Observation Deck

CMS + HME (should) = Collegiality

Policy administrators and the HME industry need to act as colleagues.

• By Steve Ackerman
• Sep 01, 2014

I’ll save you the time looking it up, because I did in order to refresh my waning memory: Collegiality is simply cooperative interaction among colleagues. It’s been awhile, probably since the early ’90s, that the words “CMS” and “colleague” were used by our industry in the same sentence. Allow me to change that.

There comes a time in many struggles when you realize in essence, you are really fighting for the same cause. In our case, it is quality homecare for our seniors and the disadvantaged among us. Very often sitting down with a perceived adversary, rekindling friendships and opening an intelligent dialogue simply makes sense. It is time we revisit the importance of a constructive relationship with the Centers for Medicare and Medicaid Services and our industry.

My history with the HME business dates back to 1981 and in that time I can honestly not remember one significant piece of legislation that really moved our industry forward. Sure, we’ve had some defensive victories, which slowed down negative changes, but never anything that fully recognized the lives we touch and the money we save.

Constructive Dialog

Given the current partisan climate on Capitol Hill, it’s foolish to think this will change any time soon. Our current industry leadership recognizes this fact. Since the first of this year, they have been actively engaged in constructive discussions with the leadership at CMS. This dialogue will hopefully restore the good communication and confidence that can facilitate change to issues and regulations that are out of date, misguided or otherwise not moving our common mission forward.

The reaction on Capitol Hill has been overwhelmingly positive and supportive for the efforts to try and solve basic problems at the regulatory level, as opposed to at the legislative level.

My tenure with the HME industry puts me in a club uniquely qualified to comment on our industry’s relationship with the Medicare Program over the years.

My experience with CMS, then HCFA, started at a meeting in the mid 1980s that included representatives from NAMES (the predecessor of the American Association for Homecare) HIDA, (another association representing the industry at that time) and staff representatives from HCFA. The issue was a wheelchair parts price list that was badly out of date at all levels. The solution was, we sat there for three, 12-hour days and worked together, line by line, in order to revise the list to make it practical. (My only regret is that I think it is substantially the same list we use today.)

The point is, collegiality can be accomplished. Getting together and hashing it out is very often the best way. Somewhere dissent and bickering with CMS became the order of the day and cost our industry dearly. It is time for a change.

However, the revisions just publicized for the Round Two re-compete show a painful lack of industry input. The reconfigurations of the competitive bidding areas, and the lumping together of walkers and power chairs and CPAP with oxygen are a few examples of policy changes that could have been much better executed with industry input. There was clearly none.

Changing the Equation

Our job is to continue to build the trust it takes to be at the table when these ideas are first in development. We all know that the administrators, who are making policy, need to spend at least a day on a delivery truck and a day in a billing office to fully grasp the impact of their policies. If that’s not possible, we need to be there, as an informed friend, to explain what really goes on. Small changes, well within CMS’s statutory authority, can have a huge, positive impact on the lives of Medicare beneficiaries. It takes the kind of talking and listening that can only happen in a collegial atmosphere.

It’s time we take ourselves out of the budget-cut crosshairs. There are much greater savings to be garnered by CMS by reviewing the activity of the other 98 percent of the healthcare providers involved with Medicare expenditure. There is nothing left to squeeze out of the HME industry. We need to help move CMS confidently forward and to do this we have to be a trustworthy associate. Bidding done right does work. We need to keep intelligently presenting that fact. (“Right” being the operative word.)

I have been in thousands of homes where people were benefiting from the availability of HME. Not one person was sad to be at home. My closing advice is this:

For HME Providers

Bitterness will not move us forward. Let’s play it fair and play it honest. It is our responsibility to be a partner and steward of a system that is desperately in need of our professional input. Please get involved.

For CMS

Welcome the input of those of us that are in beneficiaries’ homes every day. Let’s sit down again and really review what is happening on the streets. It now costs $70 in cash to rent a chain saw for four hours and it costs $72 a month to rent an electric hospital bed (with delivery, regulatory and billing requirements). How is that sustainable? How does that make sense? How does it not invite gaming? Please use your “inherently reasonable” authority to sit down with the industry and clean up the simple issues. It has been done before — I was there.

For Legislators

Please dig deeper and attentively listen. Realize how important well-constructed bidding is to the overall healthcare system. Properly used it will save all the money needed to move the baby boomer generation through our later years. Unfortunately, the bidding and subsequent follow-up with our industry showed a distressing lack of thought and concern on the part of Congressional leadership. Listen to your constituents and, as importantly, your associates who have taken the time to understand the problems.

These are not partisan issues. We know how hard it is right now to get legislation passed. Please make the calls, sign the letters and help alleviate the unintended hardship that is now occurring.

The current industry leadership understands the importance of a collegial relationship with Medicare. Let’s all support them in their efforts. In spite of all the remaining hurdles, I still get excited about the difference we make every day in so many lives.

This article originally appeared in the September 2014 issue of HME Business.