We need to remain a service industry

Monday, September 26, 2011

What's the role of the HME industry in how Medicare can save money? Is it low hanging fruit for future cuts, or a vital member of the care coordination team, which balances the needs of patients, providers and payers?

There is little doubt that healthcare spending today will be unsustainable in the future. The impact of anticipated budget cuts on both the federal and state levels clearly means we are going to have to live with less.

Additionally, there is a new alphabet soup in healthcare, from ACO (Accountable Care Organizations) to EBM (Evidence-Based Medicine) to HEDIS (Healthcare Effectiveness Data and Information Set) to P4P (Pay for Performance) to VBP (Value-Based Purchasing). Clearly the world of health care, which has little or no incentive for integration, reinforcing the silos, must change.

VBP is an important driver in this new world that is revamping how health care is paid for. The move is toward rewarding for better value, based on outcomes; and innovations and efficiencies, instead of volume. The need for integration and care coordination is upon us. The HME provider should and can be a part of this integrated model.

The trouble is we are focused on cutting our costs and services, which we know will have negative effects on patient outcomes, because we have not been seen by CMS as a viable member of that care coordination team. Instead, we seem to be the low hanging fruit ripe for more cuts when these budget discussions unfold.

The travesty today is that this flawed competitive bidding program that clearly looks at only one outcome--cost saving--is not in alignment with care coordination and quality outcomes across the healthcare continuum. The care coordination with the HME provider is vital in improving these patient outcomes through good patient education, disease management programs and better technology.

The irony is that for years HME providers were sending therapists into the home teaching to teach patients about their disease and what signs to watch for that could lead to trouble or a readmission. I started in this industry as a respiratory therapist 35 years ago, teaching the COPD patient the need to be compliant with the therapy prescribed as well as good BPT (broncho-pulmonary toilet) techniques. This education would show them the importance of how or removing and clearing secretions. The patient was instructed what to look out for and told to contact a physician as soon as these changes were noted, avoiding costly hospital readmissions. Today, as the healthcare arena coordinates better care for better outcomes, we are battling a flawed program like competitive bidding that disregards service and outcomes.

We need to get to the table and convince CMS and Congress that we can affect outcomes and save Medicare dollars. CMS will be rewarding hospitals that hold down costs and penalize those whose patients prove more expensive, using a new "Medicare spending per beneficiary" measure of performance. In October of 2012 this type of accountability of care and outcomes will be part of the payment formula. Hospitals must begin to identify potentially avoidable complications, unnecessary readmissions, inappropriate ancillary procedures and focus on reducing length of stay. The frailer patient is being sent home sometimes without understanding complicated instructions on how to take care of themselves at home. The federal program will reduce how much it pays hospitals for certain preventable readmissions such as CHF and COPD--the very same diseases the HME provider supplies equipment for, the very same patients we are forced to decrease services for, as we are looked at as a commodity in a one-sighted cost metric. We must convince Congress, CMS and the other partners in the coordinated care effort that paying us to provide good services is vital.

This industry must begin to work with more post-acute care providers or ACOs if and when they gain momentum. We must prove that we are a key team member that can improve outcomes and help to save dollars while providing quality care. Disease management, along with technology, can create independence and quality outcomes. Our job is to convince the care coordination team the value we will provide.

The best way to start: Talk to the hospital CFOs and show how you can decrease CHF and COPD re-admissions, improving quality of life in the patient preferred, most economical home environment. When they begin to listen we may be a valuable service industry again, deserving a reimbursement commensurate with the quality outcomes we can affect.

Tom Ryan is president and CEO of Homecare Concepts, Inc., a provider in Farmingdale, N.Y.