Cuts to HME: Reform report leaves door 'wide open'

Sunday, May 24, 2009

WASHINGTON - A Senate Finance Committee report released last week that outlines options for financing healthcare reform names HME reimbursement as a possible revenue source, but it doesn't propose specific cuts.

The report has left industry stakeholders uncertain.

"They've left themselves wide open to do anything they want to do," said Cara Bachenheimer, senior vice president of government relations for Invacare. "They did this in every area of the report--leaving themselves options to cut whatever they want later on without locking themselves in to anything. That doesn't give us a whole lot of comfort."

The committee, which included in its report a section titled "More Appropriate Payment for Durable Medical Equipment," plans to examine whether certain DME items are overpaid or underpaid. The Office of Inspector General (OIG) has identified items that it considers overpaid: oxygen, power wheelchairs and negative pressure wound therapy.

The report's vagueness may not be such a bad thing, said Wayne Stanfield, president of the National Association of Independent Medical Equipment Suppliers (NAIMES). In 40 pages, it only mentions HME in three paragraphs, he pointed out.

"To me, (the reference to more appropriate payments for DME) seems to be an indication that the committee is going to look at HME more broadly," Stanfield said. "For oxygen, for example, there needs to be some changes to reimbursement related to service."

The committee could decide that some DME items are underpaid, but providers shouldn't hold their breath, industry stakeholders said.

 "Concern has been raised that the 9.5% cut disproportionately harmed complex rehab, so that is one area that could be considered underpaid," said Walt Gorski, vice president of government affairs for AAHomecare. "However, in this environment, it will be a tough sell to increase payments."

Providers need to remain diligent in their grassroots efforts, industry stakeholders said. The Memorial Day recess next week is a good time to weigh in on the report, as well as build on the momentum for the 36-month oxygen cap and the 9.5% cut, both of which went into effect Jan. 1.

"There has been a significant amount of pushback from patients and providers since Jan. 1," Stanfield said. "I think many members of Congress are being told that there is more to providing HME service then the piece of equipment."