High Stakes for HME on Capitol Hill

Optimism and realism color rural provider advocates’ opinions during last week’s Washington Legislative Conference visits.

AAHomecare’s Washington Legislative Conference was the place to be for engaged providers last week.

As HME providers and industry advocates collected for last week’s AAHomecare Washington Legislative Conference, held at Washington, D.C.’s Washington Court Hotel, it was clear that the industry was in crunch time, and no one was feeling that more than rural providers

The task sitting before the industry is a tough one: providers and advocates are working with Congressional champions to fast track legislation in both the House and the Senate before the full weight of bid expansion cuts reaches implementation on July 1. Those cuts will greatly impact rural providers, who will have considerable difficulty serving their far-flung patients as a result.

So, the industry and supporting lawmakers were working doubly hard to advance  S.2736, the Patient Access to Durable Medical Equipment Act, and H.R. 5210, the Patient Access to Durable Medical Equipment Act. Among their provisions, the bills advance two very crucial components when it comes to the bid expansion:

  • Delay implementation of the second phases of reimbursement cuts for HME items in non-bid areas from July 1, 2016 until at least Oct. 1, 2017.
  • Replace the bid ceiling for future rounds of bidding with the unadjusted fee service rates from Jan. 1, 2015, rather than CMS’ current plans to cap future bid ceilings at the previous bid rates.

We Save Medicare Money

Rural providers packed into the Washington Court Hotel to hear lawmakers and experts speak before diving into their Capitol Hill appointments.

And the attendees of the Washington Legislative Conference had slightly more than 30 days to advance these two bills. Despite the tall order, feelings among rural providers attending the Washington Legislative Conference were generally optimistic about the industry’s chances. The key, they argued was making sure providers and advocates maintain an industry-wide push.

“My main focus is that were one of the only sectors of the healthcare industry that is focused on saving Medicare money,” said Jody Anderson, executive director of Yorhom Medical Essentials, Grand Forks, N.D. “That said, this is rural bill, so the big question is can we get the urban folks on board.”

Anderson’s HME business serves patients in an area covering roughly 30,000 square miles of rural North Dakota and Minnesota. If reimbursement transpires as CMS’s current implementation of bid expansion requires, that means he will have to cut down on his transportation costs.

“We provide services to all those areas once a week, and we just can’t keep that up,” Anderson explains. “We don’t get paid for delivers to those areas, so it’s going to force a lot of those folks to come to us.

“On the front of my meeting comments, I say we save Medicare money,” Anderson continues. “If [patients] don’t have the means to get there [his business] they have to near there — long-term care, assisted living — or they’re going to go without, which will end with them winding up in a hospital, more than likely.”

Do People Have to Die?

Those sentiments were echoed by Jackie Semra, corporate compliance for Reliable Medical Supply in Brooklyn Park, Minn. Semra is a member of the Midwest Association of Medical Equipment Services, and noted that MAMES sent its largest contingent ever to this year’s edition of the Washington Legislative Conference, 22 providers in all.

“We have a lot of rural areas,” she said. “This rural roll out is going to kill our providers. So we need to be here. That’s evident in how many providers left their businesses to come out here.”

And if rural providers can’t survive the July 1 implementation, their patients could be left out in the cold — literally.

“At this point we don’t know what’s going to happen,” Semra said. “I was talking to someone last night and they said that in helping their rural patients that at the prices Medicare is paying, they are losing money literally picking up the phone and talking to their patients. He said they’re going to have to come to me, and a lot of those people don’t have the ability.

“What happens to that patient who has a chair that is broken down or needs equipment supplies and they can’t get in?” she added. “In the rural areas in the Midwest, if there’s a blizzard, how are they going to get what they need? Is it going to have to take someone actually dying? … What I’m afraid will happen is that it will come back to the provider, not the fact that we can’t service and stay in business. You can’t receive less than your costs and stay in business.”

Do Lawmakers Get It?

Obviously, the stakes are high for patients and providers, as well as Medicare, whether it chooses or not to admit that fact. So the question is, do lawmakers understand what’s hanging in the balance?

Michael Bailey, CEO of Handi Medical, Saint Paul, Minn. runs a $30 million provider business serving patients in a variety of settings, including rural areas. Competitive bidding has been a trend his business has been contending with since its inception, and he’s worked hard to diminish its impact on his bottom line. That said, he’s still lobbying on behalf of his industry and its patients.

With that in mind, Bailey said that he felt that since the passage of competitive bidding in 2003, members of Congress have been “indifferent at best” to the impact the program was having on providers and beneficiaries. What will be key to unlocking a major turnaround in lawmakers’ attitudes about the competitive bidding program are the patients, he says.

“Until beneficiaries themselves step up and reach out to Congress, nothing will change,” Bailey says. “We’re going to be here. We’re going to work very hard to get [lawmakers] to realize what’s going on in our specific cities and states. But until they hear from their constituents, nothing is really going to change.”

Bailey also highlighted the fact that while the current mission at hand was to advance rural reform and delay the July 1 implementation, the industry’s overall goal should never veer from stopping competitive bidding in its entirety.

“I want competitive bidding to end,” he says. “I want to repeal this program, because it’s impacting beneficiaries up to the point of including death, and that’s unacceptable.

“… People with diabetes, according to the Minority Quality Forum are dying because of test strip access,” he continues. “I know a woman who in the last 10 weeks of her life did not get her hospital bed from a contracted supplier. She didn’t die because she didn’t get the hospital bed, but she was uncomfortable for the last 10 weeks of her life. That’s absolutely unacceptable.”

Those are high stakes indeed. No wonder providers were feeling the pressure to beat back bid expansion with a little more than a month to go. That said, confidence was in good supply on The Hill as the Washington Legislative Conference’s provider advocates headed out for their appointments with lawmakers and staff.

“I’m always optimistic,” Anderson says. “We’re an industry full of fighters and we’re gong to find a way to make [rural reform] happen, because those patients deserve it.”


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