Home Health & Hospice Week

But physician fix could doom home care reimbursement anyway.

After a double whammy from President Bush and the Medicare Payment Advisory Commission for 2007 payments, home care providers are finally seeing a positive legislative development.

The Senate Budget Committee March 9 passed a budget proposal that includes no cuts for Medicare, Medicaid or other entitlement spending programs. The budget blueprint goes against President Bush's call for $65 billion in such cuts over the next five years, including more than $4 billion in home health agency and hospice reductions (see Eli's HCW, Vol. XV, No. 6).

The proposal "lets the Senate Finance Committee off the hook" for finding Medicare cuts for next year, notes Kathy Thompson with the Visiting Nurse Associations of America. "That's excellent news."

There aren't enough Senate votes to pass a budget with such entitlement spending cuts, noted Budget Committee Chair Judd Gregg (R-NH) upon passing the proposal. Republican leadership in the Senate doesn't want to expose its members to such unpopular cuts in an election year, Thompson observes.

What's next: Now all eyes turn to the House to see what it will include in its budget proposal. Thompson predicts at least some Medicare cuts. But the National Association for Home Care & Hospice says infighting among Republicans and the unpopularity of the cuts in an election year may forestall their inclusion in the House proposal.

More than 60 moderate House Republicans sent House Budget Committee Chair Jim Nussle (R-IA) a letter saying they oppose the President's proposal to cut $37 billion from Medicare over five years.

Alarm: Home care providers should be most worried about fallout from physician payment changes. Like this year, Congress will need to intervene to avert a 4 percent cut to Medicare physician payments in 2007--and is very likely to do so.

When lawmakers look around for how to fund the physician bail-out, home care is likely to be on the chopping block. "That's what we're most worried about," Thompson tells Eli.

"The need for cuts to offset/bankroll a physician payment fix ... is the biggest threat to Medicare payments for other providers," NAHC agrees.