Succeed with Active Participation

There are a number of forces at work shaping the HME marketplace, from the exploding numbers of baby boomers reaching qualifying Medicare age to technological advances in the equipment companies sell and the systems they use to manage their employees’ time. In the case of companies that receive a significant portion of their revenue from Medicare, the government is by far the most prominent force. Within the government, Congress and CMS are the market-makers. Congress passes legislation, such as the Medicare Modernization Act and the Affordable Care Act, which contains specific language directed toward HME. CMS interprets legislation, makes rules on how to put it into effect, and devises systems for delivering, monitoring and assessing the results. Every one of these actions impacts the HME marketplace in small and large ways. Because most markets have at least some degree of volatility, successful businesspeople know that one of the keys to long-term profitability is managing proactively rather than reactively. When a company is running just to keep up, there is no room for error and it is unlikely that the company will ever truly get ahead. In other words, hoping for the best is not a good strategy for a company that wants to stay in business. For the past few years, the Medicare HME market has experienced high volatility—the start of the bidding program in 2011, the tremendous increase in audits, the power mobility prior authorization demonstration project and the introduction of PECOS are just a few examples. It stands to reason then, that companies with Medicare revenue should take advantage of every opportunity to be proactive in shaping the marketplace in which they hope to continue doing business. How else will they have real influence over what happens? One excellent way that AAHomecare members get involved is by actively participating on one of the Association’s policy councils. There are four primary councils, each with a unique focus and each staffed entirely by volunteers from among the Association’s member companies. These volunteers are experts in their fields, and the expertise they share benefits not only Association members, but also the entire HME industry. The councils are integral to AAHomecare’s legislative and regulatory advocacy. They help shape the Association’s responses to the many ways Congress and CMS try to change the HME marketplace. Below are some of the councils’ top goals for 2014. HME/RT (oxygen and respiratory)—1) Protect the Medicare Part B oxygen benefit (outside of competitive bidding) from reductions in the capped rental period or reimbursement rate 2) Make significant progress in working with the Administration and Congress to clarify or change the CPAP policy on refill and adherence. 3) Document the clinical component of the Medicare Part B respiratory benefit. Medical Supplies—1) Address access to wound care supplies and negative pressure wound therapy in competitive bid areas. 2) Work with the Congressional Diabetes Caucus to address patient access problems for diabetic testing supplies as part of the larger competitive bidding strategy. Mobility—1) Add cosponsors on the House and Senate separate benefit bills. 2) Work with the Administration to address issues in the ESRD final rule relating to repairs and replacement of component parts. 3)Work with Congress and the Administration to address issues with the prior authorization process. Regulatory—1) Participate in jurisdictional council meetings to help foster better coordination and address problems facing the home care sector. 2) Work with CMS to create educational material on confusing coverage criteria to educate providers, suppliers and prescribers. 3) Implement an audit survey tool to collect data on the impact of audits and effectively use that data in advocacy efforts. 4) Work with other organizations on the introduction and promotion of audit oversight legislation. If you are an AAHomecare member without council experience, consider joining. The HME/RT, Medical Supplies and Mobility Councils are currently accepting nominations. If you’re not yet a member of the Association, it’s time to stop reacting and start finding ways to manage your company from a position of strength.