homecaremag.com/news/joel-marx-cspan-20090908/ -
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Last Visited: 9/8/2009
WASHINGTON-Home medical equipment provider Joel Marx stood up for home care on C-SPAN's Saturday edition of Washington Journal, pressing the point that home care could save billions of dollars for Medicare and private insurance companies.
"Home health care is one of the ways that we can save money for Medicare.
People prefer to be cared for in their homes; it is the most cost-effective health care we can have," Marx told program host Libby Casey.
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Marx, owner of Medical Services Company in Cleveland and a board member of the American Association for Homecare, represented the organization.
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Marx fielded questions from both the host and callers, managing to hit many of the HME sector's hot topics during Saturday's half-hour segment.
On home health care: "There are several ways that we can save Medicare dollars within health care-getting more people included with some sort of insurance so they see a physician before they go to the emergency room at 10 at night; getting people to take control of their health care and doing preventative health care; and transferring a lot of services to the home rather than to a long-term care facility or a hospital."
A caller with muscular dystrophy noted, however, that Medicare does not cover a lot of the items and/or services she needs to stay in her home.
"Home care is the solution, and providing these services in the home would be less expensive to the system," Marx replied, adding that this does not, however, appear to be the way Medicare is going.
"One of the choices Medicare seems to be making," Marx said, "is to limit access to the type of items you need.
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"I don't know of any empirical data comparing recovery rates; I do know there is data that says patients would prefer to be home," Marx responded, adding that in the last 20 years medicine has made enormous strides and now, even patients on dialysis and those needing infusion and home inhalation drug therapy can be treated at home.
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The bills currently being discussed by both legislative bodies would pay for this accessibility in part by doing just the opposite of expanding home care coverage and instead "ratcheting down the reimbursement rates," Marx said.
On home oxygen: "Since 1997, Medicare and Congress have reduced the reimbursement level for home oxygen for patients who prefer to be in the home utilizing oxygen, and these [reductions] have been considerable … almost 50 percent over the last 12 years," Marx told viewers as a chart showing the cuts was screened.
"We're at a point where further reductions are going to start affecting the outcomes patients will have."
The ability of patients to ambulate and retain their vitality in the community will be compromised, he said.
A California caller questioned why her father, who lives in Florida, was having so many challenges with his oxygen and inquired about the 36-month home oxygen rental cap that was implemented Jan. 1.
Marx explained the cap and noted: "After 36 months, Medicare has chosen to stop reimbursing the provider for two more years.
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This is particularly hurtful to the millions of patients who use oxygen-medical oxygen ordered by their physician"-and who are unable to breathe on their own, Marx said.
He noted that medical oxygen nurtures their organs more effectively and provides greater saturation in the bloodstream.
Vladeck's comment, Marx said, was "unsympathetic" and "seemed particularly hurtful.
Perhaps he wasn't aware of what the services actually were that are provided."
On competitive bidding: Host Casey referenced a study on DMEPOS competitive bidding by Brian O'Roark, PhD, and asked Marx to explain the program.
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"Congress has proposed this program, which is being implemented right now in 10 market areas of the country," Marx said.
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Marx said that, like many other HME providers, his company has a high ratio of Medicare patients.
About 60 percent of his revenue comes from Medicare, he said.
A Florida provider, noting that he was aware the initial Round 1 of the competitive bidding project had been delayed by Congress last year, inquired about the changes CMS has made to the new round.
"Last year, Medicare awarded contracts to providers around the nation who were not licensed in the state for which they won the bid," Marx responded.
"It was inappropriate and it would hurt patients ... Medicare has made some changes; I'm not sure what they are."
Emergency service: Responding to a California caller's remark about the good service oxygen patients continued to receive in spite of being in the area of the state's wildfires, Marx explained that HME providers serving Medicare patients must be accredited and that accreditors require them to maintain services and availability in case of an emergency.
"All home medical equipment providers have elaborate back-up plans, so at 3 in the morning when the power goes out and [patients] are evacuated from their homes, you have back-up tanks, you provide them with portable oxygen.
These are all items that are not reimbursed directly by Medicare."
On the increasing need for home health care: Noting that "we have an aging population," a home health case manager called in to stress the growing necessity for home health care.
Marx took that occasion to press the need to get that message to legislators.
"This is something we all need to talk to our legislators about, the need for increasing services for patients in their home," he said.
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