Home Care Field Beset by Change

Vol. 20 •Issue 20 • Page 24
Home Care Field Beset by Change

Home care professionals have their hands full these days coping with a flurry of budget cuts and government mandates that are changing the way they do business. At least they have a friend in high places, though. One of their own, David Davis, BS, RRT, a former home care therapist and DME supplier, won a seat in the U.S. Congress in 2006.

“Being a member of Congress gives me the opportunity to highlight the importance of good quality health care at all levels,” said Rep. Davis (R-Tenn.), the first-ever RT elected to Congress. “Home care is part of that equation, and I think it can be provided in a cost-effective manner—more so than in an institution.”

Davis and others will be watching—a bit warily—this October, when Medicare’s overseer, the Centers for Medicare and Medicaid Services (CMS), begins replacing the current DME payment structure with a new competitive bidding process.

Starting in 10 metropolitan areas and then gradually taking effect around the country except for rural areas with small populations, DME suppliers will be required to submit bids to furnish medical items such as supplemental oxygen to Medicare beneficiaries.

Race to the Bottom?

Medicare officials hope to save the struggling entitlement program up to $1 billion annually when competitive bidding for DME is fully implemented in 2010.

Davis and other critics, however, worry that suppliers will be tempted to skimp on quality in a race to submit the lowest bid. Also, if the same bidders win contracts time and time again, “we have to look at the potential for monopolies,” he warned. “That wouldn’t be good for the quality of care in the future.”

The American Association for Homecare, an organization based in Arlington, Va., represents DME suppliers. That group flat out opposes competitive bidding. “We believe that the harm to the nation’s home care infrastructure caused by competitive bidding will cost the nation dearly in the long run,” Michael Reinemer, vice president of communications and policy, told ADVANCE.

No assessment of possible savings to be had from competitive bidding would be accurate, Reinemer added, without factoring in “the full administrative and bureaucratic costs of creating and implementing” such a program.


Medicare also recently ruled that home care patients must take ownership of their home oxygen equipment after renting it for 36 consecutive months.

Many pulmonary organizations, including the Virginia-based group NAMDRC, an organization representing medical directors of respiratory care departments, oppose this step as well.

With this new rule, the day-to-day responsibility for making sure home oxygen equipment is working properly falls on patients, and they may not be qualified to make that judgment, pointed out Philip Porte, NAMDRC’s executive director. “How many patients know if their concentrators are putting out the proper percentage of gas?” he asked.

CMS officials claim rent-to-ownership will reduce the co-pays of Medicare beneficiaries, according to Porte. But CMS fails to consider that patients will have to pay out of pocket to maintain their oxygen systems, he said. “Is it easier to maintain a three-year-old car or a brand new car,” Porte asked. “An oxygen system is more likely to need attention once it’s owned by the patient.”

Homecare Telehealth

On another note, the nascent field of home care telehealth, also known as remote patient monitoring, is “gaining traction and has already surpassed the clinical telehealth market” due to an aging population and ongoing shortages of health care providers, according to the independent market analysis firm Datamonitor.

In a new report titled “Telehealth’s Increasing Role in Healthcare,” Datamonitor predicts the home care telehealth market will grow at a 5 year compound annual growth rate of 56 percent, compared to 9.9 percent in the clinical market.

Telehealth refers to the use of a digital network to provide automated monitoring and treatment delivery to a patient in a different physical location than the medical expert providing the treatment. It includes remote video conferencing, home monitoring devices and remote robotic surgery.

Diabetics, for example, “would be able to transmit their blood sugar levels to their providers for review via a telephone line from the comfort of their homes,” the Datamonitor report reads. “Telehealth can decrease overall health care costs by monitoring patients daily and preventing them from requiring emergency care and expensive re-hospitalizations.”

However, lack of reimbursement remains an obstacle to further growth. “With no financial incentive for health care providers to implement the technology, providers are likely to view telehealth as an increase in workload without a subsequent increase in pay,” said Christine Chang, author of the report.

Michael Gibbons, senior associate editor, can be reached at [email protected].