What Next?

As we begin to focus on the November elections and look toward next year’s new Congress, it is time for the industry to deal head-on with its poor image in Washington, D.C.

Like it or not, our industry continues to be perceived in a very negative light on Capitol Hill. Whether it is the succession of negative and continuing Office of Inspector General and General Accountability Office reports, neither the source nor the validity is relevant. What does matter is that the perception is real and pervasive.

It is time to address the problem and pursue a multi-pronged, multi-year campaign that will effectively turn around that perception over the next few years.

First, the industry must stop being reactive and be proactive when it comes to proposing new federal Medicare policies. For example, every year, we react and oppose the president’s and Congress’ proposals to cut payment levels for our services. Yes, it’s a money/budget issue for many in Congress, but we are easy prey given the negative image we enjoy.

It’s time to turn the tables and argue for payment reform. By arguing for reform, we can propose a restructured payment system that incorporates the concept that services are critical and inextricably tied to the provision of equipment. (Remember, under the Medicare statute, the DME benefit is an equipment benefit, services are absent and, therefore, unnecessary.)

Undoubtedly, next year a new administration will be pursuing a major health care reform agenda. Our mission must be to be viewed as an integral and positive part of that process.

We all know that home health care is less expensive, patient-preferred and efficacious. We must develop patient-focused payment policy proposals that recognize the gamut of services that consumers need and want. We must demonstrate that we are an essential component of the health care system that can contribute to cost-effectiveness and quality outcomes.

Second, the industry must aggressively insist that the bad actors not be allowed to obtain a Medicare billing number. It seems unreal that the shell organizations operating out of a block of condominiums in Miami actually passed a physical site inspection by the Medicare program. How can this happen? We must insist that Medicare do its job and be an effective gate keeper before issuing Medicare supplier numbers.

Perhaps we need to scrap the current system and create one with real checks and balances. I also suggest that the industry set up a system to self-police. Perhaps HME needs its own hotline to report suspicious market behavior and establish an ongoing mechanism to communicate those details to the appropriate government authorities.

Many in the industry have embraced mandatory accreditation as one way to screen out bad actors. But it’s been late in coming. The issue has existed for decades, and, only recently in the Medicare Modernization Act did Congress require by law that all DME suppliers attain accreditation . The deadline decision was left to the Medicare Program.

The new law, the Medicare Improvements for Patients and Providers Act (MIPPA), requires all home medical equipment suppliers to be accredited by Sept. 30, 2009. This is an essential component to improve the industry’s image. We are the only Medicare provider group that does not have mandatory accreditation. Private payers typically require it, and it is critical to have a third-party (non-governmental) measure of our commitment to quality.

Third, the industry must mount an aggressive public relations campaign that highlights not just the good things we do but, more important, talks about our commitment to quality, to eradicating fraud and to ensuring that consumers receive quality items and services all the time. This must be an industry-wide campaign focused on consumers, the provision of quality items and services and the fact that home care is the solution, not a problem, in our nation’s health care system.

Finally, we know these changes cannot happen overnight. It will be a long haul — but so was obtaining a legislative delay of the bid program. And if we don’t start, we’ll never accomplish these goals. So let’s take the time now, before the frenzy of what is sure to be a legislatively very busy 2009, to begin.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at [email protected].