The Campaign for HME

HME providers face a delicate task this election season. Amid intense partisanship, they must educate politicians of all ideologies about the value home medical equipment brings to the government, along with Medicare and Medicaid beneficiaries. A fix for competitive bidding remains the most important message to deliver, but that is a complex issue requiring thoughtful communication skills.

Personal involvement is the key to political success for HME, according to Cara Bachenheimer, vice president of government relations for Invacare Corp. “It all starts with building and developing relationships,” she says. “You can’t put a dollar value on having an effective relationship with a legislator at the state or federal level.”

There are many ways to build relationships with policymakers. Providers can attend fundraisers, participate in campaign forums, visit a legislative office, or play a political card that is perhaps the most effective way to promote industry views—invite a candidate to an HME business for a personal tour.

But before organizing such a tour, consider the mindset required to traverse the tough partisan terrain that surrounds many politicians during a presidential election year.

Crossing Political Boundaries

Tyler Wilson, president and CEO of the American Association for Homecare (AAHomecare), says good policy for the HME industry does not depend upon partisan politics. “We have supporters on both sides of the aisle, and we have detractors on both sides of the aisle,” he says. “Competitive bidding is a classic issue. It was enacted by a Republican Congress, and it is being implemented by a Democratic administration. Our challenge crosses the political spectrum. We’re going to have to cobble together a bipartisan coalition that realizes we’re the solution, not the problem.”

Focus on policies instead of politics. “Reasonable people should be able to agree what policies should be in place to support a robust, vibrant home medical equipment industry,’’ Wilson says. “The reason you want to do that is so providers can provide good service and strong products to beneficiaries, which is a population that is in great need.”

Rob Brandt, board president of the American Medical Equipment Providers of America (AMEPA), says that he separates personal political beliefs from professional political action. Sure, vote your personal beliefs, but support candidates who are supporting the HME industry. It’s possible to plug personal political beliefs in the process. “If it’s a congressman who has helped our industry, I would always support them. I’d say to them, ‘I might not support your politics, but I appreciate you supporting the DME industry. I’ll support you any way I can.’”

Oddly, sometimes the higher one goes in the in the political spectrum, the more difficult it becomes to have an impact on HME policies in government, Brandt says. For example, the president of the United States often gets involved with big decisions on important programs like Medicare and Medicaid, but seldom deals with all the rules and regulations that can make or break the HME industry.

When President Obama was first elected, some people thought it would benefit the HME industry because providers had developed good relationships with a top Obama advisor, Rahm Emanuel, who had been a congressman in Chicago. “He was accessible as a congressman,” Brandt says, “but that accessibility left when he became White House chief of staff.”

Bachenheimer suggests keeping politics local and reaching out to officials with an actual stake in the area. “A lot of times you think ‘I’ve got to go to D.C. and meet all the big people,’ but that’s probably the last thing you should be doing. You probably can be a lot more effective developing those relationships at the local level. Invite those folks to businesses and get them to understand what a company does so that policymakers know what’s going on in their community.”

Arranging Site Visits

Bachenheimer and Seth Johnson, vice president of government relations for Pride Mobility Products, agree that one of the most effective ways of reaching candidates is to take them on a tour of an HME business. “People just don’t have an accurate picture in their brains of what we do,’’ Bachenheimer says. Members of Congress often get their views of the HME industry through Medicare officials or reports from the Office of the Inspector General. “It’s clearly a completely distorted way of seeing what we do.”

Johnson has participated in many of these tours, and he has found them easy to set up. Call a state or federal legislator’s office and establish a time that works. Remember, legislators are often late. When scheduling the tour, establish exactly how much time will be required. Then, when the legislator arrives, re-establish the timeframe for the tour.

“If the legislator happens to get caught in traffic and they show up at 9:15 instead of 9 o’clock, you want to confirm they are going to actually be there until 10:15,” he says. “Know what the expectation is, and just manage that so you have a good 10 to 15 minutes on the back end to answer any open questions.”

Take the legislator through the business from start to finish. Let them talk to people in the front office for a few minutes. Show them how HME connects with patients through medical referrals. Let them see processes for documentation, delivery and repair. “Just give them an overview of Home Medical Equipment 101,” Johnson says, adding that you should wait until the end of the tour to discuss a serious issue, or to ask for help in solving a problem with a government agency.

It’s fairly easy to convince politicians of the benefits of HME, Johnson and Bachenheimer say. Policymakers have largely turned the corner on home care. Most of them understand that voters want HME, and it saves the government money.

Competitive Bidding Is Critical

HME industry leaders agree that competitive bidding is the top legislative priority with Medicare, but running a close second are problems with overlapping and unreasonable audits. AAHomecare’s Wilson wants providers to focus attention on the problems caused by the Competitive Bidding Program, highlighting the impact that competitive bidding will have on communities, employees and beneficiaries.

For example, Wayne Stanfield—president and CEO of the National Association of Independent Medical Equipment Suppliers (NAIMES)—emphasizes that competitive bidding will be disastrous for small businesses and jobs. “The myth that competitive bidding will not affect rural states is critical,’’ he says. “The unsustainable bid prices can be rolled into all states in 2016.”

However, getting to that point can be difficult, especially if a candidate lacks any knowledge about competitive bidding. Try to understand what level of comprehension you are working with, and keep things clear and concise. “If the folks on Capitol Hill are convinced there is a problem, they will be very willing to listen to our solution,” Wilson explains. “The big challenge we’ve had on this whole issue is there isn’t a critical mass on the Hill convinced there is a problem. Nobody is better for accomplishing that than the providers.”

Wilson says the solution—the Market Pricing Program (MPP)—is slowly making its way through the process that will take it before Congress. “We’re going to push forward this fall,” he says. “We believe the best opportunity to push the MPP across the finish line is during the lame duck session, which will occur after the outgoing Congress comes back in and has to deal with some final issues related to Medicare.”

Stanfield sees an uphill battle. “The truth is that no politician running for office this fall cares about this tiny industry, and getting the attention of lawmakers during the election is nearly impossible,” he predicts. “If we do gain a sympathetic ear, it is highly unlikely that they will be able to change the destructive path CMS has set for DME. Every person running for election has one goal, and that’s to get elected. Most will listen and nod, but taking action is another matter.”

Congressional gridlock will continue to be a problem unless big changes are made at the ballot box, he adds. “We don’t wield the power to affect an election outcome any more than we can affect change at CMS,” Stanfield says. “Suppliers have the proverbial ‘long row to hoe,’ and a successful outcome does not seem likely.”

Bachenheimer is more optimistic, however. She sees the HME industry struggling in the short term, but succeeding in the long run. Government-supported health programs are conducting demonstration projects to confirm that people can be better cared for in their homes at less expense. “They’re going in the right direction,’’ she says. “There’s an assumption now that we need to be using home care more. There’s been a huge shift. Now that we want to get there, we’ve got to figure out how.”

Political Points to Ponder

Republican presidential nominee Mitt Romney’s selection of U.S. Rep. Paul Ryan, R-Wisc., as his running mate put a national spotlight on the future of Medicare, a program that many HME providers rely upon for much of their revenue. It is an indication of the many challenges faced by Medicare, and a sign that providers must prepare for changes in the program.

Wilson of AAHomecare says not only will Medicare be a big issue in the campaign, it is also looming large in the lame duck session of Congress late this year and in the new Congress that convenes in January. “Medicare is going to be front and center,” he says.

Medicare in 2011 spent $549.1 billion to provide insurance coverage for 48.7 million Americans. Baby Boomers are retiring at a rate of about 10,000 a day, and that steady stream of new beneficiaries will keep up for the next 19 years, according to the Pew Research Center. This year, Medicare’s trustees reported that the program’s Part A fund will not have enough income starting in 2024 to pay full benefits. That coming shortfall will likely drive change for the program. Political candidates are now advancing three Medicare reform approaches. They are:

• President Barack Obama would maintain traditional Medicare, but make payment reforms that encourage quality over quantity of services. He is focused on eliminating fraud, waste and abuse. The president wants to end the Sustainable Growth Rate formula and create a new physician payment system. He would generate savings in Medicare through better preventative care for chronic diseases and an emphasis on wellness. And he wants to strengthen the Independent Payment Advisory Board to lower costs. Most HME providers know that the president’s Affordable Care Act expanded the Competitive Bidding Program, which was created during the Bush Administration.

• Romney would maintain traditional Medicare as an option, but allow beneficiaries to choose vouchers to purchase private insurance. He would exempt people over age 55 from the voucher program and maintain traditional Medicare for them. Romney wants private insurers to competitively bid Medicare plans, much like the system that currently exists for Medicare Advantage plans. The bidding system would determine the level of support Medicare would provide to beneficiaries. For example, the “benchmark” for support might be set at the second lowest bid or the average of bids by private insurers. The theory is that competition will lower costs for health care.

• Prior to the presidential race, Ryan and Sen. Ron Wyden, D-Ore., developed a modified voucher plan that would open Medicare to private insurance in 2022. Private insurance plans would be required to offer the same essential benefits found in traditional Medicare, which would also continue to be available for beneficiaries. A Medicare exchange marketplace would supplant Medicare Advantage plans, and an annual competitive bidding process would determine the level of government support for beneficiaries. Either the cost of the second-least expensive private plan or traditional Medicare would be used as a benchmark, depending on which one is least expensive. Growth of Medicare costs would be limited to growth of gross domestic product, plus 1 percent. Premium supports would be adjusted for income, or means tested.

It’s difficult to say which plan is best for the HME industry. For example, the existing traditional Medicare plan includes competitive bidding, but there are efforts underway to modify that with the Market Pricing Program, or MPP.

AMEPA’s Robert Brandt says providers should focus on how well a Medicare plan keeps the door open for durable medical equipment suppliers. That could be any of the plans, depending on how they are managed.

For example, Brandt says that for many years he has helped fight efforts to put Florida’s Medicaid program under a single managed care administrator because  that would have meant only a few suppliers would have been chosen to provide durable medical equipment to Medicaid beneficiaries. “I’m for whatever system will allow ‘any willing provider’ status for suppliers. It’s not the form of the plan, but whether the plan offers access for many different suppliers.”

Bachenheimer, of Invacare, says it’s difficult to determine which Medicare system will work best for HME because there aren’t enough details. But, HME advocates should be part of the discussion, emphasizing that no matter what is done with Medicare, there needs to be a place for HME. Raise concerns about existing payment systems for Medicare, and how those should be changed. “Physicians are compensated for office visits or to visit patients in the hospital,” she says. “They are not compensated for home care visits. You have massive structural issues to redirect to make our system make sense. We’ve got this institutional bias that’s built into payments.”

Johnson, of Pride Mobility, predicts that the outcome of the presidential election will have a big impact on the future of Medicare. “If we have a different president, I think many of the provisions of the Affordable Care Act will be reconsidered early next year. If we don’t, it looks like the Affordable Care Act is here to stay.”

Regardless, he points to Accountable Care Organizations (ACOs) as one area of Medicare opportunity for HME providers. “Look at how you can align yourself or partner in some form with these physician and health networks in your community.”

Sidebar

A Political Playbook

Don’t think you’ve got to spend time lobbying politicians in Washington, D.C., in order to make a difference. Professional organizations—of which you should be a member—are handling that angle. Your role can involve advocating for the HME industry locally, and it’s not as complicated as you might think. Here are some suggestions for getting active in your area.

• Call a local politician or state legislator’s office and ask to get on their schedule. Explain that you’d like to provide a brief description of what home health care actually is.
• Suggest that they pay a visit to your business so you can introduce him/her to the products and services you provide. Be flexible about the timing, and realistic about how much time they have to spare.
• Invite a few customers to attend the event so they can share their personal stories, making clear how important your products and services are to them.
• Allow members of your staff who work in different areas to explain their responsibilities, the challenges they face and the difference they make in patients’ lives.
• Approach the event as an opportunity to educate your guest, and avoid making direct requests or delving into personal and/or partisan politics. Show appreciation for their support.