This is a celebratory issue for HomeCare as we mark the magazine's 30th anniversary — and for the entire home medical equipment industry, fresh off the successful delay of competitive bidding.
The raging five-year fight against the program, begun when competitive bidding was mandated by the Medicare Modernization Act of 2003, is only the latest battle in an ongoing saga of laws and regulations that have defined the industry's history. Played out in the halls of Congress and reflected in the pages of HomeCare, most have involved cuts, cuts and more cuts. As we consider the past three decades, it has at times been difficult to say which reimbursement-altering vehicle has most drastically changed the home care landscape.
What's more, as legislators push to expand health care benefits and pay for them from a shrinking pool of funds, industry observers see no change in the trend toward tougher bureaucracy — and tougher HME margins. As 78 million baby boomers head toward Medicare enrollment in 2011, it's hard not to think that the economic, demographic and political forces that have squeezed reimbursements up to now won't get tighter.
There have been other significant changes as well, noted by HomeCare's writers in an endless string of phrases, acronyms and numbers affecting providers' bottom line. From the industry's “Golden Age to the crackdown stage,” from HCFA to CMS, from HIDA, HHSSA and NAMES to AAHomecare. From 34 regional carriers to four DME MACs. From eight power wheelchair codes to more than 60. From the days when canes and crutches shared space in rental stores with garden tillers and punch bowls to modern HME showrooms with their incredible array of complex and specialized products.
That last reflects HomeCare's own history, as the magazine spun off in 1978 from a publication called Rental Equipment Register (which continues today as RER).
As a point of reference, Medicare started covering home oxygen in 1973. In HME math that hasn't changed from all those years ago, the government payer still represents the lion's share of providers' revenue. But who knows? As educated and active consumers clamor for the products they see on the Internet and providers search for ways to move away from Medicare, we may reminisce 10 years from now and point to this decade as the one in which HME retail came into its own.
Meanwhile, we stand witness to the industry's pivotal passage through the competitive bidding boondoggle. We also recognize that there will probably be more of the same ahead. What's different now is that home care has become a clear answer to the country's growing health care crisis, and that is something Congress simply cannot ignore.
Opinions are mixed on what HME will see next, and on how it will morph. But to quote Tom Antone, a Washington attorney who served in the Department of Health and Human Services in the '70s and '80s and later led the National Association for Medical Equipment Services, “This industry can survive because demand will grow. It just can't be the same industry.” He made the statement in 1999.
On behalf of HomeCare's current staff and the editors, writers and artists who have contributed to the magazine's first 30 years, we thank you for your continuing support of our effort, and we look forward to covering 30 more years of yours.
