Tuesday, October 4, 2016

Providers’ Stories Reveal Devastating Effects of Competitive Bidding on Businesses and Patient Access to HME

Let Us Know How Your Company Has Been Affected by the New Pricing Environment

While Congress is no longer in session, AAHomecare continues to keep legislators apprised of the challenges HME providers are facing as we pursue legislative relief for these unsustainable prices. Thank you for continuing to relay your experiences to the association.

Here are some excerpts from narratives providers have shared with us about their challenges and plans going forward:

Illinois - During 2016, we’ve struggled to meet budget and had a few months where our bottom line was below the break-even point. We’ve looked at our lines of business to determine where we are affected the greatest. Oxygen reimbursement has dropped drastically, and with all the expenses tied to oxygen, including tanks, supplies, 36-month cap, portability, maintenance, and salaries, we are currently reviewing if this is a viable business line to keep.

Missouri - We have been serving rural patients in SW Missouri for 30 years.  We are a long-time valuable business and employer in our small community.  The recent cuts make it impossible to adequately serve the needs of our current and future area patients.  If the pricing structure doesn't change fast, we will be forced to stop serving our community and our patients.  Telling patients "NO" for services they desperately need is heartbreaking.  The quality of life and activities of daily living of our patients will suffer drastically and ultimately cost Medicare much more as these patients will be unable to stay in their homes and move to hospitals, assisted living facilities and nursing homes to gain the services we provide at a fraction of the cost!

New Mexico - Currently, we are negotiating with every vendor possible and looking for more affordable products (which are not always the same quality), extending current loans and reducing company contributions for Medical Health Insurance benefits.  It is possible that we will soon need to stop vesting in the retirement plan for our employees.  Sad state of affairs.

Help us continue to beat the drum on Capitol Hill by submitting your story to Tilly Gambill at tillyg@aahomecare.org.

Wednesday, September 21, 2016

Washington Inaction Is Hurting Seniors’ Medicare

Wisconsin Seniors Need Speaker Ryan to Stand Up for Them

By Brian Kelly

One would think the loss of 15 jobs and the closure of four of our nine medical equipment showrooms here in Wisconsin, is the result of an economic downturn or a slowdown in our industry. The cause is a misapplied government program that is leading to less access to care, reduced quality of care, and higher out-of-pocket costs for seniors and people with disabilities that rely on Medicare.

Based in and around U.S. House Speaker Paul Ryan’s congressional district, our company employs over 500 hard-working and committed individuals who provide a wide range of medical services and supplies to our friends and neighbors in 23 counties across south central and southwestern Wisconsin. An important segment of our business is providing home medical equipment and quality service to seniors on Medicare.

Across the country many rural medical equipment suppliers like us could soon be closing their doors, laying off more employees, and leaving patients with limited options and poor service.  This is the result of Congress’ failure to resolve a problem created by the recently-instituted competitive bidding process on home medical equipment. Its objective is to save taxpayer dollars, an important initiative, but it has failed on multiple levels.

The competitive bidding process was originally designed for use in urban and suburban areas, but this year, the Centers for Medicare and Medicaid Services (CMS) began applying rates from the bidding process in major metro areas to rural communities throughout the United States.  The initial results from a first round of cuts saw a 20 to 25 percent decrease in reimbursement to rural providers for many items starting in January of this year. These reductions caused significant disruption for home medical equipment providers and patients.  Despite these problems, CMS applied a second round of similar cuts for rural communities on July 1 that have now reduced reimbursement rates by 50 percent or more when compared to the prices in effect in 2015.

The urban and national companies making the bids that set reimbursement rates often times specialize in one product – hospital beds or oxygen supplies for example.  In the small towns and communities Home Health United serves, we do not have the volume or conveniences of urban delivery routes to support these lower rates.   To make our business work in rural communities we have to provide multiple product lines and travel many miles to deliver a single unit.

We have closed showrooms in Johnson Creek, Portage, Platteville and Madison, a significant inconvenience for countless seniors who now have to drive farther.  Seniors in rural areas tend to be much older than beneficiaries in urban areas, which makes longer travel times that much more significant. Given the added travel and higher out-of-pocket costs for seniors, many Medicare beneficiaries are deciding not to purchase the medically necessary products for their home care

Congress had a chance to pause the second round of cuts to allow for further study of the impacts on patients in rural communities, but the House and Senate were unable to reconcile different versions of legislation before they recessed in July.  Wisconsin home medical equipment providers are counting on Speaker Ryan to help break the impasse and make sure seniors and people with disabilities continue to get the home medical equipment they depend on.

Brian Kelly is the vice president of Home Medical Equipment & Infusion Services for Home Health United, Inc., based in Madison


This story appeared in the Sept. 12, 2016 print edition of the Janesville (Wisc.) Gazette

Thursday, September 8, 2016

Tom Ryan Makes the Case for Competitive Bidding Reform on C-SPAN and SIRIUS/XM

In a continuing effort to educate Congress and share the struggle of HME providers in the current Medicare environment, Tom Ryan was interviewed on C-SPAN’s Washington Journal show on Labor Day Monday (Sept. 5).

“It’s patient preferred, it’s economically the best situation, and at the end of the day you will get a better outcome,” explained Ryan highlighting the service component of home medical equipment and the benefits of homecare. Ryan also discussed the need for competitive bidding legislation stating, “Being fiscally responsible in this town [DC] is important. The legislation we have had has been self-funded by the industry. We have been taking dollars from other areas of the industry. The last bill out there would take reimbursement from Medicare and have that become the new rate in 2019.”

If you did not watch live, you can still view the full interview online.

And this morning? A stop at satellite radio – Tom appeared on SIRIUS/XM radio on The Morning Briefing with Tim Farley, which airs on their Politics of the United States (POTUS) channel (#124). "We need congress to roll back these cuts to HME," Ryan said.

There has also been great coverage of these issues in the press:

Thursday, August 18, 2016

Nominate an HME Leader for the 2016 Homecare Champion Award

Do you know a champion for the HME profession? The Association is now accepting nominations for an AAHomecare member who has made an exceptional contribution to the homecare sector throughout their career. Attributes that will be recognized include:
  • A longstanding record of service within the homecare community;
  • Embodiment of the spirit of caring and generosity which are the hallmarks of this profession; 
  • Active membership and engagement in the American Association for Homecare.
While this title may relate in part to involvement in government affairs, the Homecare Champion award is not predominately focused on federal or state government advocacy. Our goal is to honor people who have been involved in various aspects of the business of HME and the care that is an essential component of it.

The recipient will be honored during the Stand Up for Homecare reception during Medtrade on Tuesday, November 1, 2016 and recognized in a special notice in the trade press and local media.

Nominations can be submitted to Sue Mairena, suem@aahomecare.org through September 9.

Find the nomination form and see past honorees here.

Thursday, August 11, 2016

Providers' Stories Foreshadow Growing Challenges for Rural Patients and Communities

Let Us Know How Your Company is Adapting to the New Pricing Environment

Thanks to the many providers in rural and non-bid areas who have reached out to share their stories about the difficult business decisions they’ve faced in light of the latest round of bidding derived cuts.

Here’s some excerpts from what providers are telling us about their challenges and plans going forward:

  • California – So here we are after 27 years in the DME business and with this second set of cuts I will have to close my doors within a 45-60-day timeframe. It will not be pretty. I've had as many as 30 employees and now I have three; two of them are part time… When all this comes down I will also lose my home. Talk about having my world turned upside down.

  • Texas – 2016 marks my 20th year serving the needs of HME and supply customers. Due to the competitive bidding debacle, I’ll pack up 20-years’ worth of memories into a box and see what is next. The 20 people that hold full time jobs with me will have to be terminated. They won’t be alone, as all private HME companies serving rural areas will go out of business and lay off their employees. There will be thousands of them across Texas… Like I’ve said a thousand times, we could set up a hospital in the home for a fraction of what it costs to be hospitalized. We can provide years’ worth of oxygen therapy for what it costs for a couple days of being in the hospital. Not anymore. After July 1st, rural patients will have to beg someone for these products.

  • Kentucky – No one thinks about the cost of our equipment along with the cost to deliver and educate the patient and family that is depending on us to help a mom or dad or a loved one. We also deal with insurance guidelines, deal with insurances two to three times on a claim, and have overhead that never stops… No business can keep its doors open when you are losing money to take care of someone.

  • New York – There is a much bigger picture that seems to be overlooked by government. It’s about preserving services and equipment to individuals and the elderly with severe disabilities and the livelihood of local and county businesses and residents… We are giving up any hope. The light at the end of the tunnel is about to go out.

  • Alaska – The only reason we are still in business is because we are family owned and operated.  Many times we do not get a paycheck. We started this business twenty years ago because of the need for DME.  We now have over 200 clients we serve. If I close the doors, they have no place to go except the hospital, which is at capacity most of the time, and the cost to Medicare will increase by 2000%. The other option is to move South. 

Our champions on Capitol Hill and other members of Congress and staffers have asked us to collect and share as many real world examples of how the new pricing environment is affecting providers and patients in rural and non-bid areas.  We hope you’ll consider adding your story to the mix.

Please help us make the strongest case possible as we prepare to advocate for relief for rural and non-bid area providers in September.  Contact Tilly Gambill at tillyg@aahomecare.org to share your story, or with any questions.