What You Don’t Know Could Help You Survive!

Now is the time to write the check for your AAHomecare membership renewal. Why? Because there’s a fresh attitude in Washington at the refocused and reenergized AAHomecare, and that’s because of the new president and CEO, Tom Ryan. You could say we have a new hired gun, and this one is also a veteran provider. For the first time ever, the national DME association is led by a peer.

AAHomecare is working hard on the lobbying and grassroots advocacy efforts that you see regularly reported in Wednesday in Washington, as well as other alerts and updates. But there’s so much more that goes into the process of defending your interests before Congress and at regulatory agencies that isn’t readily apparent from what you see in your in-box.

The people at AAHomecare have developed solid relationships with influential congressional staff and regulators. So, while the conversation on any given issue can be contentious sometimes, and doesn’t always produce the hoped-for result, the Association is seen as an honest broker, a ready resource, and a well-informed advocate by these important audiences.

Much like your patients only see a small sliver of what actually goes into the entire process of providing (and getting paid for) their equipment and services, AAHomecare members only see a fraction of what the Association does for you on a daily basis. As the old cliché goes, “if we told you everything that’s going on, we would have to shoot you,” so you’ll have to take it on faith that these behind-the-scenes efforts could be what turns the tide and changes DME’s future for the better.

Results don’t come free; they’re backed up by the engagement of AAHomecare members large and small—and by their dues. AAHomecare can’t do this alone. Now is the time to step up and give Tom and his team the tools they need to fight for us in Washington.

If you’re currently an AAHomecare member, you should have already received your renewal packet. Write the check (or get out your credit card) and send it in. If you are not a member, then now is the time to join the unified voice for the DME industry, AAHomecare. Find more information on membership here, or contact Cheryl Bass at cherylb@aahomecare.org or 571-312-6999 to support the team that is protecting your business every day.

Wayne Stanfield
former executive director, National Association of Independent Medical Equipment Suppliers
former vice president of provider relations, American Association for Homecare
current executive director, Home Care Alliance of Virginia

A Month in the Life of AAHomecare

For more than 110 years, the New York Times has proclaimed that their paper carries “All the news that’s fit to print.”

While a major daily newspaper in a major American city certainly does contain a lot of news, if you’re looking for information focused on homecare, there are better sources.

For instance, AAHomecare members have the latest news delivered directly to their inboxes every Wednesday. And for stories that are too hot to wait, special alerts go out immediately. We even publish periodical newsletters that focus on issues related to homecare in general (DME Matters) and mobility in particular (Mobility Matters).

The Association also uses social media sites like Twitter, YouTube, and Facebook to keep people informed and have nearly real-time conversations with the homecare community. These sites help us to connect our members with a stream of relevant articles from news outlets across the country in addition to the articles we produce in-house.

Running a business can keep a person busy from sun up to sun down and beyond. But even with all that there is to do in any given 24-hour period, stepping back and looking outside of the daily routine is the key to maintaining a healthy business. How else will you know what’s coming at you from CMS and their alphabet soup of contractors?

If you’re not an AAHomecare member, or if you haven’t been reading your Wednesday in Washington emails, here’s just some of what you missed in October alone:

• Guidance on Round 1 Recompete contracts
• Advice on overpayments and surety bonds
• Updated oxygen supplier requirements and licensure review tools from the National Supplier Clearinghouse 
• Summary of the CERT errors report
• Seminar on patient billing and collections
• Substantial savings on AAHomecare’s new customizable Focus on Compliance Workbook 
• Opportunity to participate in a survey on power mobility repairs that will be shared with CMS
• New scoring guidelines for hypopnea from the American Academy of Sleep Medicine 
• Introduction of a new Medicare claim review contractor 
• New Medicare overpayment/underpayment interest rate
• Update on 2014 Medicare fee-for-service regulations for end-stage renal disease
• Profile of a HME provider running for state office in Georgia.
• Initial guidance on documentation requirements for abandoned oxygen patients
• Findings from the Department of Health and Human Services Office of Inspector General on the appeals process

To get the full benefit of our news operations, join AAHomecare. But if you’re not quite ready to take that step, be a part of the conversation online—friend us on Facebook, follow us on Twitter, and subscribe to us on YouTube.

Don’t go another month missing out on vital information that affects the day-to-day running of your business.

In Case You Missed It: News & Notes from Medtrade 2013

The Luck of the Draw

Congratulations to Anna McDevitt, with Laboratory Marketing in Farmdale, Mich., who won the AAHomecare booth drawing for a high-definition TV at Medtrade.  Anna says this about her company’s involvement with AAHomecare:

"Being part of AAHomecare has made it easy to network with other professionals in the industry as well as take an active role in defending homecare providers and patients in Washington. I view my AAHomecare membership as both a business tool and professional duty. As the motto goes: 'United we stand, divided we fall.'"

If you’re an AAHomecare member, or just curious about our role as an advocate and resource for the HME community, make plans to stop by our booth at Medtrade Spring (March 10-12, 2014, Las Vegas). You may or may not win a major household appliance, but we promise to make it worth your time.

Homecare Champions Honored as Hundreds Stand Up for Homecare

At a packed Stand Up for Homecare reception, AAHomecare celebrated the recipients of its annual Homecare Champion Award:  Scott Meuser, chairman and CEO of Pride Mobility; and long-time HME industry advocate Shelly Prial. The award recognizes association members who have made exceptional contributions to the homecare community throughout their careers.

Meuser was honored for his long time leadership on public policy issues, including service on the AAHomecare board of directors, and also for Pride’s long term commitment to working in close partnership with the provider community. Prial’s award comes in recognition of a long and pioneering career in the HME sector and for his continued advocacy as Medtrade ambassador and influential blogger.

The event raised more than $75,000 in support of enhanced efforts to get positive, accurate news about home medical equipment into national and local media through direct outreach to media contacts. The campaign also helps recruit new homecare advocates, including providers, their patients, and other stakeholders build positive perceptions of the HME sector on Capitol Hill. Learn more about the Stand Up for Homecare campaign.

Make your plans to support this important campaign and meet other HME leaders at the next Stand Up for Homecare reception at Medtrade Spring. Contact Ashley Jackson at 202-372-0743 or ashleyj@aahomecare.org about sponsorship opportunities at Medtrade’s can’t-miss networking event.

Where Were You?

Did you miss out on Medtrade 2013? You can still access more than 70 educational sessions from the show, available individually or as a complete set, as well as sessions from past shows, via the Medtrade Digital Library.

More importantly, mark your calendar and get ready to join us in person at Medtrade Spring, March 10-12, 2014, in fabulous Las Vegas.  Give Medtrade three days of your time, and you’ll get back a return that will pay dividends for your business all year long!

What is CMS going to cook up next for DME providers?

Whatever it is, you’ll want to have a solid compliance program in place.

Now that the Congress has reached an agreement to keep the federal government in operation (for a few months, at least), the folks at the Centers for Medicare & Medicaid Services can get back to dreaming up new audit regimens and other requirements for you to contend with.

Speaking of requirements, did you know that 2010's Affordable Care Act will make having a compliance program mandatory for any provider who bills Medicare? That’s right: mandatory, as in the opposite of optional.

But don’t despair, while compliance programs can be complicated, time-consuming, and expensive to develop from scratch, AAHomecare has a way to make starting your program easier, faster, and cheaper! Our new Focus on Compliance Workbook, written by attorney Asela Cuervo and reviewed by members of the Association’s Regulatory Council, will guide you through the process.

The Focus on Compliance Workbook provides explanations and sample forms for these important elements of an effective compliance program:

•    written standards and procedures
•    the compliance officer
•    employee training
•    means for employees to report misconduct
•    processes to investigate reports of misconduct and take corrective action
•    enforcement through disciplinary action
•    ongoing monitoring

In addition to maintaining enrollment in federal healthcare programs, the benefits of a custom compliance program include built-in audit support, more effective internal controls, and quality improvements.

Take a look at the table of contents to get a better sense of the impressive scope of this detailed 80+ page workbook, then order your copy today and save with our early-bird pricing special:

•    $499 for AAHomecare members
•    $799 for non-members

These introductory prices are valid through December 31.

What does it mean to “Stand Up for Homecare”?

If you’re in the homecare industry, you hear that phrase a lot, but what does it really mean?

First and foremost, it means building positive perceptions of home medical equipment (HME) on Capitol Hill. At the same time, it means getting positive, accurate news about HME into national and local media through direct outreach to journalists.

Too often it’s the small number of scammers and fraud artists who think they can make a quick buck by ripping off Medicare that make the news and catch the eye of Congress—not the many dedicated HME professionals who work long hours taking care of patients. That’s just not right, and the Stand Up for Homecare campaign works year-round to change it.

Second, it means attending the Stand Up for Homecare reception, which is widely regarded as the networking event at Medtrade. The reception brings together HME leaders of all sorts—manufacturers, large and small providers, patient advocacy groups, and more. This is the place to put faces with names, join conversations covering every aspect of the homecare industry, and get energized for whatever lies ahead!

Of course, none of this can happen without resources, bringing us to…

Third, it means donating what you can afford to the Stand Up for Homecare campaign. Whether it’s a little, a lot, or something in between, every penny counts and is deeply appreciated. So far, funds raised by the campaign have helped AAHomecare:

• reach more than 10 million Americans with articles in newspapers and magazines, print ads, and letters to the editor last year.
• grow our grassroots network by signing up nearly 9,000 homecare advocates who have generated more than 20,000 messages to Congress in the past 18 months.
• collaborate with consumer and patient groups to expand awareness and support for fair Medicare policies for homecare.

In addition, the campaign funds the production of two influential newsletters that are sent to the media and to healthcare staffers on Capitol Hill:

• Mobility Matters focuses on the role that power mobility and complex rehab equipment play in allowing individuals with mobility challenges to thrive.
• DME Matters highlights problems being caused for patients and providers by the so-called “competitive” bidding program.

These newsletters are produced to inform and engage Capitol Hill, the media, and the general public. We’re happy to add you to the distribution lists, so feel free to sign up for Mobility Matters and/or DME Matters by emailing info@aahomecare.org and asking to receive either or both publications.

If you’re planning to attend Medtrade, why not join us on Tuesday, October 8 from 5:30 to 7:00 p.m. at Baterbys Art Gallery in Orlando, Fla. Network with HME leaders and welcome our newest Homecare Champions into the Homecare Champions Hall of Fame.

Even if you can’t come to the reception, please consider making a donation. We’ll include your name on signs at the event, in our Wednesday in Washington newsletter, and our website. And, we’re happy to hold tickets for anyone you choose to attend in your place. Register online or download a form to mail or fax back to us.

The homecare community understands the issues that affect both businesses and patients because we live them every day. But Congress and the media need help understanding what’s important and why. They need to hear about the knowledge and dedication required to serve patients the right way. Stand Up for Homecare and make it happen!

Which is Better?

Have you seen the Verizon commercials where an adult, sitting in a small chair at a small table with four 8 year olds, poses “which is better” questions?  Well, in the same vein as those commercials, answer these questions:

• Which is better.., one home delivery for three different medical products, or home deliveries for one product at three different times?
• Which is better.., an oxygen supplier 10 miles from your Mom, or an oxygen supplier 100 miles from your Mom?
• Who is smarter in economics.., CMS Administrator Jonathan Blum, or the economics departments of Harvard, Yale and Princeton?  (and UCLA, Cornell, Penn State, MIT, Stanford, Notre Dame, Carnegie Mellon, the University of Maryland & 40 more!)
• Which is better.., saving $20 billion in Medicare spending or saving $80 billion in Medicare spending?
• Which is better.., going home with a hospital bed from the local supplier or spending two extra nights in the hospital waiting for a delivery from a company hundreds of miles away?

We all know the answers to these questions and we see the problems resulting from the answers, but CMS doesn’t.  Mr. Blum knows better, he’s said so publicly.  In fact everyone knows which is better―except for CMS.  This is a Washington bureaucrat giving us assurance that Washington knows best.

Mr. Blum points to “sky-high prices” in a recent response to criticism of the flawed program, but failed to mention that these prices were set by CMS, not the industry, and using a formula approved by Congress.  CMS had the ability to adjust these prices without destroying the supplier community.

The real answer is “how can so much government focus be spent on squeezing pennies out of program that is less than 1.4% of the total Medicare budget when there is $60 billion lost annually to fraud, waste, and abuse in the rest of the Medicare program?  Mr. Blum also fails to note that the $25.8 billion savings he predicts is over a period of 10 years, AND the $2.6 billion per year saving is less than 0.4% (yes, you’re reading that right: 4/10 of one percent) of the CMS acknowledged fraud, waste, and abuse in Medicare.  Talk about killing an ant with a sledge hammer.

What a shame that CMS and Congress both miss the point.......DME saves money.  Keeping people at home saves money.  We’re pretty sure that even the eight year olds in the commercials can grasp that.

If YOU get the point, please call Congress and tell them YOU know better than Mr. Blum. If you have access problems or have patients with access problems, call 800-404-8702 and report it on the beneficiary hotline.  If you are disappointed with Congressional inaction over the bidding program, call 202-224-3121 and tell you legislator to delay Round 2 and replace it with a real market pricing program instead of the debacle being peddled by CMS.

Meet a Champion

In 2011, Tom Ryan, founder, president, and CEO of Homecare Concepts Inc. won one of our first Homecare Champion Awards. The award was well-deserved recognition of his “entrepreneurial achievements, professionalism, concern for patients, high level of service, and his past and continuing leadership in both AAHomecare and NYMEP.”

One of Tom’s first duties as the new president and CEO of AAHomecare will be to present this year’s Homecare Champions with their awards. The ceremony is a short but important part of the Stand Up for Homecare reception at Medtrade each fall.

Who will be the 2013 Homecare Champions? We don’t know yet because we’re still collecting nominations. And this is where we could use your help. Do you know someone in the homecare community who deserves recognition? If so, please consider nominating them using our easy online form, or download a form to fax in. The deadline is Friday, September 6.

After you’ve sent in the nomination, be sure to register for the Stand Up for Homecare reception so that you can congratulate the new Champions in person! The reception will be October 8 from 5:30 to 7:00pm at Baterbys Art Gallery in Orlando, Fla., which is easy walking distance from where Medtrade is being held.

Get a Bigger BANG for the August Recess Buck

Problems mount with Round 2 of the DME bidding program and CMS is still in denial. In fact, CMS denies everything to do with the flawed program they designed except to tout its supposedly wild success.

The latest news is that a southern hospital can’t find contractors to provide service for the patients it is discharging, so the hospital is creating its own bidding program by inviting local DME providers to submit bids for direct payment by the hospital.

Circumventing Medicare’s own absurd rules in order to help patients go home from the hospital can’t be what Congress intended, yet the people we elected have refused to stop Round 2 from going any further.

Congress NEEDS TO HEAR from YOU.

Yes, YOU—the DME provider who has been devastated by the bidding program. Yes, YOU—the patient who has been denied access to the equipment you paid your Medicare premiums to receive.

We have a plan that takes advantage of the August congressional recess, but it will have no effect unless we have huge support from YOU—the providers, patients, discharge planners, social workers, caregivers, doctors, and everyone else being affected by Medicare’s inability to take care of its beneficiaries.

So here’s the deal. To get the biggest BANG from the dog days of August, sit in the cool of your office or home and call, fax, or email (or all three) your Representative and both of your Senators. Tell them Medicare’s bidding program is not working.  It’s failing the people Medicare is supposed to care for and the very people who voted these lawmakers into office.

We can stop this train wreck if we push back against Congress’s refusal to hear our concerns. Ask your Representative and your Senators if this is what they want—sick and elderly patients in distress because of the government’s actions.

We simply can’t afford to do nothing. What will it be? Will you call Congress, or will you hang up the “going out of business” sign?

Ready! Set! Dial 1-202-224-3121! Tell Congress you just can’t take it anymore.

Better still, go to your Representative’s and Senators’ local district office. If you’re a DME provider, take a patient affected by this badly mismanaged program with you and let them tell the story. Or take your competitors with you and tell all of your stories.

Above all, don’t wait for someone else to fix it. There is no one else. There is only YOU.

Resources

For tips on how to talk to Congress and be more effective in the political process, download our 10 Step Guides in the AAHomecare Grassroots Toolbox.

For details about the bidding program and the reasonable alternative, the market pricing program, go to www.aahomecare.org/advocacy.

Find your Representative and Senators’ phone numbers and email addresses in our congressional directory.

Don’t Go It Alone—Go to Medtrade!

Bidding, audits, new regulations, whatever CMS can dream up next; they're enough to give a HME company owner nightmares! If they're keeping you up at night, too, you’re not alone. Everyone in the homecare sector is dealing with one, some, or even all of the same issues that you are working through as you serve your community while trying to maintain your bottom line.

If only there was some place where you could talk about the problems your company faces and tap into the collective expertise of a huge group of HME people. And wouldn't if be great if you could do it in just a couple of days, preferably in a place with a nice climate*?

Of course, such a place does exist—Orlando, Florida, during Medtrade, October 10-12.

Register today to take advantage of early bird discounts, then choose from more than 100 educational sessions led by industry experts, see new products from more than 400 exhibitors, network with HME leaders while supporting public policy efforts aimed at protecting your business.

Don’t go it alone—go to Medtrade. Here are some ways to help you get there without busting your budget:

Travel Info & Discounts
Hotel Accommodations

Spend some quality time with people who face the same challenges and demonstrate the same commitment to serve their patients as you do.

* The average high in Orlando in October is 84, and the average low is 66.

Virtual Fly-In: Early Reports Are Exciting!

With a lot on their plates, asking suppliers to take time to call Congress to convince them to stop the DME “competitive” bidding program was a tough request to make. But dealing with a program that’s creating huge access issues and is already putting suppliers out of business is far more difficult. 

The interest in this industry-wide effort was certainly evident in yesterday’s webinar with Rep. Glenn Thompson (R-Pa.), when attendee traffic overwhelmed the telephone service! For anyone who wasn’t able to get through, you can get a sense of what we talked about by checking out the presentation slides from the webinar.

As of late Thursday afternoon, the homecare community has generated approximately 2,500 new emails to Congress using our Action Center since we updated the message on Tuesday, and we suspect that number will increase significantly through the end of the day on Friday.

While these numbers that we can confirm are encouraging, we would also like to hear feedback from any of your calls to Capitol Hill, or responses to emails that you sent. We would also be interested in hearing about any organized efforts that companies or state associations undertook today.

All feedback—even from those offices that may have told you that CMS has assured them that there are very few complaints about the bidding program—is helpful for our lobbying team here. Please forward any intel to Gordon Barnes at gordonb@aahomecare.org.

Keep the pressure on! Talk to your peers, friends, families, patients, and anyone else affected by the bidding program. Tell them that their help is needed to convince Congress that the bidding program is bad medicine for patients, providers, and our nation's health.

CMS Can’t Handle the Truth About Round 2

Less than two weeks after implementation, problems with Round 2 of the bidding program are becoming increasingly evident. AAHomecare is receiving reports of delays, equipment shortages, and contractors refusing services in bid areas around the country. Yet, CMS is reporting just a few dozen complaints.

It is critical that home medical equipment providers report problems with the bidding program to their representatives, especially in cases where patients are seeing new barriers and complications in getting the products, services, or maintenance they need.

In congressional hearings and on Capitol Hill visits made by the HME community and the AAHomecare lobbying team over the past year, many members of Congress and their staffs expressed sympathy for the effects of the bidding program on our sector, but they were not convinced that patients would suffer significant disruptions. Now that the program is lurching forward and is indeed causing serious problems for Medicare patients, we need to make sure Congress is fully aware that these disruptions are taking place.

AAHomecare is coordinating efforts with VGM, The MED Group, and state associations to hold a virtual fly-in next Thursday, July 18, for providers and patients from all across the country. This virtual fly-in is the perfect opportunity to tell Congress about problems you or your patients have experienced since the implementation of Round 2.

You can use the AAHomecare Action Center to quickly send a message directly to your congressional representatives, or look up phone numbers to call those offices on July 18. Email Gordon Barnes at gordonb@aahomecare.org if you need any assistance.

In the meantime, we are still collecting information about provider problems through our dedicated email address: CBRound2Problems@aahomcare.org.  Don’t worry though, we won’t use any details about you or your company when we talk to members of Congress unless we have your permission first.

Don’t let CMS pull the wool over Congress’ eyes! Representatives and Senators MUST hear from you and your patients—current or former—about problems with the bidding program.  Please add your voice to our efforts on July 18. Mark your calendar!

Was That the Earth Moving Under Our Feet?

Although you may not have felt it, on July 1, 2013, the earth certainly moved under the feet of DME suppliers across the country. It was the beginnings of a tectonic shift in how consumers will get their home medical equipment and supplies. Cracks began to show up on the surface of the DME world over the past months but on July 1, fissures began to open up that will swallow a large number of suppliers and the patients they serve. How bad this movement will be is uncertain and it will be weeks before the impact will be known. In the meantime, there is work to do.

The last thing this industry can afford to do is let the shock of July 1 cloud the more urgent need to take every possible action to expose the truth about the CMS DME bidding program. Never has the need for DME suppliers to not give up the fight been greater.

Transition to this new world order for DME will be anything but smooth, and every supplier has a duty to not only insure that the problems are exposed, but also to insure that every member of Congress is engaged. 

We must somehow help Congress get past partisan politics, past the purported savings touted by CMS, and past the mid-term election blinders. We know that literally hundreds of members of Congress agree that there are problems with the current DME bidding program, now we must get them to act.

Remember that most action by Congress is constituent driven; in other words, voter driven. Since a third of the Senate and the entire House will be campaigning to keep their jobs, we must make sure that the problems with the DME bidding program are laid squarely at the feet of these elected officials.

Do not give up the fight until we have lost this war, and we have not lost yet, we just have to change our battle plan. The flawed bidding program has begun, but it will not succeed. If we believe that it is wrong, then we also believe it will not serve patients well. The problems and patient complaints must be gathered and shared with Congress.  Additionally, the impact on suppliers, both contract winners and those not receiving contracts, must be shared with Congress.

State associations and suppliers everywhere must step up their advocacy game. Yes, we are all weary of the fight that has been raging for years, but we have the forces of good on our side. Yogi Berra said, “it ain’t over til it’s over,” and this fight is far from over.

Here’s what you can do:

1. Contact Congress—demand a delay for Round 2 and ask for support of H.R. 1717
2. Get patients involved—ask them to make three calls to register their complaints

a.       Congress (1-202-224-3121)

b.      People for Quality Care Medicare beneficiary hotline  (1-800-404-8702)

c.       CMS (1-800-Medicare / 1-800-633-4237)

If you need help with how to fight back, contact Wayne Stanfield, the vice president of provider relations at AAHomecare. His email address is waynes@aahomecare.org and his phone number is 202-372-0757.

American Association for Homecare – President and CEO Search Update

JDG Associates has been engaged by Washington, DC-based American Association for Homecare (AAHomecare) to conduct the search for the position of President and CEO.

Representing healthcare providers, equipment manufacturers, and other organizations in the homecare community, AAHomecare works to preserve and strengthen access to care for the millions of Americans who require medical care in their homes. AAHomecare members provide oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion equipment, therapies, services and supplies. AAHomecare membership reflects a broad cross-section of the homecare community, including providers of all sizes operating in approximately 3,000 locations in all 50 states. Benefits to membership in AAHomecare include representation in Washington on legislative, regulatory and industry affairs, ready access to experts and information on developments in these areas, education programs and services, professional recognition and visibility, a job board, as well as leadership and networking opportunities.

AAHomecare has six Councils (Complex Rehab and Mobility, Home Medical Equipment/Respiratory Therapy, Medical Gases, Medical Supplies, Regulatory, State Leaders) through which members with common interests in homecare can influence the Association’s advocacy, communications and education programs. The Councils also serve as venues to share and promote best practices in homecare, provide insights to members facing common business challenges and helping to maintain the quality of care for the elderly. AAHomecare has an annual budget of approximately $4 million and a staff of 13 in four functional areas – organizational leadership/administration, government relations, communications, and membership. For further information please visit www.aahomecare.org.

The Position

The President and CEO serves as the principal spokesperson for the Association, able and ready at all times to promote and protect the interests of the Association and the industry it represents. Key among AAHomecare’s current representational efforts is its Market Pricing Program (MPP) initiative. Developed in response to a national bidding program introduced by the Centers for Medicare and Medicaid Services (CMS), MPP is consistent with Congress’ original intent to create a program based on competition and market prices while maintaining sustainable beneficiary access to quality items and services. The position is also charged with building AAHomecare’s membership, i.e., reaching out to current and potential member companies to promote and raise awareness in the industry of the Association’s impact on policy makers and regulators and the beneficial effect member company support can have in these efforts, for those they serve in their homes as well as the homecare community. 

Principal Responsibilities

• Work with respective market groups to develop and execute the Association’s legislative and regulatory strategies, coordinating with industry lobbyists, AAHomecare members and coalition partners to establish the “value of homecare” among policymakers in Washington. 
• Direct and energize AAHomecare’s membership retention and recruitment efforts, to include seeking opportunities to reach out and meet with members and potential members at their places of business. 
  Serve as the key spokesperson and advocate for the Association in conjunction with the Chairman, working with staff to raise the profile of the Association and the homecare sector with policy makers.
• Represent AAHomecare in negotiations with government, business, labor, and other organizations, cultivating existing and new relationships with Congress and Centers for Medicare and Medicaid Services (CMS), testifying and lobbying as needed to present the Association’s viewpoints and encourage the acceptance of its goals and objectives. 
• Maintain regular contact with the Board of Directors, its committees, the membership, manufacturers, and state associations to ensure AAHomecare’s value and effectiveness is fully understood and appreciated.
• Plan, develop, and implement strategic initiatives, new programs and ideas, conferring with the Executive Committee to evaluate services and recommend methods to promote/increase membership involvement, reviewing and updating AAHomecare’s strategic plan annually.
• Oversee AAHomecare’s finances including long-range forecasting as well as monthly and annual budgets for review and approval of the Board of Directors.
• Champion and uphold the high ethical standards for the Association and the homecare industry and ensure the legal integrity of the Association.

Requirements

Strong leadership and demonstrated success in relationship development and outreach activities associated with success in an issues-driven trade association. Strategic perspective and impact. Excellent oral and written communication skills. Highly effective in an advocacy role with a solid understanding of the legislative process and access to policy makers on Capitol Hill and CMS. Experience in an association and/or healthcare is very helpful. High degree of initiative necessary, as is a creative approach to problem solving. 

Paul A. Belford, Principal
JDG Associates, Ltd.
1700 Research Boulevard
Rockville, MD 20850
(301) 340-2210
belford@jdgsearch.com

Push Back When Congress Pushes Back

Homecare advocates are in grassroots mode and are sending letters by the thousands to members of Congress asking them to support H.R. 1717, the market pricing program bill, and this is a good thing. The AAHomecare “Action Center” has recorded over 9,000 letters sent to Congress since the bill was introduced.

One of the problems we are hearing is that advocates are receiving generic form letters, or the Representative or their staff is pushing back with incorrect responses and bad facts.

With July 1 coming quickly, we must increase the sense of urgency. We must push back to such responses and correct their misinformation. We can be firm and clear without being rude or disrespectful, but we must let Congress know that the current bidding program is bad policy and must be replaced with the sustainable market pricing process in H.R. 1717.

Advocates should respond promptly if they receive Congressional responses with statements showing that their Representatives clearly are uninformed. Responses should provide details of the impact of this program on beneficiaries. We know the program is flawed. We know the contracted suppliers are unable or unwilling to serve the market. We know the reimbursement rates are below cost.

So when lawmakers push back, we must also push back with urgency and inform them that when providers go out of business, it is patients who suffer. Access and quality will be drastically reduced when local providers stop working with Medicare or the contract winning providers are hundreds of miles away.

Congress still doesn’t get it and only you can help. Work hard to get cosponsors for H.R. 1717, and push back with urgency when necessary.

Small Business Perspective on the Bidding Program, Part 4: Where Are Our Statesmen? and The Solution

You’ve heard plenty about the extraordinary challenges that Medicare’s competitive bidding program will cause for home medical equipment providers in our first three chapters of this series:

• A Small Business Story and An Alphabet Soup of Regulation
• Fraud Alert and A Fly in the Ointment
• What the Experts Say and What the Government Says

Today, Mark Richardson offers a better alternative to CMS’ unsustainable and poorly designed scheme.

Where are Our Statesmen?

I get it that Congress has to delegate the administration of the Medicare Program to CMS.  But I don’t think Congress wanted to devastate an entire industry when it mandated CMS to implement a Competitive Bidding Program for the home medical equipment industry.  So when CMS goes too far, and fails to use conventionally accepted auction processes—and instead creates a system which all the experts agree will fail—who’s responsibility is it to step in and protect our homecare businesses, our employees, and ultimately Medicare beneficiaries?

Of course the answer is, our Statesmen and Stateswomen.  In these dark hours for homecare, we need our Congress to come forward and fix this.  We need them to deliver a fair solution for all—not just hide behind the CMS promises of easy cost-savings.  Of course CMS is promising cost-savings with reductions of 45%!  But at what cost?  The devastation of an entire industry?

The Solution

By and large, Congress has been deaf to the pleas of our industry because they want to believe the easy claims of CMS that Medicare is saving money with their “Competitive Bidding Program”.  And in this day and age, it seems Congress will grasp at any straw that technically allows spending cuts, whether it’s right or not (big example: Sequestration).  However, there have been a few statesmen that have come forward with a way of deliverance for our industry.  Congressman Tom Price (R-Ga.), a physician who understands the Home Medical Equipment industry, along with 184 other members of Congress who have co-sponsored legislation with him in the last session of Congress, are dedicated to stopping the current bidding program and replacing it with an economist-created alternative bidding program called the Market Pricing Program (MPP).  This legislation is budget neutral and will require CMS to make some fundamental changes to ensure that a financially sustainable program results and layoffs and closings will not be the order of the day in the Home Medical Equipment industry.  It is supported by all of the industry’s stakeholders and all of the national associations representing the industry.

My hopes and certainly no less than the hopes of our entire industry are pinned to this MPP legislation.  Please tell your Congressmen to support it, get it to the floor, and then vote for it.  Tell them to be Statesmen because that’s what we need in times like these.  We need them to implement a competitive bidding process that actually supports a robust provider community that partners with CMS to produce savings for the Medicare program—not the current one-sided, adversarial process that does nothing but dictate artificially low prices to a noble  industry that’s already under siege.

AAHomecare thanks Mark Richardson, owner of Home MediService in Havre de Grace, MD, for sharing his perspectives and passion.  We urge you to do the same at CBRound2BiddingProblems@aahomecare.org and learn more about what you can do to Help Save Homecare today!

Small Business Perspective on the Bidding Program, Part 3: What the Experts Say & What The Government Says

Wednesday's post from Mark Richardson concluded with an endorsement of furthering free market principles in home medical equipment pricing “as long as it doesn’t harm the industry that it’s regulating” but warns that “implementing these prices and this misguided program will harm this industry.  It puts companies out of business by barring half of them from the Medicare program and subjecting the other half of them to prices that cannot be sustained.”

Read the first two entries in this series – A Small Business Story and An Alphabet Soup of Regulation  followed by Fraud Alert and A Fly in the Ointment

What the Experts Say

But don’t take my word for it—these are not just my conclusions—they are the conclusions of many respected economists and auction experts that have been examining CMS’s “Competitive Bidding Program” for several years.  In fact, in June of 2011, 244 concerned auction experts sent a letter to President Obama detailing how the program’s structure would incentivize low-ball bids (bids dramatically below cost) which would lead to market failure.   And more recently, a study by the California Institute of Technology researchers published in the Quarterly Journal of Economics a scathing report detailing this auction’s fatal design and the unorthodox rules that CMS incorporated into the bidding program that will doom it to “face severe difficulties.”   In addition, Professor Peter Cramton, a respected professor of economics at the University of Maryland said on January 30, 2013, “One thing is certain:  these are not competitive prices set by the competitive bids of suppliers.  And there is no basis to believe that the set of ‘winning’ suppliers includes those who can supply quality goods and services at least cost.  Both the prices and the set of winners were arbitrarily set by CMS without any explanation.  On this all experts agree.  It is difficult to imagine a more flawed process.”

Some additional flaws of this CMS-dubbed “Competitive Bidding Plan” that have been pointed out by the experts are:

• Bids are non-binding—those who bid don’t have to accept their awards—this encourages “low-ball” bids because providers don’t have anything ultimately to lose if they bid below their true costs.
• The eventual selling price is set at the median of all the winning bids—causing half of the “winners” to receive a price lower than they bid—instead of the more acceptable practice of using the clearing price to pay all winners.  (In addition, as “winners” decline bid awards, the so-called median price does not adjust upward—thereby keeping the price even lower than the real median.)
• The bid areas are too big—they do not reflect the marketplace.  Healthcare is provided at the local level—not by huge mega-companies serving whole Metropolitan Statistical Areas.
• Bids were offered by product category.  Providers can “win” one product category (e.g. hospital beds) but lose another (e.g. wheelchairs).  Then, losers are barred from participating in the categories that they did not “win”.  Instead of continuing to promote competition and maintaining a robust supplier community, this program re-structures business models and puts companies out of business if they did not “win” enough categories of bids.  In addition, this flawed process delays hospital discharges by forcing discharge planners to call and coordinate multiple DMEPOS providers—by product category—for each patient and thus creates unnecessary chaos for the patient as well.

For me and my business, this is catastrophic.  Again, if nothing changes, we will certainly go out of business within a short period of time.  I don’t know of any business in this economy that can absorb a 45% cut in reimbursement, but I certainly know that we can’t sustain our business with that kind of loss. The ironic thing is, we “won” six bid awards—2 of which we declined because we would’ve lost money on every Medicare transaction in those categories—but every one of our awards were offered at levels well below the amounts that we bid.   My company is an accredited, respected, growing company that’s been in business for 42 years and we’re part of the healthcare continuum that actually saves Medicare money by helping to discharge patients from the more expensive institutional part of the system.  It just seems that we are the proverbial baby being thrown out with the bathwater—being driven out of business by our own government because they can’t come up with a fair way to cut costs without destroying our industry.

What the Government Says

If you listen to CMS, their “Competitive Bidding Program” is a great success.  They claim it will save billions of dollars, and they claim that they haven’t had to lower one price.  The DMEPOS industry has submitted these bid prices themselves, they say.  It just proves how much unmitigated profit there was in their prices, they say.  On the surface, it is true that the industry has submitted these bid prices.  What is not true is that the results of this flawed bid process represent anything relative to the industry’s margins.  The problem is that this program has produced exactly what the experts said it would produce—unsustainable suicide bid prices that were placed by providers who feared being barred from the Medicare program all together.  If left unchanged, this will ultimately lead to failure of our entire industry—but only after a lot of companies like mine are already gone.

Mark’s entry concludes Monday with Where are Our Statesmen? and The Solution

Small Business Perspective on the Bidding Program, Part 2: Fraud Alert & The Fly In the Ointment

Mark Richardson continues his take on bidding program for home medical equipment – you can read the first entry here: A Small Business Story and An Alphabet Soup of Regulation.

Fraud Alert

Of course, over the years there have been examples of overpayments and fraud within our industry.  But so have there been like examples in every other sector of healthcare.  That is the cost of any government-regulated industry.  Everyone that I know in our industry however, is just as interested in eradicating fraud where it exists as the government is.  Our national associations often point out potential areas of fraud and abuse to CMS before they even happen.  Further, everyone that I know in the homecare industry considers their jobs a noble enterprise—taking care of patients in their own homes.  We play by the dizzying myriad of rules, 24 hours a day, 7 days a week, through snow storms, natural disasters, and every kind of hardship you can think of.  We do it not out of obligation to the government, but because we believe in the dignity of our patients who want to remain independent and able to recuperate in their own homes. 

But because CMS sees us all—the vast number of good, hardworking providers and the very few providers who take advantage of the system—through the same lens, they would like to dramatically reduce the entire number of providers in our industry in order to manage us more effectively.  That’s right—in an economy where roughly 10,000 Baby Boomers will turn 65 and become eligible for Medicare EVERY SINGLE DAY FOR THE NEXT 19 YEARS, CMS thinks that we need FEWER providers of home medical equipment—FEWER of the people that get patients out of expensive hospital care and back into their own homes where they can be cared for at a fraction of the cost.  And they think that if they can accomplish this that they’ll be able to reduce Medicare expenses as well.  (I don’t understand how making home medical equipment less accessible and increasing patient days in the hospital will save Medicare money, but that’s the theory that CMS, the guardian of the Medicare program has come up with.)

How will they accomplish these goals you ask?  Ironically, they hope to accomplish it by introducing some free market principles into the healthcare system.  There can’t be anything wrong with that, can there?  That’s exactly what’s always been missing in our healthcare system, after all, right?  Actually, the problem isn’t the theory—it’s the application of the theory that’s the problem. 

The Fly in the Ointment

On July 1, 2013, if nothing changes, CMS will implement Round Two of their so-called “Competitive Bidding Program” which will set payment amounts for DMEPOS, on average, 45% lower than the current fee schedule and will bar the vast majority of current DMEPOS providers across this country from the program.  CMS will finally attain its twin goals of reducing the number of providers and reducing Medicare costs—all in one single blow.  In actuality however, there is nothing “competitive” about this program, and the “bid” system that CMS designed is actually a fundamentally failed auction that promotes low-ball, or suicide bidding.  The prices that this program is generating will lead to a certain failure of my business and I have no doubt, of our entire industry as we know it in the near future if nothing changes.  If this flawed program is allowed to continue, jobs will be lost and hospital discharges of Medicare beneficiaries will slow down dramatically.

Don’t get me wrong; as a taxpayer in these troubling times I am not against the government trying to curb its spending.  But it should do so in a way that doesn’t harm the industry that it’s regulating.  Homecare is an integral, cost-saving part of the healthcare continuum and it should be nurtured, not devastated.  But implementing these prices and this misguided program will harm this industry.  It puts companies out of business by barring half of them from the Medicare program and subjecting the other half of them to prices that cannot be sustained.

Friday: What the Experts Say and What the Government Says (we’ll give you a preview: they don’t agree)