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Talk about value

Talk about value

The home medical equipment sector needs to be part of the accelerating national conversation about healthcare costs, outcomes and value. While HME has to stay engaged in immense challenges like the Medicare bidding program, the ongoing “auditgeddon” and regulatory hurdles, it ignores the larger value debates at its peril.

Since the HME sector has the resources, intellectual and otherwise, to walk and chew gum at the same time, I don't know what's holding up progress on this big-picture front. HME's sister sector, the home health agencies, has seen huge problems in terms of Medicare regulations and reimbursement in recent years. That sector mobilized big resources and ideas to address issues such as fraud prevention and also the cost effectiveness of home care in the healthcare continuum.

In the meantime, the long-suffering HME sector remains mired in its crises du jour.

You could see a glimpse of the bigger picture and perhaps the future of health care at the fourth annual Health Datapalooza conference held in Washington, D.C., in June. It was a big, sprawling event attended by health economists, industry leaders, data geeks, journalists, and government officials, including HHS Secretary Kathleen Sebelius.

More and more data is becoming available to analyze. The White House Office of Science and Technology Policy brags that over the past four years, HHS has “liberated over 400 datasets, participated in a countless number of codeathons, and has seen and helped developers build hundreds of apps, services and products using health data.” It's about time. Imagine a world where HME News didn't have to use the Freedom of Information Act to wrench reimbursement data out of CMS.

Close scrutiny of outcomes, cost control measures and value will drive much of the real health policy debate among Washington's wonking class. Consumers, stakeholders and the industry are pressing for more data, more transparency from all sources, plus the analysis that will help draw better insights, practices and policies from the data.

While the HME sector made good connections with many economists in the course of critiquing Medicare's bidding system and seeking budget estimates (or “scores”) for legislative proposals, it should be doing the same for questions like health and financial outcomes of home care.

Health economists and advocates could help to quantitatively frame issues like the role of HME in preventing ER visits and hospitalizations, and shortening hospital lengths of stay. When the HHS Office of Inspector General opines that Medicare overpays for a specific HME item or category, where is the data and analysis to assess the validity of that indictment?

The dollars that Medicare spends to reimburse HME providers who deliver and set up canes and walkers for beneficiaries seems like a bargain when you consider that they help prevent devastating falls, which lead to long hospital stays or death. Where is the data analysis to put that item into context? Or similar analysis for oxygen therapy, nebulized drugs, hospital beds, wheelchairs, support surfaces, or diabetic supplies?

The HME sector is losing the value debate. Even though it does not deserve it, HME remains a “target rich” environment that gets a disproportionate amount of negative attention from the Inspector General, the Department of Justice, congressional investigators and too many journalists who cut and paste self-serving government press releases into their news stories.

There are no silver bullets. However, like AAHomecare got out in front of the fraud and abuse debate with specific, aggressive proposals to stop fraud, the HME sector needs an equally aggressive commitment to look at data and put HME into context that will help policy makers and the public better understand the value of home care.

Michael Reinemer is a Washington-based communications consultant. Visit


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