Dodging Bullets

The first thing this industry has to do is to start feeling better about itself.

For those who are slaves to form, I realize that the subtitle and the first line of this article are exactly the same. But this is a point I want to make sure does not get overlooked.

I became very worried when I read the comments of fellow suppliers earlier this year following the most recent round of oxygen cuts. The Centers for Medicare and Medicaid Services compared apples and oranges, cranked out fruit salad and determined that an 8 percent average cut was reasonable, fair and just. And as providers, our response was, “We really dodged the bullet on that one.”

This sounds like the same rhetoric we responded with in 1998 when we got a 25 percent cut in oxygen followed by 5 percent the following year. The rumors flew within the industry: “They’re going to cut us 50 percent;” “I heard it was going to 65 percent.” It turned out to be a total of 30 percent over two years, and “We really dodged the bullet on that one.”

Not once was there an outcry from the industry that maybe 30 percent was too much and just plain wrong.

I can only speak for myself, but I’m getting way too old to do much more bullet-dodging. If I wanted to dodge bullets, I would be wearing a whole lot better protection than a scrub shirt covering a heart filled with good intentions. I’m certain I’m not alone.

COLA Is Not My Favorite Beverage

At least when the Six Point Plan was instituted and oxygen was attacked (where our company is located in Florida, payment fell from about $290 per month to about $200), there was a sliding scale built in that would allow for re-establishment of a sufficient reimbursement for oxygen over the ensuing years. It was about that time someone in Washington said, “I don’t think so,” capped the oxygen reimbursement and froze our cost of living adjustment.

COLA may seem an innocuous term when put in all caps and bandied about, but it has a dramatic impact on our bottom line. As an industry, we have not had a pay raise in 15 years, though the cost of doing business has been rapidly increasing, at times exceeding the rate of economic growth.

As I write this, Hurricane Katrina has just torn up the Gulf Coast in Mississippi, Louisiana and Alabama, leaving in its wake unparalleled devastation and anguish. I would like to tell you about my brother Donald, who is part of a strike team that drove through the storm-force winds from Memphis to Hattiesburg after Katrina hit, and then on to New Orleans, where he remains a part of the FEMA medical effort at the airport. I would like to tell you about Truman Stokes of A&A Home Health Equipment in Greenville, Miss., who helped in coordinating an emergency HME effort to assist displaced Katrina victims. Efforts to further assist and coordinate donations have been provided through the generosity of the VGM supplier network, The Med Group and many other companies.

These stories will keep unfolding over the coming weeks and months, and as this magazine goes to press, we are only beginning to see the generous spirit of caring, giving men and women that prevails in this industry. That’s right, not companies, but individuals who are willing to sacrifice time, money, equipment and effort in the service of their fellow man.

But this is supposed to be a commentary on the issues surrounding our industry.

We were already seeing unprecedented gas increases before the storm, and we are an industry whose patients depend on the timely delivery of supplies and services.

Now we as an industry must make significant changes in how we provide our care and how we deliver that care. So we as an industry must begin to feel better about ourselves and resolve to do something as an industry to correct the inequities in our fee schedules and in our public and political persona.

Operation Wheeler Dealer didn’t help us much, though it takes only a few stories about Katrina to demonstrate what we are really all about. But it seems barriers, rules and regulations have been written specifically to target us, and we have watched it happen.

Well, I say it’s past time to reclaim our dignity. In order to survive, our congressional leaders must realize that we have to support our employees and ourselves in order to provide the care they expect us to supply. We are the ones on call 24 hours a day. We are the ones who go see Mrs. Jones in the middle of the night when her equipment might not be working properly — not Congress and not the administration of CMS.

At some point, we have to rally around a standard and take action. I refer you to a Jimmy Buffett quote from “Fruitcakes:” “I’m mad as hell! And I don’t want to take it anymore.”

If you are the owner of an HME company, if you are a supervisor, if you are an employee and have never written a single letter to your congressman, councilman, mayor or governor, then we have to start with you. Tell them how you feel. This is a grassroots effort, and it begins now. We are many and we are organized and we are due.

President of C & C Homecare in Bradenton, Fla., Alan S. Cross is a registered respiratory therapist specializing in the treatment of sleep-disordered breathing. Cross is also a lecturer and author, and co-hosts “The Surreal News,” a morning talk radio show on WSLR FM 96.5 in Sarasota, Fla. Says Cross about his comments, “It’s interesting to note, you put a microphone in front of a guy and right away he has opinions on everything. What is even more remarkable is that he thinks everyone wants to hear them. Well, this is my opinion.” He may be reached by e-mail at [email protected].