Squeaky wheels make the best advocates

Q. Why does the HME industry complain about efforts by Congress and CMS to improve the Medicare program and save taxpayer dollars? A. If Congress and CMS had some good ideas along these lines we'd be first in line to support them. But the most recent proposals affecting DME— competitive bidding, capping oxygen use and eliminating the first-month purchase option for power wheelchairs—have been so stunningly wrong-headed that HME providers have had to assume the role of front-line patient advocates. In many respects, HME providers have become the “canaries in the coal mine” in terms of patient advocacy. Like other healthcare professionals, we care about the well being of patients and we look out for their best interests. As providers we can foresee patient impacts better than the bureaucracy and often before many traditional advocacy groups. We continue to sound the alarm that competitive bidding is likely to harm beneficiaries in ways not contemplated. By concentrating market share and eliminating competition, customer service becomes a target for cutbacks. Same-day service calls will become a memory. Quality of care will suffer as surviving providers respond to pressure to treat medical services as mere commodities. If in-home care is made less safe, 911 calls will increase as will institutionalizations. Normal patient advocacy organizations tend to not focus on such matters at the same early stage. Even on a provision as draconian as prohibiting the first month purchase option for PMD for people with the most severe and persistent disabilities, it took weeks for many of the nation's best advocacy groups, such as the ALS Association and MDA, to recognize and respond to this threat. Sometimes trusted advocacy groups will surprise you and work against what would seem their own interests. AARP supported the SCHIP legislation that would have capped oxygen rentals at 18 months. If these proposals threaten patient care and result in higher costs, the question should be, “Why isn't everyone complaining?”