No Question

Last year, I was attending a national meeting when, during a question and answer period, a gentleman from the audience asked, “If I pay my state association dues and I pay my national association dues, why do I have to write letters and make phone calls?”

At first, I was taken aback by what I thought was a question with such an obvious answer. After all, I had just completed two years as vice president of the Florida Association of Medical Equipment Services and was finishing up my first year as president. And here was this man asking, essentially, what have these associations done for me?

To me, the answer was clear. Associations offer support, advocacy, and in some cases, protection for their members. Such support and advocacy are even more important in heavily regulated industries such as ours.

As I thought about what I had just been asked, I realized that there were probably many people and companies out there who felt exactly the same way as the gentleman from the audience.

The strength of any association or organization is based on the number of members it has and the commitment of its membership. When the dues dollars are paid, the commitment from the member does not stop — in fact, it increases. By joining an association, a provider says, “I want your help, I want your information, I want your protection, and I am here to help you provide those services.” An association cannot function efficiently without the financial support of its members. Likewise, an association cannot function efficiently without the active involvement — or personal time investment — of its members.

Although I have worked in this industry for 16 years, it has been only within the past 10 years that I have really advocated lobbying and working together as an industry “team.” A decade ago, I began to realize how much the home medical equipment industry had lost simply because HME providers felt they could not make a difference in what happened in the industry.

Do you remember when our oxygen reimbursement was cut by 25 percent? Prior to that cut, rumors circulated that the reduction would be anywhere from 40 percent to 75 percent. When the final figure was announced, we were grateful that it was only 25 percent.

At the time, I did not understand the political and financial reasons behind the oxygen reimbursement cut, nor did I understand that there were people out there working against that cut. Could the outcome have been different if HME providers had worked with our elected officials on a compromise? While we will never know for certain, I do feel that, then as now, we could have a large impact on the decision-making processes that affect our businesses and livelihoods.

For example, last year, Florida Medicaid attempted to implement a competitive bidding process that would determine proprietary Medicaid HME providers. This competitive bidding process would have reduced a pool of more than 900 HME providers to one provider in each of Florida Medicaid’s 12 regions. Further, the actual number of bid recipients would have been only seven, instead of 12, because some of the “winning” providers would be awarded more than one region — thereby reducing the provider pool even more.

Realizing the state had violated its own rules, FAMES filed a lawsuit — and won. As a result, the competitive bidding process in Florida has been stopped, and the state now must go back to the drawing board. Medicaid providers, whether members of FAMES or not, can thank FAMES for the fact that for the past two years, and hopefully for many years to come, they can continue to bill — and collect reimbursement — for their products and services. This is the difference that association membership can make.

I truly do not understand how businesses — particularly small businesses in the HME industry — can function in today’s constantly changing and challenged marketplace without the information found in trade publications and the support options offered by our state and national associations.

I also fail to comprehend how business owners can choose to keep plugging along with blinders on, assuming that everything eventually will work itself out, and that they can do nothing to change their circumstances. Silence implies consent, while action inspires change.

During the past couple of years, I have seen a growing trend toward providers understanding and recognizing the benefit of participating in their state and national associations. Unfortunately, during strained financial times, an association membership usually is the first thing a provider leaves unpaid. However, what may appear to be a money-saving decision is, in fact, a false economy — withdrawing your support from an association only weakens the industry as a whole.

FAMES is one of the largest, single-state HME industry associations in the country, and yet counts only 30 percent of licensed HME companies in Florida as members. We are very active and progressive, and we are working hard to represent and support the industry for our members. I believe that we have made a difference not only in our state, but in assisting the national organizations as well.

However, I am convinced that we could accomplish far more if we had the voices and voting representation of the other 70 percent of Florida providers, all of whom are just as affected by the issues that the members of FAMES face. To understand and believe that there really is strength in numbers, one has only to look at the changes associations such as the American Medical Association, AARP, the National Association for the Advancement of Colored People, and Mothers Against Drunk Driving have achieved with the support of their respective members in their respective areas.

I am a strong advocate of the “team concept,” which I apply to state HME associations. FAMES has been lucky to have a very strong board of directors and solid leadership for many years. We have expanded our membership base, and we have retained most of those members by actively communicating with them about important issues, explaining the need for active involvement and sharing the results of our actions.

If a provider is not aware of what is going on in the industry, it is rather difficult to know what we can do to help. By working together, we can achieve so much — without generating the well-known burnout that can occur when a very small group of people is delegated to do all the work.

Working together to create and maintain a strong state association helps to create a large group of individuals that can truly influence not only our state policies, but national policies as well.

Communication is the key to our success, and state associations can certainly make facilitate communication. Regardless of the size of our individual companies, we are all in the same industry. We all have knowledge to bring to the table.

With such ominous issues as national and state competitive bidding, state licensure requirements, changes to the average wholesale price of drugs, and the possibility of privatizing of Medicare currently on the table, how can you not be involved? How can you not write those letters and make those phone calls? These issues don’t affect some unknown entity — they affect you, your business and your future.

Have our grassroots efforts helped on a state level? Absolutely. Have our grassroots efforts helped on a national level with competitive bidding? Absolutely. Competitive bidding was absent from the federal budget this year for the first time in 12 years. Did the individual make a difference? Maybe a little. Did the large group of individuals — think voters — make a difference? No question.

Joan Cross is president of the Florida Association of Medical Equipment Services. She also is vice president and co-owner of C & C Homecare in Bradenton, Fla. You may contact her by phone at 941/761-8338 or by e-mail at [email protected].