Looking for Long-Term HME Solutions

A lot is in flux in the world of home medical equipment (HME). HomeCare checked in with Tom Ryan, president and CEO of the American Association for Homecare (AAHC) for the latest.

HomeCare: At press time, legislation to get the 75/25 rate extended in non-bid areas is still on hold. What’s the plan for 2024 or beyond?

Ryan: Like a lot of health care interest groups, we’re frustrated that the health care extender legislative package that our 75/25 provisions are a part of is being delayed as the House and Senate work through contentious issues. We were in the best possible position to get the 75/25 provision moved in government funding legislation in January before that package
was waylaid. If this doesn’t ultimately move in a timely manner, we’re going to have to really turn up the volume on what the loss of those 75/25 rates means for suppliers and the resulting impacts to patients, caregivers and clinicians. This situation is an example of why we need a better long-term approach to setting Medicare reimbursement rates. Relief beyond 2024 needs to be a regulatory play. We need to convince the Centers for Medicare & Medicaid Services (CMS) that we cannot keep going to Capitol Hill for this relief; it’s now being considered as a Medicare extender, so the sensible solution would be to make it permanent through regulation. We have laid the groundwork for this in 2023 with Jason Bennett and the team at CMS, and we have a meeting request in now to continue the push. The challenge will be finding a regulatory pay-for, but this industry has no more to give.

HomeCare: How has grassroots participation been in that effort?

Ryan: I think it’s been very strong.  Members of Congress are telling our lobbying team that they are hearing from HME stakeholders on this issue. In a subcommittee hearing on HR 5555, we had a legislator specifically mention the grassroots outreach they were getting on the need to extend 75/25 relief.  It really stood out compared to discussion and comments on other bills being considered.

Our advocates are doing a great job developing good relationships with legislators and staff and keeping our priorities in the spotlight, but we’ve got to keep growing that capacity and telling our story effectively. There’s so much competition for attention and support on Capitol Hill and we’ve got to collectively keep upping our game to make sure we’re being heard.

On grassroots, it has been strong but could always be stronger. If everyone working in this industry engaged in grassroots efforts, we could have a massive voice.

HomeCare: We’ve got elections this year, a possible change in administrations and a number of members of Congress have announced retirements. What’s the landscape in Washington right now?

Ryan: We just learned that Energy and Commerce Chair Cathy McMorris Rogers has added her name to the extensive list of retirements. She’s been a great champion for us and we’re going to miss working with her. That brings the turnover on the House Energy and Commerce Health Subcommittee to nine retirements—one-third of the current group of 27. Vice Chair Larry Bucshon is another significant retirement on the Health Subcommittee. He understands HME’s important role in the health care continuum as a former physician, and, thanks to our Indiana advocates, has always been a strong voice in support of our legislation. Sen. Debbie Stabenow, as senior member of the Senate Finance Committee, has been a very important champion for us, so we’ll definitely miss her influence and support.

We’ve gotten better at prioritizing grassroots advocacy and relationship-building on committees of jurisdiction for health care finance issues in recent years, and we’ll take advantage of the opportunity to engage with new members on those committees and in Congress when the next session kicks off.

As we noted earlier, the current landscape on the Hill is challenging. Unfortunately, there’s a lot of political posturing that prevents common-sense legislation like ours, with strong bipartisan support, from getting passed into law in a timely fashion.

HomeCare: What does a long-term solution to Medicare reimbursement look like?

Ryan: What we need is simple: rates that reflect market reality and a rate-setting methodology that gives suppliers some assurance about what their rates will look like a few years down the road. If CMS implements another bidding round, it needs to include guard rails that we successfully advocated for that allow for true price discovery and keep non-serious and unqualified bidders out of the process. It’s also essential that these processes are fair and transparent and do not compromise patient access to needed equipment. And we also need to ensure that CMS can’t just walk away from the process if the results don’t produce the savings they want to see.

Whether it’s through the bid program or some other mechanism, reimbursement rates have to account for rising prices for the products themselves, as well as increased costs for labor, fuel and delivery, and the substantial costs for regulatory compliance. We are in the process of engaging CMS once again to make our case, and we’ll certainly make this a priority on Capitol Hill if we don’t get clarity on a workable price-setting process soon.

In the long term, we need to encourage more innovation and research in durable medical equipment (DME), leading to the development of new technologies and approaches that improve patient outcomes and reduce overall costs. Value-based care models would shift the focus to rewarding outcomes rather than solely on the provision of equipment.

HomeCare: Continuous glucose monitors (CGMs) seem to be an area of a lot of interest. What do providers need to know?

Ryan: When it comes to CGMs, audits are a new issue the AAHC Diabetes Council is looking at. With the implementation of an expanded coverage policy last year through a new local coverage determination and the resurgence of certain audit types that were paused during the public health emergency toward the end of last year (such as targeted probe and educate, or TPE, audits), there’s been a noticeable uptick in audit activity. Also, the Office of the Inspector General has included a review of CGM acquisition costs in their work plan, further highlighting the growing scrutiny in this area.

There are also a lot of things going on at the state level on CGM coverage, with a handful of states aiming to transition the benefit from the DME channel to the pharmacy channel. Much of their motivation on this stems from the availability of collecting rebates from manufacturers. We need to expand access to CGMs through both the DME and pharmacy channels, allowing a greater number of patients to receive this evolving technology. This issue continues to be a prominent concern and ongoing discussion topic for the council and our payer relations team.

HomeCare: What are you most looking forward to at Medtrade?

Ryan: I’m really interested in seeing how the enthusiasm for going to a single-show format continues to grow in our second year in Dallas. I think the Expo floor is going to be really strong once again, and I’m excited about AAHomecare’s participation in several educational sessions, as well as the new complex rehab technology track that we helped develop and push for. Like the HME sector, Medtrade continues to evolve to meet changing needs and find new opportunities, and that’s exciting.

It’s also a great opportunity to highlight our AAHomecare team, and to meet new prospects and hopefully have them join us to support our mission. This year, we invite all Medtrade attendees to participate in our value of homecare efforts by sharing their “Why” of being a part of this industry. The HME community has a great story to tell as we touch the lives of millions of Americans who receive home-based care. Come by our booth (#750) to write your “Why” on our wall and get inspired by others’ messages!

But what I love most is catching up with so many HME leaders—and meeting new ones—on the Expo floor, at the Stand Up for Homecare reception and all around the show. I’m really looking forward to it all!