Editor's Note

Cautiously Optimistic

Despite the industry's trials, I feel positive.

• By David Kopf
• Dec 01, 2014

If you talk to my better half, I’m the world’s biggest worrywart; a man prone to prolonged pessimism. And, in comparison to my wife, that point could not be more valid. I don’t know what it is, but she can put a positive spin on the Titanic and the Mt. Vesuvius eruption combined. I marvel at her ability to see the bright side of everything.

But, I don’t think I’m as gloomy as she might interpret from her position of constant positivity. Case in point: my outlook on the home medical equipment industry.

What isn’t there to be pessimistic about? The Medicare reimbursement environment can seem like a never-ending buffet of frustrations and let-downs, featuring some absolutely ulcerinducing main courses: Competitive bidding, CMS’s audit program, the OMHA ALJ delay, and now CMS’s final rule on bundling and taking bid prices national by 2016 (see “News, Trends & Analysis” on page 8 to read more on that). No Pepto Bismol is pink enough or chalky enough to save you from that kind of heartbreaking heartburn.

But, I remain cautiously optimistic for a number of reasons:

First off, the industry does stand a fighting chance when it comes to competitive bidding and audits. Introduced by Reps. The Binding Bids Bill, which would require bidders to have special surety bonds forcing them to hold to their bid amounts, has actually picked up some muchneeded steam. The bill hadn’t seen additional congressional backers since mid-September, which was beginning to worry me. Then, just about the time we were going to press with this issue, the bill picked up 12 congressional co-sponsors, bringing the bill to 61 backers. That’s great news, as there is still time to get the bill passed as a standalone piece of legislation. That good news should inspire anyone who’s been an industry advocacy wall-flower pick up the phone and dial his or her lawmaker to ensure that Representative signs on to the bill while there is still time.

Second, the audit forecast seems glum, but here too, the industry is gaining some ground. Like the Binding Bids Bill, the industry’s Audit Improvement and Reform Act (aka, the AIR Act), gained seven new congressional backers, bringing the total number of lawmakers officially supporting the legislation to 43. That bill would reform several aspects of CMS’s audit program, including boosting transparency; providing better education and outreach; and rewarding suppliers that have low error rates on audited claims. That regained moment is great news, and again I encourage anyone who hasn’t called to support the bill to whip out his or her smart phone and spring into legislative action.

Third, I’m enthused by the industry’s renewed effort to collaborate with CMS. For a long time, CMS and the industry have worked at odds with one another, but the American Association for Homecare has recently taken solid first steps to collaborate with CMS in order to solve problems. A good example of that, was the association’s recent efforts to work with CMS’s Office of Medicare Hearings and Appeals and OMHA’s Chief ALJ Griswold to work on solving the two-year-plus audit appeal backlog.

(You can read more about these examples in “News, Trends & Analysis” section on page 8.)

Now, I write all this knowing some many might consider my perspective Pollyannish, but I’m well aware of the heavy cost providers are paying. (A good example is this month’s Observation Deck column by Eberhart Home Health Inc.’s John Eberhart; page 34.) At the same time, I know that this industry has undeniably good demographics; I know that increasing numbers of patients will need what providers have to offer; and I know that new capital continues to come into this market as others recognize the value of home medical equipment and homecare. And, ultimately, I know that if providers can find ways to diversify revenue, reinforce their margins through efficiency, and side-step CMS’s slings and arrows, their hard work and cautious optimism will pay off.

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