Glimmer of Hope for HME- CURES Bill Passes and Rep. Price Named HHS Secretary

This week the House of Representatives passed the 21st Century Cures Act, by a vote of 392 to 26. The bill is expected to move to the Senate next week and the Obama Administration has already weighed in expressing support for the legislation.

The legislation sets the stage for possible future regulatory relief for rural providers, as it requires HHS to reissue payment regulations for items and services furnished on or after January 1, 2019, with adjustments to the non-bid fee schedule in some areas based on stakeholder input, costs, volumes, and numbers of suppliers serving those areas.

Specifically, the legislation will provide six months’ worth of retroactive relief for the second phase of bidding-derived cuts for rural and non-bid area providers; delays the application of bidding-derived pricing reductions for complex rehab technology accessories used with Group 3 power wheelchairs for an additional six months; accelerates the application of plans to limit state Medicaid reimbursement amounts for HME to the Medicare fee-for-service payment rates, including applicable competitive bidding rates, by one year, to Jan. 1, 2018; and also instructs HHS to conduct a study on the impact of the bidding program on the overall number of HME providers and availability of HME products over the course of 2016.

While AAHomecare and other HME stakeholders advocated for a longer delay for the second phase of bidding derived cuts, this legislation marks an important step in efforts to scale back the effects of the bidding program.  Both chambers of Congress, along with party and committee leadership, have recognized that the home medical equipment community in rural areas needs relief and that the bidding program requires more scrutiny.

These measures set the stage for working with the new Administration to move towards more sustainable Medicare reimbursement policies for all HME providers, as well as again taking up these issues in the 115th Congress.

Also this week, President-elect Donald Trump announced he will appoint Congressman Tom Price (R-Ga.) to serve as Secretary of Health and Human Services in his Administration.  Price, who has represented Georgia’s 6th Congressional District since 2004, has been a consistent advocate for better public policy in the healthcare arena and has championed legislation to make sure that patients who rely on home medical equipment have access to those products and related services.

Seema Verma, founder and president of health policy consulting firm SVC Inc., was selected to serve as Administrator of the Centers for Medicare and Medicaid Services.

Medicare Open Enrollment Tips for HME Providers

The Medicare open enrollment period began on October 15, 2016 and runs through December 7, 2016.  It’s important to know how these plan changes will impact your patients and your company.  Even though the enrollment period runs through December 7, it may take longer for many plans to update their systems.

Determining Plans Available in your Service Area

Many insurance plans may add products or eliminate products they previously offered.  There may even be new insurance plans created and offered in your areas.

This is the website that beneficiaries can use to investigate plan choices.

        https://www.medicare.gov/find-a-plan/questions/home.aspx

Providers can enter the zip code for their service area to determine which plans are available to their patients and answer the following questions.

1.     How do you get your Medicare coverage?
        -- Select “Original Medicare”

2.    Do you get help from Medicare or your state to pay your Medicare prescription drug costs?
       -- Select “I don’t know”

3.    Select "I don’t want to add drugs now"

You can then Select “All” and “Continue to Plan Results” to obtain listing of all the plans in your service areas.  This will also give you deductible and copays for durable medical equipment for each plan. 

Next Steps After you have the Plans Available

Review these plans and determine your risk as a company in plans that you are not in network with.  Determine if these plans offer out of network benefits.

Develop a plan to ensure you have current insurance information on all new and existing rental patients.  Develop transition plan for those patients electing a payer you are not in network with if they do not offer out of network benefits.

You can elect to send letters to all your existing rental patients informing them of open enrollment and steps they should take in informing you of insurance changes.  You can suggest in this letter the plans that you are in network with as plans they may want to choose.

Evaluate if there are any big budget changes based on plans available.

Plan changes could have an impact on your revenue stream.  Preparing for these can help eliminate denials and rework in your companies.

Louisiana Home Medical Equipment Providers Hold Out a Lifeline to Flooded Communities

(3rd Installment: Home Medical Equipment Providers Overcome Major Storms to Help Patients)

Home medical equipment (HME) suppliers have a long track record of making sure their patients get the products and services they need during natural disasters.  August’s catastrophic floods in much of Louisiana provides the latest examples of the extraordinary efforts undertaken by companies to serve their communities in extremely challenging conditions.

Apria Healthcare’s employees in Louisiana have been working around the clock to ensure continuity of care for approximately 700 patients with lost or flood-damaged equipment, many of whom have had to evacuate their homes.

While Apria’s branches in Baton Rouge, Lafayette and Alexandria have been on the front lines making sure their patients are cared for, their locations in New Orleans, Shreveport, and Beaumont, TX also provided inventory.  In addition, Apria is sending tractor trailers loaded with respiratory equipment to Baton Rouge to replace damaged, lost equipment and to ensure there are enough portable cylinders to accommodate ambulatory needs of their patients.

Apria’s ability to respond quickly in these situations is the result of extensive preparation and advance planning for emergency situations.  Every branch at Apria has a pre-planned emergency preparedness plan, which includes identifying and contacting high acuity patients and all respiratory patients who need oxygen, and making sure they are triaged accordingly.  Apria staffers also coordinate with local authorities and public safety personnel to set up staging areas to meet patients if they are displaced to receive services.

“These unique situations require an extraordinary effort to replace damaged or lost equipment and help keep patients intact and avoid costly hospital visits,” said Bill Guidetti, Executive Vice President, East for Apria.  “From Hurricanes Katrina and Sandy to fires in the West, and now the flooding in Baton Rouge and Lafayette, Apria is on call for our patients.”

“Home medical equipment providers take great pride in helping to keep people out of hospitals and other clinical settings all year long,” added Guidetti.  “This role becomes even more important during times like these when healthcare and emergency services personnel are under extra pressure.”

Many HME company personnel have been helping others while trying to deal with significant challenges themselves, as evidenced by efforts by two Respiratory Therapists (RT) with Lafayette-based respiratory services provider Viemed.

Adam North, an RT in Baton Rouge, started out the week with three-and-a-half feet of water in his home and his company delivery vehicle.  Fortunately, he had bought a 20-year-old pickup truck from one of his patients the previous month.   Adam worked all week driving his “new” truck, responding to calls from patients whose non-invasive ventilator equipment was damaged or left behind in the haste to escape the quickly rising floodwaters.  

In many cases, he had to seek them out at a relative's house or in an emergency housing shelter.

Matt Bourg, an RT in nearby Denham Springs, had similar experiences, but fortunately did not suffer water coming into his house.  Matt’s efforts included meeting up with a patient discharging from the hospital evacuating to his daughter's house.   That patient had left his ventilator at home, which was under eight feet of water; Viemed replaced that equipment, and has done so in several other instances.

“We’ve replaced a lot of equipment in the last week, even though we’re not obligated to do so and it’s not clear if or how we’ll get compensated for that,” said Max Hoyt, president & CEO of Viemed. “It’s times like these that remind us that just doing the right thing is the best business practice.”

“No matter how much you prepare for an event like this you cannot completely predict the obstacles your team will face” – Family Medical Supply Tells Their Story

(2nd Installment: Home Medical Equipment Providers Overcome Major Storms to Help Patients)

Family Medical Supply is headquartered in Dunn, NC with 18 locations in the state. 

While the sun rose to a clearing sky on Sunday morning, October 10, the havoc wreaked by Hurricane Matthew just a few hours before was only beginning to be realized.

"Roads were washed out in some places and completely gone in others," states Joey Tart who, along with his brother Billy, owns Family Medical Supply and its 18 North Carolina locations.

By the time emergency crews were assessing the storm's damage the Family Medical team was already at work, delivering over 300 oxygen tanks that first day to patients over thousands of square miles.

"No matter how much you prepare for an event like this you cannot completely predict the obstacles your team will face," adds Billy.  "We have a very committed group who worked days on end to look after oxygen and ventilator patients.  We worked with emergency services and even the National Guard in an area we couldn't access due to flooding.”

"That first day's obstacles were only the beginning of one of the longest weeks in recent memory for DME companies across the southeast.  By Monday, the orders for oxygen had almost doubled and the downstream communities were suddenly coming to terms with flooding that would take out highways, interstates, and most importantly, direct access to patients.  The Tart brothers had drivers that were taking three and four different routes to try to find a way to serve patients in dire need.

"It's two weeks out and we are still trying to assess the amount of lost and damaged equipment," reflects the Tart brothers report.  "We have heard from the Department of Health and Human Services and from BlueCross/Blue Shield concerning how to proceed with looking after these patients.  So far the only thing we've gotten from Medicare is more audits."

"We are paying hundreds of hours of overtime, working with emergency services to access patients and going the extra mile for patients that Medicare does not want to pay us for because the doctor signed or dated the orders in the wrong place.  The patient visits have run into the thousands, but at this point we do not know of a single patient that had to go to the hospital because we could not get to them."

That last sentence is what is missed in the modern understanding of a DME business.  An industry that is having a definite impact on hospital costs through its commitment to service is only seen as a boxed goods provider by policy makers.  The most undervalued aspect of any industry is the bill that is not yet due.  What would a couple of thousand extra hospital admissions cost Medicare last week?  Let's hope we do not have to find out after the next hurricane.  Call your congressman and ask him to roll back the ruinous cuts for HME providers serving rural communities.

Home Medical Equipment Providers Overcome Major Storms to Help Patients

Home medical equipment suppliers have a long track record of making sure their patients get the products and services they need during natural disasters.  The recent catastrophic floods stemming from October’s Hurricane Matthew hitting the Carolinas, along with stories from the August severe flooding in Louisiana, provide compelling examples of the extraordinary efforts undertaken by companies to serve their communities in extremely challenging conditions.

This remarkable effort outlined below is the first installment of examples of home medical equipment companies providing personal and committed care to individuals with significant healthcare needs – including seniors, and people with disabilities or chronic conditions.  While HME companies devote extra resources to making sure their patients are cared for in disaster situations, they do not receive extra compensation from Medicare for providing emergency services.

Liberty Medical Overcomes Loss of Power and Phones, as well as Severe Travel Challenges to Serve Patients

Liberty Medical is headquartered in Whiteville, NC, with nine other locations in North and South Carolina.

Beginning October 3rd we began calling patients to assure they had proper back up for the equipment they had with us. For oxygen patients if they had used their back up tanks to any degree, we switched them out to assure in most cases at least two days. We also called other patients to remind them to charge any equipment they may have had that had battery backup. This included calling several hundred patients in the coastal areas as that was the areas that we had been receiving the warnings about at that time.  That process took us several days to complete and many man hours and the expense of additional equipment.

On Thursday, October 6th, as the storm was approaching our coast, we felt like we were prepared. At that time weather services were saying that we would get some rain and winds up to 60 MPH and that it would be downgraded by the time it reached the North Carolina coast. Our patients are throughout North and South Carolina and each area along the coastal regions would be impacted to some degree. The South Carolina direct coastal areas at that time were under a mandatory evacuation and we had patients calling to let us know they were leaving their homes; we advised them to take what they needed with them. North Carolina was not under any evacuation orders at that time. We began taking inventories of oxygen that we had in stock and ordered more from our supplier as we were running low as a result of stocking up the patients in the areas we felt were going to be impacted.
We began to get calls into our offices farther inland from patients of ours, as well as from patients of other companies seeking to get equipment that they left behind or trying to get more portable tanks while in hotels or with relatives.

On Friday, October 7th the storm began to get into our service areas with winds in some places over 60 MPH and rain. We had several offices that were in the evacuation areas to close at that time. All preparations for the storm had been completed. We felt like we were ready for what we had been told would be a category 1 or 2 storm.

We continued to monitor the storm and in most of our offices we continued to service our customers on a normal basis. The storms impact at this point was mostly high wind and heavy rain in the coastal areas.

As of Saturday the 8th the winds were picking up and the rain was continuing. It rained from Friday night until sometime Sunday afternoon. Many areas of North Carolina had received a considerable amount of rain several weeks prior to the storm which resulted in lakes, streams, swamps and creeks already being full of water.  The winds took down trees and the water started rising, power started going down, and roads began to become dangerous to travel by Sunday afternoon.  The inland counties by that time had received at least 16 inches of rain and the impact was just beginning. The coastal areas did not receive as much of an impact except where there was storm surge directly on the beaches.  As of Sunday afternoon, our phone system went down as well as the local 911 system as a result of flooding. We also lost our ability to get into our main software system as well because of a loss of power in another section of our building. We were running on generator power at that time. We later learned that the main substation for Duke Power that powered the entire town was underwater. We had our phone carrier to override our phone system and forward all calls to a single cell phone for calls.

By Monday morning the rivers and creeks started rising and several main roads were washed out from running water. Many of our employees could not get to work as detours were not posted and traffic began to back up on several of the main highways. As some employees began to get to work as best they could, we began to evaluate our work based on having no ability to make calls using our system but only with cell phones which were working only sporadically.  We could not at that time access any patient information using our software.

We put two customer service reps at our front entrance and provided them with our main incoming line cell phone and other cell phones to call patients back on without tying up that main line. We began contacting our branches to get a feel of what their circumstances were and who was open. All branches were open and had access to phones and systems. We at the home offices then got several lap-tops up and running and we were in business.

Then the calls started coming in from patients that were in shelters and needed oxygen as they left their equipment in their homes. We could get to them and provided them with oxygen. We also had several patients that came to the office as they had no phone service to get what they needed. We also had patients that at that time had been without power for two days contacting us for more backup.
Our problems had only started as more roads were being closed as a result of flooding.  By the end of the day on Monday we were not sure how our drivers could get to the inner part of the state as we were closed off by major highways on all sides of us. We could only go toward the coast at that time. All gas stations were closed, all stores were closed, and there was no UPS or mail service. I-95 was shut down for 30 miles, I-40 was detoured, and we had patients that needed help. Our drivers had to leave our warehouse not knowing if they could get where they were going or not. They seemed to always find a way to get where they needed to be and never complained – they just got the job done.
By Tuesday there were entire towns under water and residents being evacuated.  Some were our patients that we attempted to follow. We continued to provide services to our patients that we could get to.  Many times we would have to go East to eventually get to the West to go around closed roads and detours.

Our information system was completely functional on Wednesday the 12th, and we got full phone service restored the next day.

We are not aware of any of our patients having to get service from another source during this hurricane as a result of many hours of hard work and the dedication of our staff.  As of Tuesday the 18th we continued to have patients in shelters and we have employees that have lost their homes.
As a result of what we have learned in this process and what we know about the future of companies serving rural communities, we feel this type of service may not be available for the next event when it comes.  For the sake of the patients who depend on home medical equipment in good times and bad, we hope that doesn't come to pass.  Congress needs to take note of the high level of service that HME companies provide and finish the job on legislation to give some relief from deep cuts for suppliers in rural communities.

Visit the blog tomorrow to view a new story of an HME company devoting extra resources to make sure all of their patients are taken care of during Hurricane Matthew.

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.

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

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:

• As Congress Returns, Homecare Industry Says Urgent Action Needed on Medicare Reimbursement – InsideSources (Aug. 31)
• Congress Should Stand up for Small Businesses and Seniors on Medicare – The Hill (Aug. 30)
• Rural Americans on Medicare Will Continue to Receive Inadequate Care Unless Congress Acts – Morning Consult (Aug. 29)
• We all agree: Medicare cuts need slow phase-in, analysis - The Hill (Sep. 7)

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.

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.

Encourage Referral Sources to Take Survey on Effects of Bidding Program

AAHomecare has deployed a survey for medical professionals and related support staff (including hospital discharge planners, care managers and social workers) asking for information on their experiences in getting medically-necessary HME products for their patients in a timely manner. The brief survey gives medical professionals the opportunity to share their perspectives on issues they may have faced on account of reduced availability of HME in a changing competitive environment. AAHomecare asks suppliers to share the survey with their referral sources as soon as they can.

The Association plans to use the data to support legislative efforts to demonstrate the effects of recent deep cuts for Medicare reimbursement stemming from the rates created by the latest round of the competitive bidding program, both for companies located in competitive bidding areas, as well as those in rural and non-bid areas that are subject to pricing derived from that program.

A printable version of the survey is available at aahomecare.org/CareSurvey; suppliers may also share an online version of the survey with case managers.

For more information on the survey, contact Ashley Plauché, manager of government relations at AAHomecare, at ashleyp@aahomecare.org.

Let Us Know How You're Doing in This Challenging Environment for HME

By Michael Nicol, senior director of membership services
(excerpt from Wednesday in Washington, July 27)

Faced with the very real and serious consequences of this latest round of reimbursement cuts, and the frustration of having multiple unanimously approved bills come up centimeters short of the goal line as the clock ran out, you are understandably numb. No one could blame you for wanting nothing more than to retreat, lick your wounds, and consider waving the white flag and making a graceful exit.  

Don't do it. You may be closer than you think.

Our War of Attrition
Skeptical as you may be right now, you can still outlast those who seek to wear this industry down with untenable reimbursement policies, onerous and redundant auditing requirements, and "one size fits all" approaches to your highly specialized and value-added industry by being methodical, resolute, and doggedly determined.

Since I began my tenure at AAHomecare, I've gained a genuine appreciation and respect for our member companies. You have been chasing a fairer, more stable, and more equitable business climate - some of you for decades - and you've somehow managed to hold off the forces that threaten the very existence of your business, even as the other side held all the cards. While we might not want to go so far as to characterize these forces as our "enemies"--there is most certainly a life-or-death, sink-or-swim battle going on here for many of you, and one of the weapons we can collectively use to win it is education.

That's exactly why I and my colleagues have begun reaching out directly to you to solicit your personal stories of how the most recent set of reimbursement cuts for rural providers is going to (or already has) negatively impacted your business and your ability to serve patients. This takes many forms. Patients losing access, independence, vital services, and compliance- and outcomes-enhancing product education...employees losing their jobs and communities their neighborhood businesses...the list goes on. And ironically, all of this may ultimately cost the health care system itself so much more money than what will purportedly be "saved" through these sweeping, short-sighted reimbursement cuts and related policies.

We Need to Hear from You! 
You are the people best equipped to specifically articulate the real-world impact of these cuts on our industry and the people it serves. And we are your association. I ask you to take some time to verbalize and share your stories with us, so that we may make the most compelling case possible with our Congressional champions as we mobilize once more in the coming weeks to package and pass a legislative solution in September.

If your company is experiencing difficult business decisions, not accepting new patients, or making other changes based on the January 1 and July 1 cuts, please let us know. Send these narratives to my colleague Tilly Gambill at tillyg@aahomecare.org, or feel free to reach out to me, my contact info is below.

Michael Nicol is the Senior Director of Membership Services for AAHomecare. He is available to help members become better connected with the Association through Councils, member programs and benefits, and answer general questions. Michael also accepts recommendations on potential new members. He can be reached at 202-372-0749 or michaeln@aahomecare.org. 

Take the DME Cost Analysis Survey--Build Data to Show CB Rates Are Unsustainable!

All suppliers encouraged to participate in this Cost Study which will include multiple categories under threat by competitive bidding.

Today a national survey opened for suppliers to provide their fixed and variable costs for furnishing the services associated with supplying durable medical equipment. This Cost Study survey comes just one week after the highly disappointing news that Congress did not successfully pass the Patient Access to Durable Medical Equipment Act. Now it is paramount that we provide a strong case for delay in September--our next opportunity for Congress to act. Strong data proving that the reimbursement rates derived from Medicare's bidding program are too low to cover the actual costs associated with providing equipment will help us on Capitol Hill and at CMS.

AAHomecare has commissioned Dobson & DaVanzo to conduct the study which will focus on selected products from oxygen, sleep, manual wheelchairs, hospital beds, and walkers. The more suppliers who complete the survey, the stronger this Cost Study data will be. Ultimately, this will be a tool to be shared with members of Congress, but it will also be available for companies to compare their costs of doing business to the average costs of the industry.

AAHomecare understands that the demands on your time as a business owner are great, but the effort you put into completing this survey is vital to our legislative pursuit in September. You will need 3-4 hours to complete the HME Industry Cost Analysis Study.

While limited Cost Study analyses have been performed in the past, this will be the first to consider DME in multiple categories that are under threat by competitive bidding pricing.

AAHomecare urges all suppliers to take part in this survey and help build the critical data needed to show that CB rates are truly unsustainable. “This is our opportunity to provide hard numbers industry wide to Congress and CMS to explain the depth of cuts we are receiving compared to the actual cost of doing business,” says Laura Williard, senior director of payer relations for AAHomecare. “This Cost Study will be one more arrow in the quiver to build support on Capitol Hill. A critical mass of participation will make the difference for this strong lobbying tool.”

Visit aahomecare.org/truecost to learn more.

Help Engage Patients in Advocacy through People for Quality Care

Patients will pay the ultimate price for unsustainable rates and should have a voice in advocating for fairer policies. People for Quality Care is helping organize and amplify the voices of beneficiaries, family caregivers, and clinicians to Congress. Currently the group is focused on garnering Congressional support for a joint solution to Medicare’s competitive bidding program by July 15.

“Patients and family caregivers are already facing enough challenges as it is—the political process doesn’t need to be one more barrier that stands in their way of getting the quality medical equipment they need,” says Ashley Plauché, legislative partner for People for Quality Care and manager of government affairs for AAHomecare. “People for Quality Care guides them through the advocacy process, allowing their message to be heard by Congress. We ask all suppliers to get engaged, connecting their customers to these valuable resources.”

You can help by asking your customers to:

· Contact their Members of Congress, sending a customizable letter available at peopleforqualitycare.org/takeaction.

· Share their story with their Medicare Complaint Hotline (800.404.8702) to relay their experience and challenges accessing medical equipment.

Visit peopleforqualitycare.org for more information. You can also share a link to the website on your company site to help your patients access the site.

Local Businesses Across the Country Weighing Options in Anticipation of July 1 Cuts

Just a day away from the July 1 cuts, AAHomecare is receiving information from from suppliers across the country who are faced with tough business decisions that will hurt patients.

Sandwich, Massachusetts
As a result of Medicare's application of competitive bidding-derived prices in rural markets, Cape Medical Supply, Inc. in Sandwich, Mass. announced they will no longer accept new patients on Nantucket Island.  As the only respiratory care provider for this market, Gary Sheehan, president and chief executive officer for Cape Medical Supply, said, “it was not a decision we took lightly; however, a 52% reduction in reimbursement was simply operationally unworkable for us.” 

You can read more about what brought this company--that has provided service to Nantucket beneficiaries for 30 years--to this difficult decision in this impassioned blog post from Sheehan.
 


Bangor, Maine
In Maine, WABI Channel 5 reported on the issue and interviewed Coastal Med Tech’s CFO, Cathy Hamilton:

“The industry is seeing business closures all over the country right now as a result of these cuts both in metropolitan and in rural areas because people have had trouble, even sustaining the January cuts,” Hamilton told the station.

The story cites rates portable oxygen rental reimbursement going from $40 a month to $18 a month following the July 1 cuts as one significant example of the reductions they have to deal with.

Coastal Med Tech is weighing its options, including possibly cutting back on delivery service, leaving patients waiting longer for items or making them come into their stores themselves.

The station also interviewed Karyn Estrella, President & CEO of the Home Medical Equipment & Services Association of New England, who added  “In rural Maine, it is not unusual for a company to drive an hour one way to deliver equipment and that’s all included in the reimbursement”

You can watch the full report and interview with Cathy Hamilton here.

Minden, Louisiana
In Minden, Louisiana Andy Fish, co-owner of Minden HomeCare Equipment, shared with AAHomecare that due to the cuts they have already experienced in rural Louisiana, the company is no longer able to provide manual or power wheelchairs. Minded HomeCare was formerly able to provide equipment with same day service, but now they will have to wait until there are more than one delivery going in the same direction, and if patients have a bill they will now have to pay up front when the items are delivered. This is a new practice for the company, who used to work with patients and allow them to pay a little now and a little each month. Many patients are required to come pick up most of their items rather than having them delivered.

“We hate this, we started this business in 1998 to help the people in this area,” Andy explains. “We know almost everyone that we go to church with and see them in Walmart or the grocery stores.”

He went on to explain they no longer offer TENS units, full electric hospital beds (now only semi), nebulizer supplies, or canes through Medicare. Patients are asked to pay cash for those items and if a deductible is remaining the patient cannot receive supplies until it is met. The company has had to downsize their staffing and can no longer support school and civic organizations financially as they have in the past. The cuts have taken a toll on the homecare company.

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If your company is making difficult business decisions based on these latest cuts, please share your story with Tilly Gambill at tillyg@aahomecare.org so we can document real examples of why competitive bidding rural relief legislation is critically needed.

Clock is Ticking for Home Medical Equipment Providers

C.N.Y. Medical Products is one of many home medical equipment (HME) companies in New York, and across the country, who did not receive a contract in the Centers for Medicare and Medicaid Services (CMS) competitive bidding program. “We have a large retail store and when Medicare customers come in we have to turn them away. It makes no sense!” says Lynn Komuda, vice president of C.N.Y. Medical Products in Syracuse. “I have a sense of shame having the equipment right in front of them and telling them they have to pay out of pocket if they want to support their local vendor.” Komuda said she even has to turn away her own family, friends and neighbors because they live in these bid regions.

At the heart of the problem is preserving services and equipment to individuals and the elderly with severe disabilities, as well as the livelihood of local and county businesses and residents. HME providers like C.N.Y. Medical Products, care for the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other home medical equipment, therapies, services, and supplies in the home.

But the clock is ticking. The first phase of implementing new reimbursement cuts, set by applying pricing from CMS’ competitive bidding process to rural areas not previously covered by the program, took effect January 1, 2016. And just a few days from now, on July 1, 2016, a new round of deep cuts for HME providers in these rural areas will take effect. The HME community feels strongly that these further payment cuts to rural areas will decimate the HME safety net that supports some of America’s most vulnerable patient populations.

C.N.Y. Medical Products was started in 1981 by John and Lynn Komuda. Over the years the company has employed family, friends, and neighbors. They have had as many as 35 employees but due to continuous cuts to Medicare payments, the company has had to reduce staff to 16, yet continue to cover 22 counties in New York State—the majority of these counties will have Medicare payments for HME reduced again, by 25-30% come July 1.

The American Association for Homecare and many consumer groups and partners in the HME community believe six months to monitor for disruption in Medicare beneficiaries’ access to DME items in rural areas is not enough time. Several factors come in to play when considering the cost of providing HME to rural areas of Texas, such as:

·      Employee time, fuel costs, and mileage to drive to the beneficiary’s residence

·      Widely ranging geological and road characteristics that could require specialty vehicles, including 4-wheel drive, ATVs, tractors, and more sparsely populated areas that don’t offer the same routing efficiencies as dense urban areas

We believe this program will have a devastating effect on HME providers in New York and across the country, as well as for the elderly and severely disabled patients they serve in these communities come July 1. To learn more, visit www.aahomecare.org/issues/competitive-bidding.