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George Will Column Misguided in Touting 'Competitive Bidding' as a Medicare Solution; Controversial Bidding Program is Actually Anti-Competitive and Lowers Quality of Care and Access to Care for Seniors and Disabled
Date:1/8/2009

ARLINGTON, Va., Jan. 8 /PRNewswire-USNewswire/ -- A congressionally mandated "competitive bidding" initiative for home medical equipment -- already the slowest-rising cost in Medicare -- intended to reduce homecare costs will only succeed in reducing the quality of, and access to, care for patients and will drive up costs elsewhere in Medicare. Washington Post columnist George F. Will's recent column on healthcare overlooks the inherent flaws in the bidding program, and fails to recognize that homecare providers already offer what Health and Human Services Secretary Mike Leavitt has called a "radically more efficient" and cost-effective setting for healthcare than institutional care.

"There is nothing competitive about what will result from this misconceived program," said Tyler J. Wilson, president of the American Association for Homecare. "There will be fewer competitors, fewer homecare services, and lowest-common-denominator healthcare for older Americans and people with disabilities who require medical care at home."

"This bidding initiative will end up selecting a small group of providers that will be forced to deliver the cheapest, lowest quality equipment and cut back on critical services including emergency repair, middle of the night oxygen service, and home visits to address serious patient issues. It is a disaster for senior citizens and disabled patients, especially those who live in rural areas since those areas are already expensive to serve," added Wilson.

The program would allow the government to selectively contract with only a small group of providers. By focusing solely on the lowest-cost, the program would force out providers who utilize high-quality equipment or provide critical services to patients related to the use of that equipment. Under this program, seniors and other homecare patients will face:

  • Longer, more costly hospital stays since hospitals could no longer choose to use a single homecare provider to equip patients returning home, but instead would have to contact as many as 10 different providers for basic items needed by patients.
  • Lower-quality durable medical equipment made overseas.
  • Fewer home visits in rural areas where providers can travel an hour plus to reach the patient.
  • Less access to 24-hour equipment service for patients who depend on oxygen to breathe. Without this service, patients will dial 911 when problems arise.
  • Reduced access to commonly prescribed products. For example, the bidding initiative discourages use of the most commonly prescribed testing strips for diabetes patients.
  • Reduced access to diabetes patient call centers, which answer key medical questions.
  • Fewer resources to properly set up and adjust wheelchairs, walkers, and hospital beds.
  • Restricted ability to properly repair home medical equipment items in a timely manner.

Cutbacks in homecare services will increase hospital stays, thereby increasing costs to Medicare and taxpayers. Wilson said, "Homecare represents a clinically proven, cost-effective option that is part of the solution to the nation's healthcare crisis."

The latest federal data shows that spending on home medical equipment is again the slowest-growing sector in Medicare, with homecare proving to be one of the smallest sectors, constituting $7 billion out of the $431 billion Medicare budget. The latest figures in the National Health Expenditures report published in Health Affairs this month show Medicare spending for home medical equipment increased only 0.9 percent over the previous year for which data is available (2006), while Medicare spending generally increased by a full 6.1 percent.

A program that selectively contracts with a small group of providers to care for seniors based primarily on price is fundamentally flawed. Not only does the program sacrifice quality of, and access to, care for patients, it has the opposite affect intended: it clears the marketplace of competition by reducing the number of eligible providers. During a trial period of enactment in 2008, of the more than 4,000 providers in the initial bidding areas, only 376 were deemed to have met the bidding program requirements, which were not clearly defined. So 90 percent of the marketplace was closed out of the bidding program, proving that the program depresses competition and limits patient access and choice.

In a recent Washington Post column, George Will overlooked the larger questions about whether a program that aims for the cheapest cost of care with no regard to patient outcomes is the ideal basis for policy to care for older Americans and people with disabilities. A program designed to cut the number of providers would inevitably reduce the ability of Medicare to serve the growing numbers of seniors and other patients who require medical care at home, especially in rural regions. The program constructed by Medicare ignores the services required to provide home medical equipment and therapies and treats home care as if it were a commodity, instead of recognizing it for what it is -- a life necessity.

Contacts: Michael Reinemer, 703-535-1881, michaelr@aahomecare.org; Tilly Gambill, 703-535-1896, tillyg@aahomecare.org.

The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org.


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SOURCE American Association for Homecare
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