Collins and care

On behalf of the Visiting Nurse Associations of America (VNAA), I want to thank you for increasing public awareness of the plight of home health care, which was addressed in your June 5 editorial “Rebuilding Home Care.” VNAA is the national membership association for non-profit Visiting Nurse Agencies (VNAs) — the providers who created home health care in this country over 100 years ago.

VNAA agrees wholeheartedly with you that the Balanced Budget Act of 1997 (BBA) has inadvertently devastated the Medicare home health benefit, causing access to care problems for homebound seniors and individuals with disabilities in many parts of the country. Since the passage of the BBA, 17 VNAs have closed and four have discontinued participation in the Medicare program. Those VNAs that are still in existence are struggling to meet patients’ needs under Medicare’s low reimbursement levels.

Although we agree with your assessment that Congress needs to reject further cuts in home health reimbursement and restore the unintended massive cuts resulting from the BBA, we believe the editorial undervalued the significant role Sen. Susan Collins has played in advocating for legislative relief. Sen. Collins has been the primary champion of vital home health legislation during the past three years. Without her attention and persistence, Congress may not have passed helpful legislation in 1998 and 1999.

Sen. Collins has introduced a bill this year to eliminate the future 15 percent cut in home health expenditures. If there was any chance that Congress would be willing to do more than prevent further damage to the Medicare home health benefit, no doubt Sen. Collins will lead that effort. Unfortunately, leaders in the Senate and House have demonstrated during the past two years that merely delaying the cut is as far as they have been willing to go.

Sen. Collins is doing more than what anyone realistically expects could be done given political constraints. With 47 cosponsors on her bill, she is pioneering legislation that addresses the most important issue facing home health providers. We are grateful to Sen. Collins for her leadership and want to make sure that her leadership is publicly recognized. Carolyn Markey President and CEO, VNAA Washington, D.C.

The National Association for Home Care, the nation’s largest organization representing home care and hospice providers and the patients they serve, thanks you for your recent editorial on the crisis in home care. You really hit the nail on the head with your description of the devastating impact of the cuts in Medicare home health funding, both to efficient, high quality home care providers and seniors nationwide.

We are also grateful to your senator, Susan Collins, for her leadership in seeking to turn things around by first eliminating the additional 15 percent cut scheduled for next year. Last year she was instrumental in obtaining a delay in the cut and other measures to alleviate this crisis. Sen. Collins also led the fight last year to reduce the ever increasing regulatory burdens that have exacerbated an already bad situation. As chairman of the Government Affairs Subcommittee on Investigations, she held an important oversight hearing that turned the corner in improving the working relationship between HCFA, the home care community, and Congress. For these reasons we honored her at our recent Policy Conference in Washington as a home care hero. Maine can be justly proud of her leadership in tackling issues of such importance to senior and disabled citizens and those who love and care for them.

Your editorial makes clear that, given the enormity of the cut in home health services, measures such as elimintating the additional 15 percent cut and adding back funding to home health services should not be viewed as a “give back” as some on Capitol Hill and in the media have described these proposals. The savings targets for home health under the Balanced Budget Act have been exceeded by four times the original estimate. Congressional proponents of the BBA said they were merely cutting the rate of growth of home care. Instead, funding has been cut by 45 percent over the last two years and home care has been reduced from 9 percent of the Medicare program to four. Much remains to be done to rebuild the home care benefit, including relief for rural agencies and additional home health funding to ensure that intensive care patients are adequately served under the new prospective payment system. Val J. Halamandaris President National Association for Home Care Washington, D.C.