Save Homecare Now

ATLANTA — “I have never seen any situation that we have
experienced that even remotely resembles how dire the situation is
right now.” Those are the words of Dave McCausland, senior vice
president of planning and government affairs for The Roho Group,
Belleville, Ill.

McCausland, who has been in the home medical industry for more
than 30 years, said Friday the future has never looked as bleak to
him as it does now.

“It is not just one thing. One issue is compounded against one
thing and then another,” McCausland said, noting particularly
competitive bidding,
invasive numbers of Medicare audits that have staunched the cash
flow of thousands of providers and a host of other government-issue
mandates that are all but strangling HME businesses.

And that is exactly why McCausland wrote a letter urging both
beneficiaries and colleagues to support the American Association
for Homecare’s “Save Homecare Now” campaign. The project offers an
easy way for everyone involved in HME to contact legislators and
raise their voices in support of home care.

“We are looking for ‘super advocates’ to get the message out and
encourage colleagues and others that they know to save home care
now,” said AAHomecare’s Tilly Gambill, manager, marketing and
communications, of the effort. The hope is that those advocates
will encourage 20 others to voice their support of the
industry.

“This is really a grassroots effort in getting people involved
in saving home care and making a point to contact their members of
Congress,” Gambill continued. “This campaign is really geared
toward everyone — all HME stakeholders, providers,
manufacturers, beneficiaries, caregivers, therapists, clinicians,
anyone who is interested in the future of home care.”

Stakeholders can connect with legislators through the campaign’s
“Take Action” center at capwiz.com@aahomecare/mlm/signup.

Randy Wolfe of Lambert’s Health Care in Knoxville, Tenn., one of
the early champions of the idea, said the super advocates “are
going to be sort of the teachers and communicators and recruiters.
We’re trying to find people with communication skills and a passion
who can take on the network building.

“I think that, really long term, we could have 100,000 people in
our network that really understand what we are all about,” he said.
“That’s when things turn. You can’t go to Washington with 300
people [and expect things to change].”

McCausland was one of the first to respond.

“It’s like, ‘we’re going to pay you less, we’re going to pay you
later and we’re going to ask you to do more,’” McCausland said. “My
frustration is that I just really believe that home care —
and not just durable medical equipment, but home care in general
— is being made a scapegoat here. We have the smallest voice
to defend ourselves and the least amount of dollars to influence
anything.”

In his letter to colleagues, McCausland, a former history
teacher, wrote: “Our current situation reminds me of a quote that
has been credited to both Thomas Paine and Benjamin Franklin. ‘If
we do not hang together we will most assuredly hang separately.’ We
may have different interests/involvements/allegiances in home care;
but, we are all stakeholders (providers, referral sources, clients
…) and we need to band together to overcome the common threats we
are facing.”

Gambill said Save Homecare Now is already seeing results from
McCausland’s letter, particularly from beneficiaries.

“We’ve now had more than 900 messages sent to 219 different
members of Congress since the campaign began,” Gambill said. The
messages have centered on whatever issue most concerns the sender
— competitive bidding, audits, elimination of the
first-month-purchase option for power wheelchairs.

This, said McCausland, is an industry battle, and it is
imperative that the industry unite. “Whether competitive bidding
shows up in your rural area or not, your reimbursement is going
down. If you are spending more to stay in business and your revenue
is going to down, it doesn’t take much to see that [you’ve] got a
problem.”

Wolfe agreed. “This is no place for turfs,” he said. “It’s not
about your competition. It’s about all those we serve. I think
[Save Homecare Now] can be a big uniter, and we want a big umbrella
with this.”

The home care sector does not have huge numbers of lobbyists or
big money behind it, he added. “But we have a great story, and we
have millions of patients and families that are in this battle with
us,” he said. “We just have to recruit them.”

Editor’s Note: Dave McCausland’s letter
asking for support of the Save Homecare Now campaign follows in its
entirety. We hope you’ll join him at capwiz.com/aahomecare/mlm/signup/.

All,

I sincerely hope that I’m being “Chicken Little,” believing that
the sky is falling when it really isn’t. However, I’ve been in the
home care industry for almost 30 years now and I can’t recall a
time when I saw the situation as dire as it is right now.

• We’ve got Medicare implementing all kinds of programs that will
  reduce reimbursement and increase the cost of doing business in the
  home care industry with competitive bidding at the top of the list.
  Most recently Medicare proudly proclaimed that competitive bidding
  of DME will reduce Medicare expenditures by over $17 billion over
  10 years (based on my math that equates to a cut of over 15%).

• We’ve got many state Medicaid programs in financial crisis
  desperate to find ways to delay payments and cut costs. Multi-month
  lag on payments and payments with promissory notes is not out of
  the question.

• We’ve got Medicare implementing a variety of prepayment and
  post-payment audits that are causing providers an extraordinary
  burden. Imagine getting a letter requesting documentation on
  hundreds of patients over an extended period [of] time, just to
  prove that you have all the documents the auditor “deems necessary”
  for you to have been reimbursed!

In addition, it is not at all unheard of that a provider will be
placed on 100% prepay audit/review for new claims while they’re
being audited for their historic claims. If this happens the
provider’s cash flow comes to a screeching halt. Their expenses
continue but the money to pay those expenses is held up for months!
Sadly, some providers cannot survive.

I know that the home care industry has its share of problems and
rotten apples. At the same time, it also includes some of the most
dedicated folks I’ve ever had the pleasure to work with, and I
sincerely believe that the programs being implemented punish the
innocent far more than the guilty.

In addition, even with all the problems that may exist in home
care, I still believe that it is an essential part of the solution
to our health care challenges and a key component for the future of
health care … so long as it is allowed to survive and thrive.

Left unchecked, I don’t see how we can avoid a situation where
the quality of goods and services, and the access to those goods
and services, will be dramatically reduced. Ultimately, the
consumers of these goods and services will suffer most.

Yet, how do we get our message across when home care as an
industry (whether it be goods or services, DME or HHA) has one of
the smallest voices in the health care industry and other players
are more than willing to throw dirt at home care?

Our current situation reminds me of a quote that has been
credited to both Thomas Paine and Benjamin Franklin: “If we do not
hang together we will most assuredly hang separately.” We may have
different interests/involvements/allegiances in home care; but, we
are all stakeholders (providers, referral sources, clients …) and
we need to band together to overcome the common threats we are
facing.

For that reason I just signed up for the Save Homecare Now
Campaign, and I hope that you’ll consider doing the same thing.
It’s being coordinated by AAH but the message is applicable to any
home care stakeholders (AAH member or not).

Below is the link if you’re interested in signing up to be an
“advocate for home care.”

capwiz.com/aahomecare/mlm/signup/

Thanks for taking the time to let me get on my soap box. I hope
that you’re all doing well and look forward to any opportunity to
see each and every one of you.

Kind regards,

Dave

J. David McCausland