Tom Ryan: Challenges Ahead for HME

ATLANTA (October 19, 2021)— The home medical industry has made significant progress in recent months but still faces big challenges in Washington, including the threat of Medicare cuts and uncertainty about competitive bidding, Tom Ryan, president and CEO of the American Association of Homecare, said in his update at Medtrade East.

The association recently announced the success of a House sign-on letter surrounding the durable medical equipment final rule and continued rate protections for providers–and helped get the Centers for Medicare & Medicaid Services (CMS) to move its long-awaited DME interim rule to the Office of Management and Budget, the required next step. The letter received 95 House signatures, and Jay Witter, senior vice president of public policy, said there has been great interest in the Senate.

Witter said that the next big vehicles the association is eyeing for legislative action are the Dec. 3 need to raise the debt ceiling and an end-of-year Medicare package. 

But the timing is tough, given the partisan atmosphere in Washington and focus on the debt limit and infrastructure package, Ryan said,  

“It’s an extremely challenging time on the Hill,” he said. 

“The calendar is not our friend,” John Gallagher, vice president of governmental relations for VGM, said in a separate session. “The end of the year is quickly coming on us. But there will be an end-of-year package for Medicare–and that’s what we want. Our bill will never be voted up or down; we just need the language inserted into a must-pass piece of legislation.”

Also on the horizon is a possible 2% cut to Medicare spending from sequestration plus another 4% cut due to the PAYGO component of the American Rescue Plan Act, which could lead to as much as a 6% reduction in health care spending, Gallagher said. 

Continued questions about competitive bidding pose another challenge going forward, but Ryan said that the industry played a role in getting the program paused for Round 2021.

“We asked you to bid smart, and you did,” said Ryan. The Centers for Medicare & Medicare Services (CMS) is allowed to pause the program if it does not deliver significant savings. Early in the pandemic, noninvasive vents were removed, and then the agency announced bidding would only go through for off-the-shelf orthotics and back braces. 

“My gut says they won’t move forward with those 13 categories,” said Ryan. But, he added, the association has not been able to get meetings with the new administration. “We can’t lose what we have,” if the program goes forward. “The guardrails have to stay,” he added. 

Witter added that it’s vital for providers to relay to their representatives that they can’t deliver at a loss. As supply chain disruptions hammer the industry, it’s more important than ever that rates increase, especially in competitive bidding areas that are also COVID-19 hotspots, said Witter.

Ryan said that the recent AAHomecare Washington Legislative Conference had more than 180 providers registered and garnered 240 virtual meetings on Capitol Hill. The association is still working on dates for 2022, but plans to again host the conference in a virtual format. 

Immediate past board chair Steve Ackerman was also honored with the Chairman Award for Extraordinary Service. Ackerman led the board from 2019 to 2020, including the start of the COVID-19 pandemic. Ackerman’s efforts help to secure more than $2 billion in federal relief for HME industry.

“When John Letiza [previous board chair] passed the role on, he said the ball was on the five-yard line,” said Ackerman in his acceptance. “But we were penalized right away. To Bill [Guidetti, current chair], I felt like I was handing him a flaming bobsled and giving him a push.” Ackerman added that “being in leadership gives you the ability to see around corners,” and encouraged providers in attendance to get involved with the association.