Election 2004

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Sunday, October 31, 2004

Kerry stumps for more home healthcare; the president wants to see how MMA changes pan out

We asked the Bush and Kerry campaigns a series of questions about home-based health care, competitive bidding, the FEHPB-based payment rate reductions, fraud and HCPCS coding. A senior health policy advisor for the Bush/Cheney campaign answered with a single statement. A Kerry/Edwards adviser answered in greater detail. (For the sake of brevity, our questions precede the Kerry campaign’s replies only.)

To insure the accuracy of their oral answers, we transcribed the answers and sent them to the campaign office for review and revision if necessary. Those versions are provided here.
The Bush campaign

“The items listed in your questionnaire all stem from action taken at the congressional level. The evidence of fraud and abuse within the Medicare system is clear and irrefutable. Drastic, sometimes painful steps must be taken to protect the Medicare Trust Fund. President Bush and his advisors are quite aware of the concerns of your industry and wish to work with the industry to insure that public funds are spent responsibly and that the provider network remains a viable force to meet legitimate needs of providers and their customers.

“Some of the suggestions contained in your questions deserve thoughtful review. However, at this point in time the administration would like to see how the reforms contained in the MMA work before proposing new initiatives. Nonetheless, we welcome the opportunity to receive and discuss industry generated ideas for reducing fraud and creating efficiencies within the Medicare program as well as other healthcare programs.”
The Kerry campaign
HME News: Various independent academic studies show that significant savings can be obtained by placing a stronger emphasis on providing health care in the home; that clinical outcomes are equal to or better than facility-based care in certain cases; and, the overwhelming majority of Americans age 55 and older prefer to receive long terms care in their homes. Will your administration support expansion of the role of home-based health care and remove the current biases that favor SNF and other facility-based care?

Kerry Campaign: “Home-based health-care must be seen as part of the solution to driving down what our nation is paying for long-term care. The fact that it is preferred by an overwhelming majority of our senior citizens and is widely accepted as clinically appropriate by physicians is a bonus. We must offer clinicians and their patients a continuum of options without any incentives associated with one or the other. As president, John Kerry will create a level playing field where home-based healthcare can compete with facility-based care for a variety of acute and long-term healthcare needs.”

HME: The GAO and OMB have both questioned the data upon which two onerous provisions of the MMA affecting the HME industry were based. Will your administration take the steps necessary to ensure that public policy is based on accurate and relevant statistical data? Will your administration suspend the implementation of such initiatives as nationwide competitive bidding and basing Medicare fee schedules for HME on the fees paid to the various plans included within the FEHBP?

HME: “All substantive policy related to healthcare must be based on sound actuarial data and subjected to a thorough and vigorous public debate. Unfortunately the issues of competitive bidding, FEHBP-based pricing and other issues were literally rushed through in the dead of night by Republican leadership with, at a minimum, the acquiescence of the Bush White House. These policies have become law without being exposed to this essential process. As president, John Kerry will form an advisory panel composed of representatives of the administration (OMB & CMS), clinicians, independent actuaries and representatives of the HME services industry to review and, if necessary make recommendations to modify these provisions. If possible under MMA, implementation of the FEHBP-based adjustments will be suspended until the report of this advisory panel is completed.

Competitive bidding is a horse of a different color. Nationwide competitive bidding as proposed in the MMA is not true competitive bidding. Instead, it is nothing less than government sponsored price fixing. As president, John Kerry will send this provision back to Congress with a demand that they find defensible actuarial data to support the need for a competitive bidding program and then, if justified, design such a program in a way similar to those used in the private sector. Competitive bidding done correctly is a good idea that can reduce spending and be fair to all providers and consumers.”

HME: The HME services industry acknowledges that a small number of providers have taken advantage of the system and submitted fraudulent claims to the Medicare program. The industry supported the proposal to include mandatory accreditation in the MMA as a way to help separate the small number of scoundrels from the larger number of legitimate and ethical providers. Will your administration sit down with industry representatives to discuss accreditation and any additional methods for reducing fraud and abuse within the Medicare system as partners rather than adversaries?

KC: “Fraud and abuse within all federal spending programs must be reduced if not eliminated. However, unlike the current administration the Kerry/Edwards team realizes that the best way to catch a crook is to provide incentives so that those affected by their larceny, report them. John Kerry realizes that there must be a partnership between legitimate providers and the government to identify fraudulent operators and put them out of business. Working hand-in-hand with the HME industry, John Kerry will raise the bar for all providers to insure that only ethical businesses operating with the best interests of their patients in mind are allowed to participate in federally funded programs. The Kerry administration will look to the industry for suggestions and guidance on such things as accreditation and licensure.”

HME: A major reason for confusion, difficulties and errors in claim processing in the Medicare program stem from the fact that the HCPCS coding system needs major revisions. In fact, the inadequacy of the HCPCS system makes it easier for criminals to engage in fraudulent activity. Will your administration institute an aggressive program for overall review and revision of the HCPCS coding system?

KC: “The HME industry is not the only group of healthcare providers who have raised the issue of the inadequacy of the HCPCS coding system. Physicians, hospitals and others have all complained about the fact that the HCPCS coding system has not kept up with the explosion of new technologies in healthcare. All coding systems should be regularly reviewed and revised. As president, John Kerry will direct (CMS) to begin an immediate and comprehensive program to review and revise the HCPCS coding system. His directive will include instructions that clinicians, private payers and providers be included on all the working groups associated with this initiative. Any changes proposed by CMS during the 12 months preceding his inauguration will be subject to vigorous scrutiny and review.”

Concluding Statement from Kerry Campaign: “Senators Kerry and Edwards are acutely aware that the current administration has used the HME services industry as a whipping boy to make itself look tough on the issue of healthcare fraud and abuse. They know that fraud and abuse occurs and that it occurs in greater amounts and with greater frequency among other healthcare providers. Unfortunately, as the newest kids on the block, HME has been targeted and targeted unfairly. You can count on John Kerry to treat your industry the same as he will treat any other industry engaged in addressing the healthcare needs of Americans. The costs of doing any less, in terms of quality of life, are too great to do otherwise.”

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