Observation Deck

It's Time to be Part of the Solution

Bidding reforms are making solid progress, but they need providers' help.

• By Steve Ackerman
• Mar 01, 2015

First, some backstory: I was speaking to a younger group of associates the other day and off-handedly mentioned that I didn’t want to sound like a broken record, only to realize that everyone in the group was born after 1975 and therefore, had probably never heard a broken record. In the day, a broken record was a sad moment when most often your favorite LP or 45 developed nick (usually of unknown origin) that caused the needle to get stuck and keep repeating the same line over and over — “hey-hey, you-you, get off of my cloud … cloud … cloud … cloud … ” comes to mind for some reason.

The point is (and once again at the risk of sounding like a broken record) I write to encourage — no, challenge — those among us who have not yet joined the American Association for Homecare and your State Association, or have not made plans to attend Medtrade (March 30-April 1), or the Washington Legislative Conference (May 20-21), and are not buying from vendors that are actively supporting the industry, to please do so soon. The industry needs you and you need to do your part to support the strong unified voice that is now championing your issues at the highest levels of government.

Constructive, well-defined activity is at an all time high at AAHomecare. The team in place there is, across the boards, the best in recent memory. Government relations efforts on Capitol Hill have matured into a well-oiled machine that is proactive not reactive and is showing very positive results. Regulatory efforts and communication with Medicare, although always challenging, are showing signs of real progress is ways that will help the operations of all sizes of providers. It’s vitally important that we thank this group of dedicated professionals by giving them our support through membership and participation.

State Association initiatives have become more numerous and crucial in recent months. Organizing and deploying grassroots support, monitoring local legislative changes and reacting to the daily challenges facing suppliers has never been more important. Issues related Medicaid and “bricks and mortar” requirements are hot topics this year that will need your input and support. All providers need to be there in order to help our committed state leaders move these matters forward in ways favorable to the industry.

Medtrade (east and west) and The Washington Legislative Conference have evolved into “can’t miss” opportunities to join industry leaders and prominent supporters in setting priorities and advancing them on Capitol Hill. The management at Medtrade is dedicated to diligently reviewing its format and programs to make sure time spent and the effort of the participating vendors is rewarded with the most productive returns possible. The large, positive gains recently made in disseminating our messages on Capitol Hill has made participation in the Legislative Conference this year critically important.

Growing Momentum

New levels of support and cooperation have begun to blossom throughout the industry. Partnerships and alliances are forming where they never existed before. AAHomecare’s diverse group of prominent corporate sponsors is at an all time high and increasing almost monthly. Manufacturing, business services and consulting leaders are stepping up their active involvement in trying to stabilize and bring some sense back to the HME industry. It’s a slow process, however, it’s working. Please thank them by directing your purchasing to them whenever possible.

Government relations and regulatory clarification efforts are continuing to try and ease the burden on an industry that somehow became the personification of all that is wrong at Medicare. The Market Pricing Program (MPP), developed by economic scholars to bring a fair and sustainable bid pricing format to HME reimbursement, was undermined by a short-sighted CBO score. Industry stakeholders are now deconstructing that program and presenting it in small, budget neutral “bites” that have a real chance of being implemented into law. The MPP was advanced by Reps. Pat Tiberi (R-Ohio) and John Larson (D-Conn.), who introduced H.R. 4920, the Medicare DMEPOS Competitive Bidding Improvement Act of 2014, which aimed to make all bids binding as well as requiring providers to obtain bonds and provide proof of licensure before bidding.

That bill lapsed, but set the stage for the The Medicare Competitive Bidding Improvement Act (MCBIA). The MCBIA was launched when the 114th Congress began at the start of 2015, and aims to remove the central problem of suicide bidding by requiring bidders in the Round Two re-compete and all future bids to obtain surety bonds that force them to accept bidding contracts. If a bidder declines a contract that is at or above its bid amount, the bidder forfeits the bond. The House bill, H.R. 284, was introduced by Reps. Pat Tiberi (R-Ohio) and John Larson (D-Conn.), who are both members of the House Ways and Means Committee. The companion bill in the Senate, S.148 (a bill in the upper chamber is a big win for the industry), was launched by Sens. Rob Portman (R-Ohio) and Ben Cardin (D-Md.), both members of the Senate Finance Committee. These bills are making their way through Congress at this moment, and it is time for everyone to be part of the solution by supporting them.

The future is beginning to develop a sense of clarity that we haven’t seen in the past 10 years. “Aging in Place,” once a buzz term, has been determined to be the way of life predicted for the next 30 years.

To that point, the Joint Center for Housing Studies of Harvard University recently released a report titled “Housing America’s Older Adults — Meeting the Needs of an Aging Population” (available at www.jchs.harvard.edu/research/housing_americas_older_adults). The report affirms a lot of what has been suspected about the baby boom generation. Statistics such as three out of four seniors over 80 would like to stay in their residence as long as possible and in 15 years one in five Americans will be over 65 and by the year 2030 the 50 and over population will have expanded 20 percent to 132 million people, should signal nothing but opportunity for our industry.

The Aging in Place phenomenon and homecare are a natural fit and will sync up because that is what happens in nature. How it will look is the exciting challenge. The model we have had for the past 30 years will very likely collapse under the weight of too many people and not enough public money. What springs up will very likely be family and community based networks of support that will recognize the value of HME services in the home. Great opportunities, if you can think outside the box.

The fact that we have to bid for our lives every three years, in the face of the need our nation has for our services, makes no sense. However, Congress will not get this message unless we as a unified group relentlessly continue to carry it to them. If you haven’t already, please join us.

This article originally appeared in the March 2015 issue of HME Business.