Editor's Note

Viva the Little Guy

The tiny HME industry faces big changes in2013, but small guys pack a mighty punch.

• By David Kopf
• Jan 01, 2013

I write this in the wee hours of 2012, before the dawn of 2013, and the industry’s situation reminds me of a stirring scene from J.R.R. Tolkien’s “The Return of the King”: The world of Middle Earth sits in early morning darkness right before it is about to launch into a battle that could spell the fate of their world. The wise and powerful wizard Gandalf and the little hobbit Pippin stand on the ramparts of a giant city overlooking a massive battle plain. Pippin remarks, “It’s so quiet,” to which Gandalf replies, “It is the deep breathbefore the plunge.”

That’s the breath the home medical equipment is inhaling at this very moment. Congress is in its Lame Duck session and providers, state and national associations and even patients are working overtime to convince lawmakers to back H.R. 6490, the bill introduced into the House by Rep. Tom Price (R-Ga.) that would replace the Centers for Medicare and Medicaid Services’ competitive bidding program with the industry’s marketpricing program.

The strategy is that the Lame Duck Congress is not going to be able to pass the sorts of sweeping legislation that would turn the country back from the so-called “fiscal cliff,” which would implement substantial spending cuts and tax rate increases if the budget wasn’t balanced by the New Year. There is simply not enough time. But, Congress would most likely be able to pass legislation that would address at least some of the major fixable issuesover which it still presides before the New Year.

One of those fixable problems is the physician “Doc Fix” that would adjust physicians’ Medicare reimbursement. As legislative items go, the Doc Fix is almost an absolute must, and that means it could be an excellent piece of legislation to which the industry could attach H.R. 6490. So, the focus has been on getting co-sponsors of the MPP bill. As of press time, the industry has scored 80 backers andis still hustling. But time is running out.

Moreover, a factor that has yet to come into play is for CMS to release the Round Two bid amounts. Would these bid amounts throw off any scoring for the currently budget neutral MPP bill? That’s tough to say, but CMS’s timing for release of those figures has to at least be partly political, if not entirely. The Centers were slated to release the figures sometime in fall, but mere days before the Winter Solstice lawmakers and the industry are withoutbid amounts.

Time is running very tight. I hope the industry is able to make some serious progress on Capitol Hill and wheel a deal that secures the MPP. The alternative is too awful to consider. Already providers are having to make tough decisions about care and product quality in the face of other funding cuts. Already we have seen many provider businesses close up shop thanks to Round One. How much worse could things get if Round Two is implemented in summer? That’s something I don’t wantto even consider.

But Tolkien’s stories did contain a theme that resonates with the HME industry: All throughout his stories the true heroes are not the powerful wizards or mighty warriors. They are truly “the little guys.” Half the height of a human being, these little hobbits, who are typically fixated on creature comforts and living blissfully routine everyday lives, wind up saving the entire world. And they do it not through magical powers or some sort of “just in time” fix; the little hobbits do it simply by struggling and slogging along through tough circumstances, knowing that doing so is their dutyand hoping that they can pull it off.

If the industry can’t secure the MPP bill’s passage by the dawn of 2013, the industry will still be smack-dab in the middle of the battle of its life, but that’s not any place it hasn’t been before. Providers will need to take that deep breath, plunge into the fray, and remember that even the little guys cancome out on top.

This article originally appeared in the January 2013 issue of HME Business.