisions encouraging privatization of the Medicare program, judges VNAA's Kathy Thompson. Medicare HMOs are notorious for limiting home care services to the bare minimum.

The proposed managed care plan, which could cover 15 percent of Medicare beneficiaries just in its pilot phase, "will be devastating to home- and community-based care in this country," Markey insists in the letter.

"Home health coverage will be severely restricted under the comparative cost adjustment program in comparison with the current Medicare program," the letter says.

Editor's Note: The compromise legislation summary is at http://waysandmeans.house.gov/media/pdf/healthdocs/confagreement.pdf.