What Are You Going to Do?

I recently sat in a hotel meeting room full of providers who were concerned about what is going to happen to their small businesses.

At this meeting, what I heard most often was, “What am I going to do? How can I become accredited by Aug. 31 and still figure out the bidding process?” Add to this the impending destruction of business by CMS — which may virtually eliminate 80 percent of the providers in each area with its mathematic formula for provider selection — and the next obvious question is, “Where am I going to get the money?”

Since I am, fortunately, not included in this process at the moment, I thought it would be easy to sit back and observe from a distance. That was not the case.

The feeling in the room was almost palpable. I had images of an innocent man on trial but facing a jury that he couldn’t see or talk to, blindly trying to explain who he is and why he is innocent. Yet the jurors — CMS in this case — only turn their backs to discuss what they will be ordering for lunch, the decision made, the verdict in.

As for questions? CMS has responded to the need for answers with teleconferences. Other than sending out a form letter, I cannot think of any way more impersonal to react to the confusion and dismay providers have about the bid process.

If you have never participated in a teleconference in which you are allowed to ask questions, the process is simple. You push a designated number and wait until a disembodied voice states it is your turn, then you must state your name and your question. After several seconds of silence, another disembodied voice will give you a prepared answer from the paperwork that you have already read prior to the teleconference.

That’s it. No chance for further discussion, no chance for those in that indistinct room to look at your face, to see your fear. This is the easiest way, I guess, to execute this mass destruction of so many lives.

I have been in this business for over 20 years and was involved when the demonstration projects were conducted in Polk County, Fla., and San Antonio. At that time, the usual blame for the endeavor was fraud and abuse.

I am not naïve. I know that there are people in this industry whose intentions are to grab as much money as they can and then run with it. But I also believe that the majority of providers want to catch the bad guys as much as I do. And as I observe other industries, I realize that I cannot find one that is fraud-free. There has been abuse in our churches, our Congress, among our teachers and the medical community at large.

Why are HME-owners being punished and made to feel that we are all criminals? How can CMS, or Congress for that matter, just sit back and blithely say to the small businesses in the CBAs, “Oh, well, you will be able to bid again in three years.”

How would those government employees feel if they were told that they would have to live — and pay all their bills — on approximately half of their pay for three years and then maybe they would win the next bid? How would members of Congress feel if the same option were given to them? Most likely, they would feel as desperate as the providers in that hotel room.

Many of the bureaucrats forget the benefit of our industry because of the few that taint our names with their greed. But imagine if there were no HME providers. Mrs. Jones might be forced into a nursing center because she needs oxygen and a walker to participate in activities of daily living. With our help and service, however, she is able to stay in her home with her memories, among all the things that are familiar.

How many providers have gotten up at three in the morning to visit a patient because she thought her oxygen concentrator was broken, only to discover that when she added water to the humidifier, she was unable to reattach the lid correctly? How many patients have asked delivery techs to sit for a few minutes and talk because they are lonely?

All of these things have happened in my small business on many occasions over the years. And now, CMS and Congress have decided that there are just too many providers and the majority of us have to go. Is the reason cost-savings or fraud and abuse? Or could it be the mess that has been created through unbelievably complicated rules and inadequate funding?

CMS has forgotten the Six-Point Plan of the late ’80s. CMS has forgotten the COLA freeze directed at the home medical care industry as our utility bills, gas costs and the costs of doing business continue to soar. CMS has forgotten the oxygen rate reductions already in place. In fact, everything that competitive bidding is supposed to accomplish has already happened.

Not only does this industry provide a compassionate, cost-containing and useful service to Medicare beneficiaries but providers also contribute to the economy of our communities through taxes, employment, office expenses, gasoline, etc. How many individuals will be out of jobs if the HME providers are forced to close their doors? How many office buildings will lose income when those leases are not renewed? How many unemployment claims will be filed? How much will this trickle down to the billing agencies and manufacturers? Will we experience downsizing and layoffs in these areas as well?

Should this industry have done more for itself — and sooner? Absolutely. As usual, hindsight is always 20/20.

But I don’t think it is ever too late to do the right thing. Talk to your congressmen, call your senators and let the governor of your state know how competitive bidding will affect their constituents and the small businesses that have made America what it is. Every provider, whether immediately affected or not, needs to stand up and protect our industry against this impending calamity.

Joan Cross is director of operations for C & C Homecare and a consultant with US Medical Consulting Group in Bradenton, Fla. She is past president of the Florida Association of Medical Equipment Suppliers (FAMES), a past member of the Medicare SAC Committee, and currently serves as vice chairman of the National Supplier Clearinghouse Advisory Council and on the Medicare DMERC Advisory Council for Region C. A recipient of HomeCare magazine’s HomeCaring Award, most recently Cross was named to the board of directors for the Healthcare Quality Association on Accreditation. She may be contacted at 941/761-8338 or by e-mail at [email protected].