AAHomecare’s Wilson: ‘We’re in the Gun Sights’

ATLANTA — The home medical equipment sector of health care
is under full assault and, while numerous defenses are being
mounted, they can only be successful with a united, concentrated
grassroots effort from HME stakeholders, American Association for
Homecare officials said last week during Medtrade.

Speaking to a room crowded with stakeholders on Wednesday, Tyler
J. Wilson, president of the organization, and Walt Gorski, vice
president of government relations, pressed the need for providers
and other stakeholders to get involved if they are to save access
for consumers — and their own livelihoods.

“We are straight in the gun sights of those focused on cost,”
Wilson warned, ticking off such issues as DMEPOS competitive bidding, the
36-month oxygen cap, congressional proposals to eliminate the
first-month purchase option for power wheelchairs and a
$4-billion-a-year device tax on
manufacturers.

“We are addressing every issue through Capitol Hill, CMS and the
media … We have a struggle before us.”

However, he said, there is some good news with Florida Democrat
Rep. Kendrick Meek’s introduction of a bill to repeal competitive
bidding (see Rep.
Meek: Repeal Competitive Bidding, HomeCare Monday Special
Alert, Oct. 13).

“It’s a critical first step to getting competitive bidding
repealed. We want to make sure it’s on everyone’s radar screen,”
said Wilson about H.R. 3790, adding that it will take an all-out
grassroots press from providers and other stakeholders talking to
their legislators to get the bill passed.

He spelled out seven key factors the industry needs to achieve
to get the job done:

1. More agreement, more consensus, less fighting. “When we go to
   Capitol Hill, we have to go with a unified voice,” he said.
2. Adopt a broader view on how our issues fit into the overall
   picture on the Hill.
3. Develop more allies on the Hill.
4. Get the good message of home care out to legislators and the
   public. “We have to convey how well-delivered home care can cut the
   cost of health care,” he said.
5. More grassroots activity. “We need that figure [of those
   involved] not to be 15 percent, but 40 percent or 60 percent.”
6. Band together to accomplish goals. “All industry groups must do
   a better job of working together,” he said, including everyone from
   AAHomecare to state and regional organizations and specialty
   groups.
7. Transform passion into results. “All of you can play a role in
   getting this to happen,” Wilson said, urging attendees to become
   active members of industry organizations.

While Wilson spoke in generalities, Gorski offered specifics on
some of the key threats to HME, starting with the Senate Finance
Committee health care package, which was passed by the committee
last week. That package, he said, would, among other things:

• Speed up implementation of competitive bidding, allowing 20
  more sites in Round 2 and enabling CMS to implement the new lower
  reimbursement rates across the nation;
• Eliminate the first-month purchase option for power
  wheelchairs; and
• Establish an excise tax for device manufacturers.
• The bill also does not provide for DME coverage in its public
  plan.

“This package is a nuclear bomb when it comes to HME,” Gorski
said. “It is looking to take $5 billion from us in the next few
years.”

Meanwhile, the health reform package in the House also
eliminates the first-month purchase option for power wheelchairs;
that should come up for action within a month.

Gorski said AAHomecare and others in the industry have devised
an alternative called the “clawback provision.” (See First-Month
Power Wheelchair Purchase Elimination Still in Play, Aug. 3.)
Under the proposal, should the patient die before 13 months, the
reimbursement for the remaining months would be returned to
Medicare and the provider would take ownership of the chair. Gorski
noted that 87 percent of those in wheelchairs live longer than 13
months.

Still, some providers attending the talk wondered aloud what
they would do with “a bunch of used chairs” and whether
manufacturers would take them back.

As to competitive bidding, Gorski reiterated Wilson’s call for a
grassroots effort to help get cosponsors for Meek’s bill. “We need
100 or more cosponsors,” he said.

On the regulatory front, Gorski said, AAHomecare is appealing to
CMS to modify the competitive bidding program to allow more
providers to survive and to change the pricing method.

Such efforts demand more staff, so AAHomecare will add a senior
director of government affairs and a manager of government affairs
within the next few weeks, Gorski said.

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