I don't think a single colleague of mine would disagree that we already have a very serious and complicated situation on our hands in the Medicare program's services for hospitalization and post-hospitalization care, especially home health and nursing home care. It only gets more complicated and serious with the imposition of the proposed ergonomics rule. While I believe Congress and the Administration have worked in a bipartisan fashion to monitor and adjust the effects of the 1997 Balanced Budget Act on Medicare beneficiaries' access to quality care, there is still significant concern that the most needy patients may be experiencing difficulty in accessing care. Panelists also indicated that once patients are identified as having expensive care needs, agencies may discontinue their care abruptly and these patients may have difficulty obtaining care from other agencies. In effect, some home health agencies are making coverage decisions based on payment considerations.
Industry reports paint a bleak financial picture as well.
For example, since September 1999, one thousand, eight hundred and forty-one nursing facilities have filed for bankruptcy and more than two thousand, five hundred home health agencies have closed since 1997. Cuts imposed in the Balanced Budget Act are blamed by almost all providers. Now let's see what kind of havoc the proposed rule will wreak on this already bleak picture. OSHA engaged in some fancy accounting to make the annual cost of the rule look lower than this, but even OSHA acknowledges that the first year cost will be at least this high. And some say OSHA's Year One figure is a gross underestimation of the cost.