Observation Deck

Investing in Advocacy

Advocating for HME can be tumultuous, but building relationships pays off.

• By Georgie Blackburn
• Oct 01, 2009

Just like most of you, I have spent my 31 years in this industry working hard to grow our business and improve quality of life for our customers. Moving internally from marketing to rehab to compliance, I believed if we provided excellent service, excellent product and outstanding referral resourcefulness, we would create a secure placewithin the market. I no longer feel it’s that simple.

When Pennsylvania Medical Assistance attempted to replace our fee-for-service system in 2006 with “selective contracting,” reducing the number of providers through a bid process, it was a wake up call. The Pennsylvania Association of Medical Suppliers (PAMS) and its members worked non-stop to educate state legislators on the project’s shortcomings, but it wasn’t until our customers and advocacy groups got involved, did we succeed in stopping the initiative. They better communicated the important role we play in their continuum of care and their message was simple: Service and access to product are the most important factors. If not provided, patients had freedom to select another firm. Selective Contracting seriously diminished competition and that would diminish their quality of care. The effort stopped the program in its tracks.

Looking back, Pennsylvania’s Selective Contracting was our warm up to Medicare competitive bidding. When released, Complex Power Chairs were within the bid categories and our firm vehemently disagreed with that. I wrote Sen. Arlen Specter (D-Pa.), Sen. Bob Casey, Jr. (D-Pa.), Rep. Jason Altmire (D-Pa.), Rep. John Murtha (D-Pa.). and Rep. Tim Murphy (R-Pa.) about our position. Those communications became the true beginning of our advocacy work. It was an easy decision to fight competitive bidding even when we became a round one contracted provider in six categories. The illogical way round one was bid, its poor methodology, and the reasoning for which the program had to be stopped after only two weeks in operation helped our cause. The fiasco culminated in a congressional vote that overrode a presidential veto. The journey we took as an industry didn’t just bring closure — it made history.

Once again competitive bidding looms overhead. After winning a 18- to 24-month delay in July 2008, the Interim Final Rule was not permanently rescinded. CMS prevailed with moving forward, protected by law. As of Jan. 1, we paid for the delay with a 9.5 percent cut to all categories within the project, including complex rehab. A lower allowable now sets the new ceiling for bids. And round one Metropolitan Statistical Areas face a replay of a nowin situation. The Program Advisory and Oversight Committee members are suggesting ideas to improve methodology. Will CMS listen this time?

Can we repeal competitive bidding? We won’t know unless we try. Competitive bidding is poor health policy. Poor, because it does not guarantee improved quality of care. Poor, because it does not guarantee improved access to care. Poor, because it promotes formation of oligopolies that drive costs upward. Very simply, the care of our disabled and elderly should not be “auctioned off” to the lowest bidder. Healthcare is not a commodity. My husband looks at it a little differently: “The fallacy within our healthcare system is that the government thinks by cheapening healthcare, the result will be savings.”

The outcomes of only two weeks of competitive bidding in July 2008 served as the basis for Chairman Rep. Pete Stark’s (D-Calif.) Ways and Means Healthcare Subcommittee hearing that ultimately halted the program. While accreditation is now mandatory for all providers, including subcontracted parties, little else has changed.

I don’t foresee a happy ending to this saga, so I speak up, often and consistently, against competitive bidding and other issues, such as oxygen reform and the first month purchase option for power mobility. It’s called advocacy. I consider it education, whether talking to a congressman from my district or communicating with clients and referral sources.

There’s a lot to learn and there’s no comfort zone in advocacy; it is tumultuous work involving many tactical moves. Luckily, there are mentors who help direct our energy, such as Cara Bachenheimer of Invacare, Walt Gorski of AAHomecare, Seth Johnson of Pride Mobility, and John Shirvinsky of PAMS.

I’ve had some epiphanies: we do have a voice; we have earned credibility for the work we do and the care we give; legislators want to understand our legitimate issues; perspective and poor PR play a role in the progress made; and we need data to support our position.

I didn’t train for this job, didn’t envision doing this type of work, and wasn’t sure if our company would create the opportunity to do advocacy when I first suggested we needed to step up. Since making the commitment, however, we’ve seen benefits.

For example, Rep. Altmire and I have developed a collaborative relationship. I share our concerns and issues and receive constant updates from his staff as healthcare reform moves forward. I was invited to serve on his Healthcare Advisory Committee for the current term. As a Pennsylvania Congressman, he’s vocal on fiscal conservancy, on retaining the integrity of small businesses and on insuring homecare services remain intact. I count on him to act on behalf of our industry and he counts on me to give him credible reasons to act.

It takes passion, a firm commitment and a strong belief that one person can make a difference. Do you feel passionately about the challenges we face? Do you educate your staff, customers and legislators on industry issues? Have you hosted a congressional site visit? Do you write editorials to your local newspaper? Are you a member of your state association and AAHomecare? If you’ve answered “Yes,” then I’m privileged to fight alongside you for the the repeal of competitive bidding, for logical oxygen reform, and preventing loss of patient choice by overturning of the first month purchase option for power wheelchairs.

If your answer is “No”, then add your voice to our choir. Help drive our industry’s destiny. The return on your investment will be limitless.

This article originally appeared in the October 2009 issue of HME Business.