You know the expression “the irresistible force meets the immovable object”? Well, for HME/DME providers, both of these are coming at us at once, and we are caught between them. The “irresistible force” is the ever-present torment of CMS, the nemesis of our business lives. The “immovable object” is Congress, the body of self-serving, self-preserving elected officials, engaged in gridlock and at a standstill in making any meaningful laws or decisions.
The issue at hand is our very survival. DME suppliers are the most over-regulated, over-audited and underappreciated providers of health care in the country. But if you listen to the CMS and Congress we are the most overpaid, overpopulated and fraudulent element of Medicare. In 1997, Congress passed laws resulting in scores of regulations all aimed at solving a problem that didn’t exist then and doesn’t exist now. But we know that DME suppliers are part of the solution to the high cost of health care, not the problem. The evidence shows that for every dollar spent on DME, Medicare avoids spending an average of $7.50 on care for the chronically ill. Add in similar savings from home health services and you would think Congress and CMS would be pushing to expand home care, not kill it.
But the downward pressure of reduced payments for Medicare and Medicaid, followed closely by private insurance fee reductions, means suppliers are struggling. Competitive bidding and the oppressive audit process are putting good suppliers out of business. Gas prices climb, employee health insurance premiums increase and every other overhead cost is more today than it was last year.
Over 240 world-renowned experts have told these powers that the bidding program is flawed and will fail, but no one listens. Nearly a dozen reports by independent entities state the problems with the bidding program, but no one listens. Job losses will be high, business failures will increase and access to care will be reduced, all resulting in higher costs to states and reduced tax revenue. Still the powers don’t listen.
It appears that Washington is out of control. CMS acts with impunity, doing what it likes, and no one responsible is willing to challenge them. Congress is hopelessly deadlocked, refusing to pass meaningful laws for fear it will cost them the election. Partisan politics drives everything, with both parties far from their roots. In the meantime, America drifts along as a ship with no rudder.
The power of America has always been The People, yet it seems that the most abundant commodity in the country is apathy. Just as we need suppliers to get involved in district level grassroots politics, we also need to have all Americans involved. Do we to need to make changes at the polls in this election? If we do, suppliers don’t have the power to make those changes alone. Many feel that whatever the outcome of this election, little will change for DME suppliers and the campaign for 2014 will begin soon after New Year’s Day.
But, all is not lost. Demand for what we do will grow, not wane. Those who need DME will get their products. What will change is where patients get their DME, and who pays for it. Small suppliers may become fewer and large suppliers may get larger, but suppliers will always have a place in the home-care market. What will also change will be how suppliers integrate into the health-care continuum. The new world order is prevention and Accountable Care Organizations (ACOs), and suppliers are a key element in this new order.
The need for suppliers to join forces and fight as a unified community has never been greater. Those suppliers who believe they can survive without being involved in politics and without being members of trade organizations are misguided. The power of grassroots advocacy can make the difference for suppliers, but only if we have thousands more willing to stand and be counted.
So here is the call to arms: Suppliers take heed, and join your national and state trade associations! Become a political activist for your business and your industry, and get educated on how to be your own lobbyist. Stay informed through educational programs. Not getting involved may be the difference between being a part of this growth industry and finding a new way to make a living.
