HME doesn’t have to be the Rodney Dangerfield of health care

Thursday, August 31, 2006

Through attitudes and actions, policy-makers in Washington and Baltimore have shown that they have little, if any, respect for the industry. They continue to view people who work in the HME industry as vendors, people whose only motive is profit and whose tactics are often less than honorable. Until policy-makers see HME businesses as healthcare providers and the people who provide direct services to patients as healthcare professionals, reimbursement rates will continue to plummet, accusations of rampant fraud and abuse will remain credible, and issues important to the industry and the people it serves will be ignored.
The first step in gaining respect and recognition is to be widely acknowledged as healthcare professionals. Industry leaders know that but seem to think that if they say it often enough, policy-makers will believe they are healthcare professionals. Time has proven that it will take more than that.
The fact is, policy-makers believe healthcare professionals are people who have formal training and credentials issued by an impartial third party and recognized by payers, accreditation organizations and, most importantly, patients.
Medical technicians, therapists and nurses all have completed some approved formal training before they’re allowed to work with patients. They have passed a state or national exam to be licensed, registered or certified. In many states, even nurse aides must complete 100 or more hours of training and meet annual continuing education requirements.
HME mindsets and practices need to change.
The HME industry must invest in getting the people who sell, deliver and set up equipment the training and credentials needed to be held in the same regard as a registered nurse. Immediate steps should be taken to develop formal academic programs and identify impartial third-party entities to conduct exams and issue credentials. Such a commitment to excellence would get the attention of policy-makers in Washington and Baltimore at this critical time in the history of the HME industry.
This does not mean that everyone involved in providing HME has to have a bachelor’s degree. Community colleges have proven that they can develop tailor-made programs for a variety of healthcare professionals.
Community colleges may be the most practical venue for training people working in the HME industry. They are agile and open to change. Many are already offering some of the “core” courses and have faculty trained and ready to accept new students. Equally important is the fact that community colleges are on the cutting edge of the practice of distance learning and excel in work-based learning where employees take their course work at the job site.
Through distance learning, an individual who is working can take coursework via the Internet at times more convenient for him or her. This way a provider could hire someone and have them complete the necessary training as a condition of continuing employment. A combination of academic and hands-on experience is widely accepted in the training of healthcare professionals, and distance learning is a proven model to deliver it.
A community college could, for example, develop a short-term program for delivery technicians. New employees would be required to complete a program of instruction during their probationary period. Topics covered during this training could include written and oral communications, basic business math, principles of good customer service, basic first aid, safety considerations, and information about the products and services they will be delivering. Using distance learning, the training could be accomplished at the provider’s location.
After completing the coursework, delivery technicians, for example, would have to take and pass a standardized test administered by a credentialing body. Once certified, these employees would be required to demonstrate completion of some continuing education annually to retain their certification.
Programs could be developed for more involved disciplines like the sales and fitting of high-end rehab products. Coursework could include written and oral communications, business math, anatomy and physiology, disease conditions and needs, proper techniques for measuring and fitting, and extensive coursework on the proper application of state-of-the-art technology. Completion of these academic requirements could be accomplished during the first year of on-the-job training.
It is time for everyone in the HME, respiratory and rehab technology to “think outside the box” and embrace minimum standards of formal education for the people who provide direct services to patients and the equipment they use.
The industry fondly cites the services it provides as worthy of reimbursement. Those services will not be valued, however, until and unless they are provided by personnel who have demonstrated clinical competencies through programs from well-accepted institutions and been credentialed by impartial third parties.
Some will argue that this will add additional costs because credentialed individuals will demand more pay. To that, the industry must say, that’s the cost of doing business in the 21st century. A credentialed individual who has formal training behind them and mandatory continuing education each year will be a better employee and provide better services to the customer. More importantly, trained and credentialed employees will create a strong argument that the product provided and the services delivered meet established professional standards. This will help to ensure positive patient outcomes that are worthy of reimbursement.

Dave Williams is a consultant on legislative and policy strategy. He can be reached via e-mail at