Maybe No News Is Good News After All: Press Reports Damage HME Lobby Effort

ATLANTA--In an ironic twist of fate, the home medical equipment industry is finally getting the national recognition it has yearned for--but not the kind it envisioned.

Rather than being seen as the best hope to stem continually escalating health care costs, it has, through recent newspaper, radio and governmental reports, been painted as the scourge of the system, an industry of fraudulent providers and money-grabbers who exploit the oldest and sickest among us to ensure top-dollar reimbursement.

The persistent assault on HME has seriously damaged the industry's reputation, stakeholders say, and sent manufacturers, buying groups and national associations scrambling to respond in some productive way.

"There are so many things being shot at us you don't know how to respond," said Cara Bachenheimer, vice president of government relations for Elyria, Ohio-based Invacare. "This isn't the kind of press we were looking for."

The industry has been catapulted into the national limelight via a series of blistering reports. The most recent was an explosive New York Times article Nov. 30 that asserted Medicare is vastly overpaying for oxygen compared to "what somebody might spend at a drugstore." (See HomeCare Monday, Dec. 3.)

The story came on the heels of a segment on National Public Radio that depicted the entire HME industry as overrun with fraudulent providers and a report from the Office of Inspector General that maintained Medicare could save millions if it reimbursed providers for power wheelchairs at the same prices found on the Internet.

Another two-part report on HME fraud and abuse is scheduled to air tonight and Tuesday on "NBC Nightly News with Brian Williams." The reporter's field notes on the story, posted last week on the MSNBC Web site, preview what he describes as "the brazen, organized and widespread looting of Medicare, which seems all-too-easy prey for criminals hiding behind phony medical supply companies and clinics."

Discouraging to Advocates
"It does have a cumulative and negative effect on the attitudes and optimism of those of us who have spent most of our lives in the business," said Jim Walsh, president and general counsel of buying group VGM, Waterloo, Iowa. "And we wonder, how is all this happening now? Many of us who have spent time in Washington, D.C., understand the cozy relationships between the media and the legislative staffs. The timing is not coincidental."

It also couldn't be worse. Many HME advocates have been lobbying heavily to lessen the impact of competitive bidding, which is projected to kill off thousands of small providers, and also to forestall further reimbursement cuts by Congress.

As the days dwindle before their Christmas recess, both houses of Congress are working frantically to craft legislation on a variety of issues. One key measure is a Medicare package and its so-called "doc fix." Physicians are the target of a 10 percent reimbursement cut set to take effect Jan. 1, and legislators are seeking ways to sidestep that pay cut by cutting somewhere else. Both home oxygen and the first-month purchase option for power wheelchairs could get the axe.

With a barrage of such negative publicity, the industry's lobbying efforts, never easy under the best of circumstances, could be even harder. Stakeholders shifted into damage control with swift responses to the bad press, particularly the article, written by Charles Duhigg:

--In its response, the American Association for Homecare said the article "paints an extremely biased and misleading picture" of HME. "The fundamental flaw ... is the dangerously simplistic assumption that oxygen therapy delivered to Medicare patients in their homes should cost the same as the Internet or eBay price to buy the equipment only," AAHomecare said.

--Calling Duhigg's story "an inaccurate picture of the home oxygen industry," Invacare pointed out that "in reality, the costs of home oxygen therapy go beyond product acquisition costs to include the service that accompanies this medical therapy." The manufacturer's response also noted "the industry has withstood almost 50 percent in payment cuts over the last 10 years and has an additional 19 percent scheduled to take effect in 2008 and 2009."

--In a letter to Duhigg, the National Association of Independent Medical Equipment Suppliers noted "the cost of oxygen in the home for one year is less than one day in a hospital" and requested the opportunity for the industry to respond in an Op-Ed piece in the Times. "Remember that the $1.8 billion figure you quoted as the expense of oxygen equipment kept more than one million Medicare patients alive last year," the letter said.

--The Council for Quality Respiratory Care said the Times article "omits salient facts about home oxygen therapy and the critical role it plays in keeping some of Medicare's sickest beneficiaries in their own homes." The group also challenged the piece on its portrayal of home oxygen therapy "as though it is nothing more than the rental of inert equipment, when in fact home oxygen therapy is a prescribed therapy, that when properly administered, requires both medical devices and myriad patient services."

--VGM, which labeled the story "hack journalism," issued an alert to its members, urging them to contact their legislators immediately to set the record straight and plead for no more cuts either to oxygen or power mobility.