The Good, Bad and Ugly

One of the most frequently asked questions I get from industry folks across the country is, “Why?” Why does the government continue to pick on us? Why do we have such a bad image in Washington, D.C.?

Yes, we're a small industry. But Congress seems to make continual disproportionate payment cuts to the benefit and CMS continues to whack away with increasingly stringent coverage and documentation requirements, all when competitive bidding appears to be coming toward us at an alarming rate.

While there are multiple answers to these questions, let's focus on what we can do to address the problem. First, “the bad and the ugly.”

There are probably two main reasons why our industry continues under a shroud of negative perception in Washington. One is that barriers to entry are minimal. Obtaining a Medicare supplier number is relatively easy. And the government does not do a particularly superlative job when screening applicants or conducting onsite inspections, as evidenced by the numerous stories out of Miami and southern California where there appear to be a bevy of criminals intent upon defrauding the Medicare program under the guise of being a DME provider.

The second reason is one that stems from federal regulators. Their perception that we are “overpaid” goes back more than 20 years to how the current fee schedules were developed. The 1987 law that created the “Six Point Plan” required then-HCFA (now CMS) to develop fee schedules based on suppliers' submitted charges. Granted, it was Congress that established the methodology to develop the fee schedule, but as an industry, we take the blame as regulators assume that suppliers submitted charges that were inflated.

One of the “good” things is that an increasing number of members of Congress are having personal experiences with our industry. Parents and in-laws are requiring home oxygen therapy or have mobility issues. These legislators generally have a very positive view of our services, simply based upon their firsthand experiences.

Despite this move in the right direction, we can't control this activity, and we need to focus our energies on doing things that can make a difference more broadly in improving our industry's image.

Lots of folks have very good ideas about launching national public relations campaigns to help improve our battered image. While these ideas have great merit, they also carry great cost.