As HomeCare opens its scrapbook on the last 30 years, there's a lot to take in.

Since the magazine's first issue in 1978, the home medical equipment industry has certainly changed. Many of its notable players, both manufacturers and providers, have come and gone. Product technology has zoomed forward, offering the most advanced solutions available for the nation's growing population of home-based patients.

The government's regulations and requirements have multiplied (exponentially, some say), and legislation with dramatic import for providers and their customers has punctuated HME's history. Reimbursement reform began with the Six-Point Plan, passed in 1987 as part of a budget bill. The Balanced Budget Act of 1997 cut some providers' profits by more than 30 percent. The Medicare Modernization Act of 2003 mandated competitive bidding. The Deficit Reduction Act of 2005 required beneficiaries to assume ownership of their oxygen equipment after 36 months.

But at its most critical turning point yet, the industry won one for a change with passage of a somewhat gentler measure — the Medicare Improvements for Patients and Providers Act of 2008 — that delays competitive bidding and repeals the oxygen equipment transfer. On the flip side, though, the act also calls for a nationwide 9.5 percent reimbursement cut on products that were included in round one of competitive bidding.

Looking back, it's clear the industry's path has been plotted by the vagaries of politics and prevailing attitudes in Congress. And as we look ahead, it's certain that scenario won't be any different. Add to the unsettled future two presidential candidates who both say they want to reform Medicare, and there's no question there are still significant changes to come.

Perhaps the only thing that is sure? The HME industry will look incredibly different as it moves through the next three decades, and maybe in only the next three years, as, somehow, the government and providers must figure out how to serve the 78 million baby boomers who will swell Medicare's ranks beginning in 2011.

It is also clear that one thing about this industry has never changed, and we hope it never will: the caring and compassion with which you, our readers, serve your patients.

As you look through this collection of HomeCare covers, reflecting the issues and answers that have shaped the past 30 years, we hope you will remember not only the challenges you have faced but the fortitude with which you have met them — and the lives you have touched in service to the nation's chronically ill and disabled.

1978

HomeCare Rental/Sales spins off of Rental Equipment Register, and 4,000 HME providers receive the first issue.

1979

“We are a labor-intensive industry and we need to be recognized as such,” said Arizona Medical Supply's Don Redman, who went on to become the first president of NAMES.

1980

Abbey Medical acquires three top rehab firms, NADMEC holds its second annual convention and the magazine debuts its first annual Home Health Care Buyers' Guide.

1981

Johnson Rents prepares to expand to meet “intense” DME rental competition and counter third-party reimbursement cost pressures.

1982

DeVito's Pharmacy and Surgical bucks the trend as independent pharmacies nationwide close due to lack of business or sell out to major chains.

1983

Mike Hamilton of Hamilton Oxygen Service forecasts a government cost-saving target on HME's back: “We're more defenseless than the hospital industry, physicians or pharmaceuticals,” he told HomeCare. Today he serves as director of ADMEA.