Balancing idealism & pragmatism

Two decades after he discovered the power of lobbying at the grassroots level, Tom Ryan is now the lead voice for the HME industry as chairman of the American Association for Homecare. Ryan, president of Farmingdale, NY-based Homecare Concepts and a 30-year industry veteran, took over as AAHomecare's chairman in June, after years of involvement with the national group, as well as with the New York Medical Equipment Providers state association. His first experience with industry politics came in the early 1980s. Before launching his own company in 1987, Ryan worked as an RT for local independent homecare companies in the New York area during the late 1970s and '80s. One of his ventilator patients had difficulty getting state-funded coverage for home-based nursing care, so Ryan met with the local state assembly representative to show him then-new LP4 ventilator technology. As a result, the legislator arranged it so that the patient could get the care he needed and the patient lived at home the next 20 years. "That was my first taste of lobbying - if you want to call it that," Ryan said. "What I learned is that we can and should be a resource to our elected officials, and we should not assume they have all the answers. I also realized after I started my own company that anytime the majority of your funding comes from government entitlement programs one of the main functions of the CEO is to educate the lawmakers that control your funding sources." Ryan became active in the New York Medical Equipment Providers state association in 1996, chairing the licensure committee and currently serving as chairman of both the NYMEP and AAHomecare legislative committees. He faced his share of contentious issues at the state level and through persistence and determination, helped NYMEP earn "a seat at the table" with the Region A Medicare Council and State Medicaid Committee. As AAHomecare chairman, Ryan says his job is to marshal the association's resources in a manner that presents "a unified voice on Capitol Hill that together with the help of our consultants and lobbyists, protects the interests of the members it serves." In order to do that effectively, the association team must continually evaluate the issues that arise, he said. "We need to determine whether it is a global issue impacting a significant majority of the industry or a market-specific issue that impacts primarily one segment," Ryan said. "Then with the advice of our consultants, we can determine the relative urgency of the initiative." In his new role, Ryan presides over the organization's competitive bidding battle strategy, which has drawn criticism in certain circles for not being caustic enough in its rhetoric. He dismisses the call for a harsher tone, preferring to remain firm minus the hysterics. "There have been comments made that since we are not blasting CMS and Congress in the press, we must have turned our backs on the smaller companies -- nothing could be further from the truth," he said. "I don't think the industry has an air of resignation that NCB is an eventual reality. There will always be the hope that this can be legislated out as the industry knows that it is poor public policy." The association also needs to be realistic in facing up to the fact that competitive bidding has rock-solid support among legislators and policymakers and that the industry can't back away from looking at a potential bidding scenario in a constructive manner, he said. "[Therefore] we need to work with CMS and Medicare and make sure that if it cannot be legislated out, we are at the table as a stakeholder every step of the way making sure that it is as fair as possible," Ryan said. "In the current Congress, if we were to put all our eggs in one basket and tried to force NCB from being legislated away and failed, we would be doing the entire industry a huge disservice." As tense as the HME climate is right now, Ryan says it is also an exciting time for the industry. Favorable demographics show great growth potential and older Americans' desire to stay home is encouraging, he said. And despite Medicare's constant funding cuts, government officials by and large recognize the economic value of homecare. "The challenge is continuing to prove that value," Ryan said. "I would have to say that it is one of the most - if not the most - challenging time in the brief history of the HME industry. Growing a business with the veil of NCB and the uncertainties that it will bring is a difficult assignment." Even so, the industry is up for the task because of what Ryan sees as "passion in the eyes of providers that serve the homecare industry."