If you have seen a lot of stories in the local paper about Medicare payment cuts to home health agencies, the National Association for Home Care is probably responsible.
The home health industry, led by the NAHC, has launched a massive lobbying campaign to change or eliminate the new Medicare home health reimbursement system being implemented by HCFA. The agency is engineering a transition to a prospective payment system for the home-care industry, which now receives about $20 billion in Medicare funds annually.
The industry also is concerned about a requirement in last year's balanced-budget law that every home health agency that does business with Medicare and Medicaid carries surety bonds.
According to several members of Congress and congressional aides, the NAHC effort has been one of the most concentrated in recent memory.
"The home health people are just screaming about (the new payment system)," says Sen. Don Nickles (R-Okla.). "All I know is that we have a time bomb on our hands."
"It's like nothing I've ever experienced," says one House aide, who asked not to be identified.
The cornerstone of the industry's efforts is a campaign that has thousands of agencies and beneficiaries contacting Congress. The National Association of Home Care released a "grass-root action plan" through its World Wide Web site. The plan instructs agencies on how to do everything from write a press release ("Be firm with your opinion but avoid being fanatical") to meet a member of Congress ("Relax, there is nothing magical about meeting with legislators").
Some of the efforts have bordered on the comical. Several congressional aides received videotapes of home health workers helping seniors to the strains of the Hollies song "He Ain't Heavy, He's My Brother."
Other groups also have joined in. The Visiting Nurse Associations of America has started a corporation devoted to lobbying the reimbursement issue, according to Kathy Thompson, director of government affairs for the VNAA.
The VNAA and the NAHC declined to say how much they're spending, and public disclosure documents don't reflect the most recent figures.
The groups have made some headway. At a recent hearing of the Senate Aging Committee, Sen. Charles Grassley (R-Iowa), the committee chairman, and Sen. John Breaux (D-La.), the ranking minority member, expressed concern about the new payment system. Breaux told the committee HCFA "ought to scrap the entire interim payment system."
The groups also have found sponsors in both the House and Senate for bills to revise the new payment system. The Senate bill was introduced April 28 by Sen. Susan Collins (R-Maine), whose campaign finance chairman is an executive at a Portland, Maine-based visiting nurse agency.
But the campaign also has detractors. House Ways and Means health subcommittee Chairman William Thomas (R-Calif.), along with three House members, sent a letter to other representatives denouncing the NAHC's tactics.
Thomas accused the NAHC campaign of trying to "manipulate innocent seniors, the media, the members of Congress with half-truths and misrepresentations."