Observation Deck

Industry Intersections

Regular updates on the reimbursement policy with a good friend helped put the industry's challenges in perspective.

• By Georgie Blackburn
• May 01, 2016

Every summer we travel with members of our family to the Outer Banks of North Carolina, specifically Hatteras Village on the southern tip of the Cape Hatteras National Seashore. We began traveling there in the 1970s. It’s where the sun, the water and the wind revive and heal us. Each year, we count the weeks, but this year is different.

It’s where one of my best friends, Patty Gallek, lived until she passed away suddenly and unexpectedly mid March. She was a physical therapist, one of the very best I’ve ever encountered in my career. Her special gift was successfully treating spinal cord injuries. She worked in Pennsylvania for 20-plus years before heading south to her beloved seashore home where she continued to help people achieve function.

During the 1980s, when BLACKBURN’S was building our Rehab Mobility and Positioning Division, Patty was a force that catapulted us in the right direction. She involved us in clinical evaluations with her and her team before it was a Medicare requirement. And long before the advent of the ATS/CRTS/ATP credential, she taught me the nuances of the injured or severed spinal cord, the complications it presented, the importance of positioning for function, the psychological issues that impact outcomes and the absolute need to assist families and the injured reach a new normal.

I watched her use her sarcastic sense of humor to goad, taunt, tease and test her patients, turning challenging days into doable ones, helping individuals establish new goals for managing Plan B, making sure they were attained. She challenged me too, and I recognize now that she taught me to think holistically about our clients and place their needs beyond the initial specifications. Patty paved the way to my love of advocacy.

A few years ago we were sitting in her kitchen talking about the “old days” and she told me the thing that always impressed her was the way I fought for coverage, no matter what the insurer, making certain her patient got the optimal equipment. I took that compliment to heart.

Keeping Tabs on the Industry

I will miss her tremendously in Hatteras this summer. Friends and colleagues for longer than 35 years, our annual summer visit became an opportunity to “remember when” and discuss new policy developments. A favorite discussion the last two years was twofold: one, the importance of securing a separate benefit under Medicare for complex rehab technology to ensure complex rehab patients receive the mobility devices and positioning required to thrive, work, and live long, healthy lives; and, two, fix the Centers for Medicare and Medicaid CMS bid program.

My horror stories about Round One and Round Two of competitive bidding back home concerned her. She cared so deeply about her patients, especially those who depended upon complex rehab technology to help provide the ultimate quality of life. She feared that CMS would someday incorporate all complex rehab technology into the bid structure and that the level of provider service for very involved patients would diminish.

This June, I was looking forward to telling Patty our industry had made some progress. Bids now require a supplier to be licensed and H.R. 1516 and companion bill S.1013 (the Ensuring Access to Quality Complex Technology Act) have gained cosponsors. Legislation introduced by Rep. F. James Sensenbrenner, Jr. (R-Wis.) and Rep. Joseph Crowley (D-N.Y.) in the House, and Sen. Thad Cochran (R-Miss.) in the upper chamber is gathering steam.

Our representatives and senators now recognize that complex rehab patients differ from those who require basic DME. They realize the qualifications to be a competent rehab supplier need to differ too. Numerous advocacy groups have raised their voices and joined with the National Coalition for Assistive and Rehab Technology and the American Association for Homecare to elevate awareness. Rehab providers everywhere are working hard to make legislation a reality.

Separating complex rehab technology as its own Medicare benefit will do several positive things for the patients we serve as well as place additional requirements on the providers of those services.

Patty would have loved that. She used to discuss what she considered to be a good provider and her distaste for “bad” providers in much the way she identified “good and bad” doctors. They exist and there was no room in her world for substandard patient care.

Yet, substandard care is exactly what will manifest if we don’t drive the separate benefit into legislation. Substandard care is also what we predicted at the onset of the bid program.

Ironically, the Round Two re-compete pricing recently released underscores low balled bidding continues in a race to the bottom as stories of patients paying out of pocket surface. It’s as if our industry had a crystal ball. What we predicted would happen way back in 2006 is happening. This train must be stopped. Plus, further expansion of bid pricing to all of America, slated for July 1, must be derailed. Rural areas simply can’t do the job for these rates.

Keeping Up the Fight

So many of my colleagues have contributed considerable time, energy, and finances to getting the job done. I admire them. Many others are growing weary of the fight. I understand that too. But here’s the thing: if we don’t continue striving to reach our goals, we will never know that they were achievable.

It comes down to believing that what we are saying and doing is the right thing to do. I believe we are right in asserting that the bid program requires specific corrections to its structure to make it a viable, sustainable model. We are right in asserting complex rehab technology is for people with significant disabilities that require a broader range of services and specialized personnel than what is required for standard durable medical equipment. We are right to argue rural America cannot service patients for bid rates derived by low balled bidding. Access needs protection!

Our champions in Congress have had years of education about CMS’s illogical policies ,regulations and industry challenges — such as expanding the bid program pricing nationwide this July when the ramifications of the Jan. 1 kickoff are not yet clear. Key members on the committees of jurisdiction understand our plight and are trying to assist. We need to continue to build bridges. We need to continue to communicate outcomes and issues effectively. We need to continue to hold site visits and introduce our representatives and senators to our world.

It is 2016. We are at a critical intersection in our advocacy. Even though many of us suffer battle fatigue emotionally and financially, now is the time to push harder than ever to make legislation on several fronts a reality!

The changes we plead as necessary are positive for our clients and their families that we serve. They are positive for the health and longevity of the businesses we operate. They honor all of the dedicated Patty’s of our lives.

This article originally appeared in the May 2016 issue of HME Business.