Swimming Lessons

• By David Kopf
• Feb 12, 2008

How can providers swim out of a regulatory rip tide?

When I was a kid, I loved to swim. I adored it, and, unlike a lot of things, I actually was good at it. I counted the days for winter to pass so that I could dive back in. To my parents’ chagrin, I’d stare at the thermometer with all the monomania a small fry can muster (which, by the way, is considerable) until it reached the 70 degree benchmark my parents required for swimming, at which point I’d jump for joy while they rolled their eyes.

However, when I reached the ripe old age of 11 years old, my parents moved us from often-frigid Northern Ohio to the sunny shores of Southern California. You’d think living near the Pacific would come as a boon to a kid who thought he was part fish, but I had to learn to swim all over again. Much to my consternation, I learned the ocean is bigger — and more dangerous — than the neighborhood pool. A specific concern was rip tides, which can suck swimmers out to sea and keep them there until they can no longer tread water and thusly perish. Local schools devoted regular instruction on how to swim out of one. The trick is to resist fighting against the rip tide and instead swim across it, parallel to the beach, until you are out of the deadly currents. Then you’re home free.

HME providers now find themselves in a bit of regulatory rip tide. Competitive bidding has dragged them out into seemingly perilous waters: If they try to keep doing business as usual, while incurring additional accreditation costs and constantly having to shave down the costs of their services, they will simply tread water until they run out of steam. If they swim against the current, they’ll find themselves going nowhere.

Is it wrong for the fed to put providers in dangerous waters? Absolutely. We all know that the HME industry accounts for less than 2 percent of Medicare’s budget and is its slowest growing line item, yet it sits under a glaring spotlight – all in the name of fraud prevention. Meanwhile, Washington politicians are scrambling to bail out mortgage investors, lenders and borrowers who engaged in financing loans so spurious they engendered the term “liar loans.” To further feed your sense of irony/ire, folks on the beltway are considering tighter rental caps or additional cuts on oxygen equipment that helps patients, well, live (see our News section, starting page 8). That is wrong in every sense of the word.

But getting upset about competitive bidding and an increasingly surreal regulatory landscape makes about as much sense as fighting the tide. It’s not going to change anything, so why struggle against it when you can swim out of it?

And that’s exactly what smart HME providers are trying to do. The oxygen market illustrates the point perfectly. As this month’s feature “Oxygen Outlook” (page 24) illustrates, a blend of technology and business practices might give providers running oxygen businesses a way to sidestep some regulatory curveballs. Likewise, this month’s cover story “Going for the Cash” (page 30) shows how many providers are trying to take Medicare funding out of the financial picture as much as possible by leveraging cash sales to increase income and keep afloat.This rip tide won’t last forever.

Remember, patients vote, and there will come a point in time when they will feel the pain and frustration of competitive bidding. When patients can’t obtain the products or services that will help them live their lives to the fullest — or just plain old live — because the agencies their tax dollars fund won’t pay for them, they will write letters, send emails and call their Congress persons to read them the riot act. Then, the ebb and flow of Washington politics will work to providers’ favor for a change, and the HME industry will be the better swimmers for it. The tide will turn.

This article originally appeared in the February 2008 issue of HME Business.