Walk the Walk

I’m excited! I have just seen some behavior — and more importantly, some action and results — that give me hope for the future of the HME industry.

I think the problem is this: Our government does not believe that we have our act together. Our legislators appear to believe that we parade before them our “best and brightest,” and that most home care companies are, at best, ignorant of and indifferent to the rules.

When I look at the Medicare Modernization Act and CMS’ proposals for competitive bidding, mandatory accreditation and supplier standards, I infer that the government does not believe our industry is particularly professional.

I do not agree with this assessment. But I think we delude ourselves if we ignore this perception, for it results in bad legislation, bad regulations and bad enforcement initiatives.

I see it all around us. For example, I believe the quality standard rules for power mobility are extremely nitpicky because of this so-called “HME credibility gap.” I worry that the government will continue to make us its whipping boy for home care funding and quality concerns until mandatory accreditation suggests that we “get it” and take government rules seriously. By that point, many home care companies will have gone out of business.

But the credibility gap may be starting to shrink. On June 27, more than 40 congressional staffers met to discuss a new study commissioned by the American Association for Homecare. This study showed that most of the costs incurred when providing home oxygen — 72 percent — were the result of services expended by home care suppliers on behalf of beneficiaries.

This information was gathered by an independent research firm based on a survey of 74 home oxygen providers that collectively serve more than 600,000 beneficiaries. That number represents more than 50 percent of the Medicare population receiving oxygen at home. According to the study, the average cost per patient, per month, for home oxygen therapy is $55.81 for equipment and $145.39 for services.

AAHomecare is using this study to persuade Congress to repeal the oxygen provisions in the Deficit Reduction Act, which caps Medicare oxygen rental at 36 months, then transfers equipment title to the beneficiary.

But I love the study for other reasons. First, it demonstrates our ability to gather and utilize hard data about what it really means to be a home care company. Congress claimed that the industry’s revenues from respiratory therapy could absorb the DRA’s reimbursement hit. Congress claimed that our complaints to the contrary were just “whining” because we had no data to back up our assertions.

We responded with information, data and objective, persuasive evidence. We didn’t just parade before Congress our best providers, sickest patients or most articulate orators. We nailed them with information. AAHomecare did a great job demonstrating — not yelling or proclaiming — that we are a service industry.

What works for our trade associations also works for us individually. So let me ask each of you some questions. On average, how much do you spend on deliveries to your respiratory patients, mobility patients or O&P patients? On patient assessment and education? Maintenance? Emergency services? Regulatory compliance?

I fear that many suppliers do not have dollar-specific answers to these questions. I fear that many suppliers respond to managed care opportunities by guessing what their costs are, and therefore where and how they can make a profit. I fear that many suppliers could not respond right now to a competitive bidding proposal if it required them to justify the reasonableness of their fee quotes. If we do not know our present capabilities, we cannot grow effectively. We cannot respond to opportunities effectively. We cannot survive.

So let’s learn from this AAHomecare study and what it represents. Let’s use it as an example of productive, objective internal assessment. Let’s show payers and colleagues and the government that we know how to “walk the walk.”

Neil Caesar is president of the Health Law Center (Neil B. Caesar Law Associates, PA), a national health law practice in Greenville, S.C. He also is a principal with Caesar Cohen Ltd., which offers compliance training, outsourcing and consulting and the author of the Home Care Compliance Answer Book. He can be reached by e-mail at [email protected] or by telephone at 864/676-9075.