The Wile E. Coyote effect

There's no end to the irony in the disparity between the opportunity for home respiratory suppliers and the reimbursement trend for home respiratory equipment in America. There's a gulf between the two that's widening every day, precluding bridge construction, it would seem. On the one hand, you've got the National Heart, Lung and Blood Institute (NHLBI) launching a "Learn More, Breathe Better" campaign that would seem to open all sorts of doors for home respiratory suppliers. "I'd say close to half our oxygen patients are COPDers, and being in the tobacco belt, a lot of them are smokers," a home respiratory supplier told us last month. "Our delivery techs give them the literature and document it in their chart, and we pass that info along to their physicians." This is progressive. This is part of the solution. And it seems clear to anybody in this industry that so much more could be done: That suppliers, if utilized, could achieve a more exalted place in the healthcare continuum. But now for the other side of that gulf: reimbursement. It's going south and flowing faster. Remember Ross Perot's sucking sound? That's suppliers and patients, gasping at what's happening to oxygen reimbursement these days. And why? Well, there's capped rental, of course, and now there's competitive bidding. Enough said. Home respiratory suppliers are the Rodney Dangerfields of health care: They don't get no respect. The roots of this problem go back to the days of the golden commode and the equipment jockey, when all the service tech was supposed to do was deliver equipment and show people how to use it. Since then, technology has enabled so much more to be done in the home, but suppliers are still stuck with that same old reputation. National equipment scandals have fed the flames of this reputation, but so too have legions of suppliers who don't fancy themselves anything but equipment guys. These are the business people who've made the model work as is and don't relish having accreditation foisted on them. But for better or worse--no, it's for the better--more can be done in the home, and the equipment jockey is uniquely positioned to make a real impact in the continuum of care, as opposed to making just a salary. It's hard to fault the people who just want to keep things the way they are, but it's a schizophrenic situation. That's not a good thing. The industry wants to speak with one voice, and it manages, too, but really, there is no consensus. Some suppliers want to be progressive; some don't. How do you bridge that? Until we know the answer, we're going to be a little like Wile E. Coyote, suspended above the gulch, waiting to fall, while the opportunity zips by.