Let's build on our momentum

Monday, April 26, 2010

The HME sector has more than its fair share of challenges ahead: the competitive bidding program, the oxygen cap, burdens on mobility providers, the device tax, regulatory issues. The list is long and daunting. But as a community, the HME sector has made important strides forward. Let’s applaud efforts that have produced momentum, unity, and success—and build on them.

Start with H.R. 3790, the bill to eliminate the “competitive” bidding program. At press time for this article, we were officially at 185 cosponsors, with about a dozen additional commitments to sign on. For a healthcare bill, it is unusually bipartisan: about 43% of both Democrats and Republicans in the House of Representatives back this bill. Let’s continue to build that support.

The American Association for Homecare held a successful Washington Legislative Conference in March. Hundreds of HME providers came to the nation’s capital to meet with senators and representatives. This type of contact is vital. But it’s also important to meet with your members of Congress and staff back home in their district offices to put a face on HME issues. There are more opportunities to meet and develop relationships with your senators and your representatives on their home turf.

At the March conference in Washington, we heard directly from one of our speakers, Rep. Phil Gingrey, R-Ga., that he would cosponsor H.R. 3790. This was no accident. Gingrey, a physician who serves on the influential House Energy and Commerce Committee, has received many visits by HME providers from Georgia who have briefed the Congressman and his staff about the flaws in the bidding program. It’s because of this type of work—stretching back months and years all across the United States—that we have enlisted nearly half of the House of Representatives in opposing the bidding program.

The association is also working to restore the first-month purchase option for power wheelchairs, eliminate the 36-month oxygen cap and provide long-term stability for the benefit, defeat the excise tax on HME manufacturers, and enact anti-fraud legislation. With respect to fraud, AAHomecare has put the HME sector ahead of the curve with its 13-point anti-fraud action plan, and key policymakers in Washington are taking notice of that leadership. The association is also preparing to introduce a more comprehensive code of ethics as an added step to distinguish the HME profession from the handful of high-profile criminals who have posed as legitimate HME providers and defrauded the Medicare program.

In Washington, AAHomecare is the voice for HME providers. The staff and volunteer leadership from the HME sector work hard on regulatory and legislative issues. A few of the recent successes merit a mention:

• New CMS requirements under the physicians’ Provider Enrollment, Chain and Ownership System (PECOS) posed a severe threat to HME providers. CMS planned to begin rejecting claims that did not list a physician who was enrolled in PECOS in January of 2010. Providers reported that more than half of their claims were being flagged based on the PECOS enrollment requirement. AAHomecare waged an intense effort to raise concerns at CMS, among physicians’ groups including the AMA, and among HME stakeholders. As a result, we were able to get this requirement delayed until Jan. 3, 2011.

• Last August, CMS released a new consignment closet policy that would have prohibited the consignment closet relationships that HME providers currently have with physicians’ offices. Through its Regulatory Council, AAHomecare drafted comments on the policy and requested that CMS rescind the policy. The association staff worked with CMS to address our concerns, and CMS ultimately rescinded the policy.

• Also, the HHS Office of the Inspector General (OIG) updated its special fraud alert on HME telemarketing in January. HME providers would have been prohibited from calling a beneficiary to arrange for delivery of an item based solely on a physician’s written or verbal order unless one of a few exemptions applied. AAHomecare contacted CMS and OIG staff to explain the problems. CMS determined that HME providers may, in fact, call beneficiaries to arrange delivery of items as long as the physicians informed the beneficiaries that they would be calling an HME provider to order the item for the beneficiary.

So let’s build on this momentum and these success stories. All HME providers should be grateful to the providers, consultants, buying groups, and manufacturers who support AAHomecare through membership and fundraising activities. We hope everyone will join and amplify our efforts to restore sound policies for home care. We will need all the help we can get.

A.J. Filippis is president and CEO of Wright & Filippis, based in Rochester Hills, Mich., and he is chairman of the board of the American Association for Homecare.