Industry battles bad reputation

HME has more than its fair share of skeptics among those who control its destiny. As a result, many would argue, the industry gets prejudicial treatment every time policymakers consider altering the status quo. The routine has become increasingly prevalent in recent years: Congress or CMS develops a heavily restrictive proposal and industry spokespeople object vehemently. Revised measures and adamant protests volley back and forth over the course of months and if the industry is lucky, the damage is minimized. Even so, whatever reversals HME proponents are able to get still amount to nothing more than moral victories-Uncle Sam gets his way every time. One who knows this better than practically anyone is Cara Bachenheimer, vice president of government relations for Elyria, Ohio-based Invacare. For nearly 20 years, she has represented the HME industry's interests on Capitol Hill, arguing strongly to stave off the relentless attacks on her constituents' livelihoods, whether it's drastic Medicare reimbursement cuts, stifling paperwork layers, confounding regulatory hoops or radical format changes. Despite her eloquence and perseverance, those who sit in judgment remain largely unconvinced of HME's legitimacy in health care and continue to build obstacles. "There's a number of reasons for this--both historic and current," Bachenheimer reasons. "It started with the golden commode and continues today with a lack of awareness and understanding of what the industry provides. If legislators aren't contacted, 99% of the time they have no clue what's involved. That lack of understanding is countered by information from the [Office of Inspector General], which paints the industry in a negative light. If that's the only information you receive, it's a distorted picture of what the industry is like." Rep. Bill Thomas, R-Calif., is among HME's most formidable adversaries, responsible for various congressional bills designed to inhibit the industry's prosperity. As long as Thomas and others like him steadfastly believe that providers are nothing more than leeches on the Medicare system, the onslaught will continue unabated, Bachenheimer said. "They have it lodged in their brains that Medicare is paying too much for home medical equipment," she said. "They see that the price of a concentrator is $1,000, and that the program pays $200 for monthly rentals. They don't see why they should pay it. They have no clue about the oxygen therapy part of it." Indeed, the misguided perception of HME as a bunch of "equipment jockeys" colors legislators' judgment when it comes to making policy decisions, sources say. And while it's true that other clinical professionals aren't immune to politicians' meddling, there's no doubt they are spared more often and garner much more respect. Severely handicapping the industry's case is a lack of hard data showing HME's clinical efficacy and dollar-saving potential to Medicare through preventing hospital readmissions. Though some providers have started gauging outcomes and publishing results, they have relied too heavily on anecdotes to convey their message. "We have wonderful heartwarming stories, but we need to translate that into something more concrete," Bachenheimer said. Vernon Pertelle, vice president of outpatient services at Tri-City Hospital in San Diego County, has long been pushing for an HME outcomes movement and says the need to document and publish in clinical journals is more paramount than ever. "When competitive bidding comes in there will be standards and many of those are in the form of outcomes," he said. "The bottom line is that if we don't begin today, we'll be behind the eight-ball. It needs to become part of how we do business on a regular basis." A major reason why providers have resisted outcomes measurement is that they don't know where to start. Home respiratory specialist Patrick Dunne says it comes down to providers understanding their companies' capabilities for gathering data. "I've said repeatedly that the key is generic patient satisfaction levels," said Dunne, founder of Anaheim, Calif.-based Healthcare Productions. "Once you become familiar with quantifying this data, it eventually becomes part of a clinical outcomes program." Conducting outcomes research has another benefit as well, said Bob McCoy, managing director for Apple Valley, Minn.-based Valley Inspired Products--it shows policymakers that the provider community is willing to make sacrifices in the quest for knowledge. "What gives us a black eye is when a provider says 'I won't do it because I don't get paid for it,'" he said. "When you say that, it looks like you're only in the business for the money." The same rationale applies to HME accreditation, which the industry has traditionally resisted out of concern about cost and time expenditures. "In a business that doesn't generate massive revenues and has high employee turnover, providers don't see the value of it immediately," said Mary Ellen Conway, president of Bethesda, Md.-based Capital Healthcare Group. "Adding more processes and layers to the business is a hard sell, especially when people say they're doing their work and their customers are already happy." Now CMS has forced the issue with mandatory accreditation standards due out in April. While the regulations may not require all providers to become accredited, health care attorney Jeff Baird strongly recommends it as yet another way providers can build credibility. "Being accredited shows society, the medical community and regulators that you've spent the time and money to follow principles," said Baird, chairman of Amarillo, Texas-based Brown & Fortunato's health care group. "To be seen as a medical professional, you have to act like one." Another reason why other health care professionals keep regulators at bay is a high degree of association membership. The fact that only 800 HME companies out of several thousand belong to AAHomecare reveals a stubborn lethargy throughout the industry, said Tom Williams, president of Scottsdale, Ariz.-based Strategic Dynamics. "Why do physicians have lobbying power? It's numbers," he said. "If more HME providers joined their state and national associations, it would certainly strengthen the industry's presence, image and stature."