Do you know who can hold a grudge? My
daughters. I don’t know if this is a trait universal to
all teenagers, or just mine, but boy oh boy are they
experts at recording slights and then calling them
up at a later date.
I freely admit that I’m courting absolute doom
by writing about my girls’ spats in a column, but I
can’t help it, and besides … it’s true! For example,
one of my kids will misappropriate a greatly
coveted food item from another’s lunch bag, and
you can count on two outcomes: First, the finger
pointing and recriminations will be on par with
what takes place on Capitol Hill. Second, the kid
who got victimized will mentally file this crime,
and call it back up like an ace up her sleeve, to be
played during a future dispute. For example:
“Hey, you swiped my granola bar!”
“Well, five months ago you drank my smoothie!”
Then they’ll launch into trading volleys of
recorded insults and wrongdoings back and forth
like a cross between the world’s loudest, angriest
tennis match and an oral history cage match that
recounts every minor, intra-personal infraction
that’s ever occurred between them.
Honestly? I’d get mad, but I’m too impressed by
their total recall. I think their brains are connected
via WiFi to some kind of cloud-based, argument
storage system that only teenagers can access.
You know who else can hold a grudge? CMS. It’s
attitude toward DMEPOS providers relies on suspicions
and attitudes that don’t jibe with current
reality. One of the big problems is HME providers’
status as a “supplier” instead of a provider.
CMS sees what HME providers do as no different
from supplying filing cabinets, or truck tires, or
computer equipment, or any other “widget” that
a supplier might provide the government. The
agency doesn’t take the time to study the services
providers include with the equipment they provision,
or how their clinical and product expertise
can greatly enhance patient outcomes.
It also views providers as a problem. We know
this from the incredibly outsized attention CMS
gives DMEPOS when it comes competitive bidding,
audits and other policies. For a benefit that makes
up less than 2 percent of Medicare’s budget, CMS
sure seems to think that DMEPOS is the problem
child. Looking at how policies are implemented
and enforced indicates an obvious, institutional
culture that puts our industry in the crosshairs.
Case in point: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act. Passed
in 2014, the act aims to improve post-acute care
provisioned to Medicare beneficiaries through
standardizing and the recording and reporting of
patient assessment data. It aims to create interoperability
so that all that patient data can be shared
between the various healthcare providers who
hold a stake in a patient’s continuum of care. After
reviewing a variety of IMPACT Act documentation,
what I’ve found is that, beyond casual mention, it
doesn’t mention DMEPOS at all.
This magazine, the industry, and a variety of
vendors and providers have discussed the pivotal
role that providers can play in patient monitoring
and reporting for literally years. Anyone in the
post-acute care space would literally have to be
asleep not to notice that fact that sleep providers
have been rolling PAP therapy devices that help
physicians and other healthcare experts track sleep
patients’ progress and therapy in detail in order to
fine tune outcomes. And, as our January feature
“Continuous, Connected Care” showed, now even
more sectors of HME, such as oxygen and diabetes
are moving fast to help facilitate the monitoring
and reporting on their patients’ care, as well. All
of these providers are in the post-acute care space,
and they are all looking for ways to help their
patients through data reporting, but none of them
are involved in the IMPACT Act discussion.
It’s clear that CMS has an “attitude” toward HME
providers: we’re a problem; not a solution. And
that’s where CMS and my daughters depart. My
girls might have their differences, but in the end
they settle their beefs and move on. If they hold a
grudge, it’s temporary. In contrast, CMS appears to
harbor an institutional “grudge” with HME.
CMS needs to create a new internal culture that
sees DME/HME for what it is: a vital player in postacute
care and a money-saving asset in building
our nation’s healthcare future. I believe new HHS
Secretary Tom Price and CMS Administrator
Seema Verma (see “News, Trends & Analysis,” page
8) might be the team to foster that change. It’s time
to move onward and forward.