Why can't industry shake bad reputation?

Although I responded to the HME NewsPoll that asked why CMS continues to single out HME providers when it comes to fraud and abuse, I wanted to "take another whack at it." With that in mind, here are the seven reasons that I think CMS and federal lawmakers continue to target the HME industry. Our image The first national images of our industry were linked to fraud and abuse, and you "never get a second chance to make a good first impression." Over time, that reputation has been over-generalized and today, the entire industry is painted with the same broad brush. Other examples of over-generalized character misrepresentations include: all blonds are brainless; all Harley bikers are violent; and all sharks are man-eaters. Political perception The reimbursement methodology for our industry was originally based on medical equipment rentals, and the perception that we still only deliver equipment is widespread. But, for decades now, the industry has accepted the responsibility of caring for customers, as well as our equipment, expanding the role of the HME provider into America's healthcare system. Competition has forced HME providers to supplement deliveries with uncompensated 24/7 service, to hire qualified medical professionals and to meet standards of accreditation that heretofore did not exist. "Service" is now a vital factor in the industry to the patient and the payer. Until now, those service costs have been borne by the providers. To continue to grow, that service component must be compensated for or lost. Bureaucratic perception Anyone can get into the HME industry, anytime. There are no professional credentials or formal training required, so those in the business are untrained, uneducated and self-serving. Lack of performance data The nature of our industry is supportive and preventive. Our primary mission is to keep the infirm from expensive hospitalizations. Subsequently, when we care for patients at home, and keep them there, we are successful. But how do you quantify hospitalizations and exacerbations that don't happen? There are studies that have proven oxygen use, overseen by professionals, results in fewer hospitalizations and decreased length of stay when hospitalizations do occur. When will they be recognized, accepted and acted on? Lack of Clout By and large, our industry is fragmented throughout the country, unorganized and weak. When it comes time to lobby for healthcare dollars, few step forward with a loud voice or deep pockets. And what, if any, industries can measure up to the power of the hospital and AMA lobbies? It has always seemed to be a "David and Goliath" battle. position in the food chain We are the low man on the totem pole in America's healthcare delivery system. We are the little guys; the laborers; the foot soldiers; the grunts. We couldn't possibly have anything valuable to contribute. We should just do as we are told, accept our fate and move on. Washington turnover Our negative reputation stays in the system and the people who get to know us and our value, move on to other jobs or, more frequently, get frustrated by the political and bureaucratic machines and leave for better paying jobs or choose to just be away from the irrational pressures that exist there. hme Wayne Sale is chairman of the National Association of Independent Medical Equipment Suppliers and a long-time HME provider.