On Monday, Senator John Kerry sent a letter to Harry Reid, Max Baucus, Christopher Dodd, and Tom Harkin, urging them to "protect access to home health care" as they work to finalize health care reform legislation. You can download the letter here. The letter mentions that if the House cuts are enacted, by 2011 more than two-thirds of home health providers will be reimbursed for services at a rate that is less than the cost of care. The letter does not state it explicitly, but the conclusion to be drawn is two-thirds of the Medicare home health providers will either go under completely or pull out of Medicare.
Unfortunately, the letter goes on to mention the Senate's proposed cuts as a "responsible level" for home health care cuts. I continue to maintain that the Senate's cuts are very damaging to the industry, but I will concede they are less severe than the House's proposed cuts. They are also phased in over a longer period of time, which gives providers more time to adjust (or retire). Unless health care reform gets completely derailed (which, in my opinion, is the best outcome), the Home Health industry is going to end up with cuts. The Senate bill simply denotes the floor of those cuts.
Today, in Roll Call, there was an article stating that the negotiators are facing real difficulties. Due to this problem, they are not likely to have a final bill until February. Some are indicating it may be even later than that. This means there is still time to educate your representatives and Senators. I know I keep beating a dead horse, but I fear that many in the home health industry may have simply accepted that these cuts are inevitable. Ultimately, we may see these draconian cuts enacted, but as long as the bill is stalled on the Hill, you can continue to make noise.
Some of Senator Kerry's points in his letter are worth noting to your Senators and Representatives (you can mention that 32 of their colleagues in the Senate agree with these points):
These cuts will reduce access to the home health care
The populations served by home health are truly vulnerable
People prefer to stay in their homes and receive care
Another point to keep hammering away on is that home health care is very cost effective. Why reduce access to cost effective care at a time when everyone wants to "bend the cost curve." Finally, you may want to reiterate the reality that home health providers do not operate with the margins that MedPAC thinks you do.
I know I am repeating myself, but you need to keep trying to persuade your elected representatives that voting for these cuts will harm their constituents and cost Medicare more in the long run. Until the bill is signed, there is still a chance we can change it and, at a minimum, get the lower cuts enacted in place of the House's cuts.
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