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.
Can the Good Guys Win?
Despite those official rejoinders, the question remains: In light
of the tidal wave of negative press, can the industry shore up its
reputation?
Most stakeholders believe that will take all home care providers
stepping up to the plate to ensure the accurate story of HME gets
out to their legislators. While Washington insiders agree it is
unlikely federal lawmakers will reach agreement on Medicare this
year–“We are running out of time in terms of a Christmas
deadline,” said Bachenheimer–no one is suggesting waiting to lobby
until Congress returns next year.
“The threat is really real,” said Seth Johnson, vice president
of government relations for Pride Mobility Products, Exeter,
Pa.
As of Friday, the House Medicare package called for cutting home
oxygen rental payments from 36 to 18 months. While the Senate
package was not set, “we do know the Senate has a $77 reduction
[for oxygen] in their package, which would take it down to around
$120 a month,” Johnson said. “As far as the first-month purchase
option for power wheelchairs, we have heard conflicting information
about whether it’s in the Senate bill or not. Regardless, going
into negotiations, it’s clearly on the table for inclusion.
“What we need the industry to do is to pick up the phone and
call their legislators and let them know what the impact of these
two provisions in the Medicare package would be and what the impact
would be on their companies if these changes are implemented,”
Johnson said.
Bachenheimer, too, stressed the need for provider lobbying.
“People get frustrated or dismayed that they can’t get a meeting
[with their legislators], but they just have got to keep at it,”
she said.
Despite the bad news, Bachenheimer continued, “the industry has
done a decent job [of lobbying] this year relative to previous
years. There are a lot of folks who advocate for us.”
She lauded in particular the support of Sen. Pat Roberts,
R-Kan., a member of the powerful Senate Finance Committee, which
oversees Medicare. “He’s a huge advocate,” Bachenheimer said. “He’s
really close to his constituents. Over the years, providers have
been educating him, and he sees access to home medical products and
services as critical … It’s wonderful to see some of the results
of these efforts over the years.”
Hoping for a Fair Shake
Raul Lopez, president of the Florida Association of Medical
Equipment Services and director of operations for Bayshore Dura
Medical in Miami Lakes, is hoping that education about HME will
make the difference in NBC’s upcoming report.
Lopez spent three hours with NBC News correspondent Mark Potter
three weeks ago. The reporter, who was following the NPR story on
fraud and abuse in Miami, had already spoken to Health and Human
Services Secretary Michael Leavitt and gone on a ride-along with
the FBI to a non-existent HME facility.
Lopez took him on a tour of Bayshore’s 20,000-sq. ft. facility,
explained the industry and even armed Potter with a General
Accounting Office report on Medicare “that showed $70 million to
$75 million of Medicare’s own boo-boos.”
He has no idea how much, if any, of his 25 minutes on tape
Potter will use. But he is hopeful the NBC story will, at the
least, present a balanced view of the industry. “Though the focus
of the story is fraud, the fact that Mr. Potter went out of his way
to look at our perspective and acknowledge that there are good
providers out there serving beneficiaries was a great opportunity
to change some minds,” Lopez said in a FAMES memo about the
reporter’s visit.
“[Potter] was open-minded enough to look for legitimacy in the
industry,” Lopez told HomeCare Monday. “I was quite
pleased with that. Even if it is a 10-second blurb, it’s better
than we’ve ever gotten before.”
Said VGM’s Walsh, “It’s a continuing public relations battle,
and it’s always going to have to be fought. This is not a
day-to-day battle, this is a decade-to-decade battle. We re going
to have to make a convincing case that home care can effectively
cut health care costs for everyone.
“I guess,” he said, “it’s shame on us for not being able to
effectively get that message across.”
For more information:
Read field notes on his report from NBC News correspondent Mark
Potter.
View Charles Duhigg’s New York Times article.
View AAHomecare’s response to the New York Times
article.
View a response to the New York Times article from the
CQRC.
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