Professionalism Is Part of Solution

Just as with regulatory compliance, one of the keys to addressing the new Medicare Prescription Drug, Improvement, and Modernization Act (MMA) successfully is to address your own internal management systems. Ironically, this is both a key part of the solution and a key part of why we're in this mess in the first place.

Why? The greatest insight I draw from the Medicare reform law is sobering: Congress does not believe that the HME industry has its act together.

We cannot discount the fine lobbying work done by the American Association for Homecare and state associations. But Congress appears convinced that those organizations present the voice of only the very best suppliers. Our lawmakers evidently believe that most HME providers do not have their acts together, are not professional and do not know “the Rules” or much care about them. In short, the clear message of MMA is that the government does not believe our industry is particularly “professional.”

Consider: More than 60 percent of providers in the industry remain unaccredited. Of those, more than half had no immediate plans to become accredited, at least before accreditation became mandatory under the new law (see HomeCare, December 2003).

I do not suggest that accreditation instantly confers respectability and accountability. However, it is one of our few — and often the only — objective measurements of professionalism.

Consider: In a mid-November announcement, the Centers for Medicare and Medicaid Services estimated that the error rate for Medicare payments went down from 13.8 percent in 1996 to 6.3 percent in 2001 and 2002. However, in 2001-2002, DME suppliers, on average, showed a 13.6 percent error rate — more than twice as high as the health care average. Let me repeat — twice as high.

Consider: Prior to the new Medicare law, the national trade association for home health agencies responded to an erroneous report about high industry profit margins by efficiently collecting and analyzing 6,425 cost reports. They demonstrated that the profits for the reported period were actually only 5.15 percent and that they would fall to virtually nothing in 2003. Many industry experts believe that this action convinced Congress to back away from reimbursement cuts for home health agencies.

What reliable, Medicare-specific financial statements could the HME industry provide? Umm … none? How long would it take us to gather this information? Umm … never?