Editor's Note

A New Attitude

CMS needs to change how it regards HME.

• By David Kopf
• Apr 01, 2017

Do you know who can hold a grudge? My daughters. I don’t know if this is a trait universal to all teenagers, or just mine, but boy oh boy are they experts at recording slights and then calling them up at a later date.

I freely admit that I’m courting absolute doom by writing about my girls’ spats in a column, but I can’t help it, and besides … it’s true! For example, one of my kids will misappropriate a greatly coveted food item from another’s lunch bag, and you can count on two outcomes: First, the finger pointing and recriminations will be on par with what takes place on Capitol Hill. Second, the kid who got victimized will mentally file this crime, and call it back up like an ace up her sleeve, to be played during a future dispute. For example:

“Hey, you swiped my granola bar!”

“Well, five months ago you drank my smoothie!”

Then they’ll launch into trading volleys of recorded insults and wrongdoings back and forth like a cross between the world’s loudest, angriest tennis match and an oral history cage match that recounts every minor, intra-personal infraction that’s ever occurred between them.

Honestly? I’d get mad, but I’m too impressed by their total recall. I think their brains are connected via WiFi to some kind of cloud-based, argument storage system that only teenagers can access.

You know who else can hold a grudge? CMS. It’s attitude toward DMEPOS providers relies on suspicions and attitudes that don’t jibe with current reality. One of the big problems is HME providers’ status as a “supplier” instead of a provider.

CMS sees what HME providers do as no different from supplying filing cabinets, or truck tires, or computer equipment, or any other “widget” that a supplier might provide the government. The agency doesn’t take the time to study the services providers include with the equipment they provision, or how their clinical and product expertise can greatly enhance patient outcomes.

It also views providers as a problem. We know this from the incredibly outsized attention CMS gives DMEPOS when it comes competitive bidding, audits and other policies. For a benefit that makes up less than 2 percent of Medicare’s budget, CMS sure seems to think that DMEPOS is the problem child. Looking at how policies are implemented and enforced indicates an obvious, institutional culture that puts our industry in the crosshairs.

Case in point: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act. Passed in 2014, the act aims to improve post-acute care provisioned to Medicare beneficiaries through standardizing and the recording and reporting of patient assessment data. It aims to create interoperability so that all that patient data can be shared between the various healthcare providers who hold a stake in a patient’s continuum of care. After reviewing a variety of IMPACT Act documentation, what I’ve found is that, beyond casual mention, it doesn’t mention DMEPOS at all.

This magazine, the industry, and a variety of vendors and providers have discussed the pivotal role that providers can play in patient monitoring and reporting for literally years. Anyone in the post-acute care space would literally have to be asleep not to notice that fact that sleep providers have been rolling PAP therapy devices that help physicians and other healthcare experts track sleep patients’ progress and therapy in detail in order to fine tune outcomes. And, as our January feature “Continuous, Connected Care” showed, now even more sectors of HME, such as oxygen and diabetes are moving fast to help facilitate the monitoring and reporting on their patients’ care, as well. All of these providers are in the post-acute care space, and they are all looking for ways to help their patients through data reporting, but none of them are involved in the IMPACT Act discussion.

It’s clear that CMS has an “attitude” toward HME providers: we’re a problem; not a solution. And that’s where CMS and my daughters depart. My girls might have their differences, but in the end they settle their beefs and move on. If they hold a grudge, it’s temporary. In contrast, CMS appears to harbor an institutional “grudge” with HME.

CMS needs to create a new internal culture that sees DME/HME for what it is: a vital player in postacute care and a money-saving asset in building our nation’s healthcare future. I believe new HHS Secretary Tom Price and CMS Administrator Seema Verma (see “News, Trends & Analysis,” page 8) might be the team to foster that change. It’s time to move onward and forward.

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