Nothing ever changes

Friday, June 30, 2006

After a bit of sojourning from our shores, I've returned from Vietnam to the States and--for today, at least--to my old desk, where the HME industry doesn't look all that different from the days when I routinely forgot to water a ficus that's now thriving. This reminds me of a comment made years ago by Michael DeCarlo, NAMES's (now AAHomecare) legal counsel, during an exit interview: Ten years after he came into the industry, the stuff on his plate when he left was the stuff they put on his plate when he came in: competitive bidding, oxygen cuts, inherent reasonableness, etc.
We don't talk much about inherent reasonableness anymore. But none of us should be surprised if CMS doesn't apply a little mouth-to-mouth to that old bugaboo--if and when competitive bidding reorients everybody's expectations of what providers should be paid for services and products.
For half the supplier base, this doesn't really matter. Why not? Because half the supplier base is going out of business, according to the impact analysis portion of CMS's competitive bidding proposal, released May 1. That seems a bit far-fetched until you remember that the industry's own assessment of its chances portends similarly dire straits. Nor does it seem like a stretch when we look back to the late 1990s, and the tsunami (BBA '97) that wiped out so many home health agencies. The only difference between competitive bidding now, and when Michael DeCarlo first glimpsed it, is the warmth of the dish. It's a lot hottter these days.
More remarkable, however, and most disappointing, is the ongoing perception of industry suppliers as delivery people. CMS put this perception on the record recently (see story page 1) when officials at a PAOC meeting revealed this conclusion from a study among beneficiaries. You can quibble with the sample size (44), and call the results insulting, but the more important takeaway for HMEs, the action-item here, must be self-reflective.
The industry was struggling with this perception in 1995 when I came into the industry (when DeCarlo was at NAMES) and industry leaders mounted a PR campaign to change the perception of HMEs from dealers to suppliers. But no one buys this, and if industry suppliers simply continue to insist that it's so, others will continue not to buy it.
So, what is the prescription here? If I knew for sure, I'd be in the running for CEO of AAHomecare. I am sure it's the industry's obligation to demonstrate, unequivocally, that its practitioners are more savvy than delivery people, that service means more than showing people how to change crutch tips, or advising people about the dangers of throw rugs.
The solution must be white-coat, if I can use the noun as an adjective. It has to be clinical, and it has to be demonstrable (i.e. persuasive in the way an Excel spreadsheet is persuasive; in other words, no more hot air). Otherwise, this column is as likely to be all too relevant 10 years from today.
On the wheelchair front, it doesn't appear there's any more clarity today than there was at the end of last summer. CMS released 6- new codes June 2, but everything's still up in the air. NSM's Simon Margolis calls this new development a skeleton. He's waiting for flesh. Let's hope we don't have to then look forward to blood.
The iBot, whose knell we sounded in these pages last year, is still powering up. I guess that's not much of a surprise, given that the investment dollars for the project exceed well more than $100 million. Independence Medical is trying to get a code for the device now. The woman whose managing the process at Independence Technologies is Elizabeth Patience. Apt enough.
Most disappointing of all, however, is the degree to which providers are still thought of as dealers, or delivery people.