Editor's Note:

HME’s Next Chapter?

The coming year will bring an entirely new political landscape for the industry.

• By David Kopf
• Jan 03, 2017

Do you ever skip ahead when reading a novel? I do. It’s a terrible habit. The author takes all that time to painstakingly weave an engaging plot, revise the language so that it has literary appeal, and put the final product through multiple editorial revisions until it shines. Then here I come and skip right by all that hard work so that I can get to the good part.

I can’t help it. Sometimes I simply have to know. I have the same feeling about the next 12 months. With the outcome of the 2016 General Election, I have a feeling that a whole truckload of changes are in store for the home medical equipment industry, but I’m not sure what they are — and I really want to know. 

What We Do Know

Unfortunately, there’s no way to skip ahead — not unless someone invents a time machine, or I discover a crystal ball that yields 100 percent accurate predictions. Instead, we’re going to have to make some educated guesses. For starters, we know that we have a whole new political landscape in Washington D.C. President elect Donald Trump will take office on Jan. 20, as will the 115th Congress of the United States. This will be the first time we will have a Republican-controlled Congress working with a Republican President since the 2003-to-2007 period of the Bush administration.

Already, we know that President-elect Trump has named Rep. Tom Price (R-Ga.), a longtime congressional champion of the HME industry, as the next Secretary of Health and Human Services. Moreover, Trump has also named Seema Verma, founder and president of healthcare policy consulting firm SVC Inc. to serve as Administrator of the Centers for Medicare and Medicaid Services. (See “News, Trends & Analysis,” page 8, to read more about those appointments.)

Furthermore, we know that Rep. Price is a primary proponent of the industry’s Market Pricing Program alternative to competitive bidding. This could create a landscape for the industry finally seeing deeper competitive bidding reforms. We’ve made some progress with binding bids, bidding surety bonds, and the bid ceiling set to pre-bid rates. Perhaps the industry could finally have the opportunity to push for broader reforms to the bid program that will create a truly competitive marketplace for the DMEPOS program.

Here and Now Priority

In the meantime, we still have a more pressing, immediate concern: rural bid relief. The industry was able to accomplish some rural bid relief thanks to the 21st Century CURES Act, which the 114th Congress passed and Pres. Obama signed in the remaining days of the legislature’s Lame Duck session. That law extends the initial phase of partial reimbursement cuts to items impacted by bidding from ending on June 30, 2016 to ending on Dec. 31, 2016, and pushes implementation of the full reimbursement cuts, which had started on July 1, 2016 cut to Jan. 1, 2017. CMS will reimburse post-July 1 claims for the difference between the partial reimbursement cut and the full reimbursement cut.

So, by the time you read this column, those full reimbursement cuts will be back in play. This means that the industry must push for a better deal for rural providers and patients who will once again find themselves at the tip of the spear when it comes to bid expansion. I’m not sure how that will play out legislatively, but I know that a much more favorable political landscape is just around the corner. And I’m sure the industry’s government relations experts are already working on a plan to leverage that new environment to its fullest so that these highly vulnerable providers and patients can finally feel some confidence about their future.

Will the cabinet appointments, new administration and legislative environment also mean that we could see audit reforms? How about creating a separate benefit for CRT? I’m desperate to skip ahead, but since I can’t, I’ll have to take confidence in the fact that the HME industry’s unfolding story appears to have taken a more optimistic turn. This next chapter should be a page-turner.

This article originally appeared in the January 2017 issue of HME Business.