ATLANTA — "I have never seen any situation that we have experienced that even remotely resembles how dire the situation is right now." Those are the words of Dave McCausland, senior vice president of planning and government affairs for The Roho Group, Belleville, Ill.
McCausland, who has been in the home medical industry for more than 30 years, said Friday the future has never looked as bleak to him as it does now.
"It is not just one thing. One issue is compounded against one thing and then another," McCausland said, noting particularly competitive bidding, invasive numbers of Medicare audits that have staunched the cash flow of thousands of providers and a host of other government-issue mandates that are all but strangling HME businesses.
And that is exactly why McCausland wrote a letter urging both beneficiaries and colleagues to support the American Association for Homecare's "Save Homecare Now" campaign. The project offers an easy way for everyone involved in HME to contact legislators and raise their voices in support of home care.
"We are looking for 'super advocates' to get the message out and encourage colleagues and others that they know to save home care now," said AAHomecare's Tilly Gambill, manager, marketing and communications, of the effort. The hope is that those advocates will encourage 20 others to voice their support of the industry.
"This is really a grassroots effort in getting people involved in saving home care and making a point to contact their members of Congress," Gambill continued. "This campaign is really geared toward everyone — all HME stakeholders, providers, manufacturers, beneficiaries, caregivers, therapists, clinicians, anyone who is interested in the future of home care."
Stakeholders can connect with legislators through the campaign's "Take Action" center at capwiz.com@aahomecare/mlm/signup.
Randy Wolfe of Lambert's Health Care in Knoxville, Tenn., one of the early champions of the idea, said the super advocates "are going to be sort of the teachers and communicators and recruiters. We're trying to find people with communication skills and a passion who can take on the network building.
"I think that, really long term, we could have 100,000 people in our network that really understand what we are all about," he said. "That's when things turn. You can't go to Washington with 300 people [and expect things to change]."
McCausland was one of the first to respond.
"It's like, 'we're going to pay you less, we're going to pay you later and we're going to ask you to do more,'" McCausland said. "My frustration is that I just really believe that home care — and not just durable medical equipment, but home care in general — is being made a scapegoat here. We have the smallest voice to defend ourselves and the least amount of dollars to influence anything."
In his letter to colleagues, McCausland, a former history teacher, wrote: "Our current situation reminds me of a quote that has been credited to both Thomas Paine and Benjamin Franklin. 'If we do not hang together we will most assuredly hang separately.' We may have different interests/involvements/allegiances in home care; but, we are all stakeholders (providers, referral sources, clients ...) and we need to band together to overcome the common threats we are facing."
Gambill said Save Homecare Now is already seeing results from McCausland's letter, particularly from beneficiaries.
"We've now had more than 900 messages sent to 219 different members of Congress since the campaign began," Gambill said. The messages have centered on whatever issue most concerns the sender — competitive bidding, audits, elimination of the first-month-purchase option for power wheelchairs.
This, said McCausland, is an industry battle, and it is imperative that the industry unite. "Whether competitive bidding shows up in your rural area or not, your reimbursement is going down. If you are spending more to stay in business and your revenue is going to down, it doesn't take much to see that [you've] got a problem."
Wolfe agreed. "This is no place for turfs," he said. "It's not about your competition. It's about all those we serve. I think [Save Homecare Now] can be a big uniter, and we want a big umbrella with this."
The home care sector does not have huge numbers of lobbyists or big money behind it, he added. "But we have a great story, and we have millions of patients and families that are in this battle with us," he said. "We just have to recruit them."
Editor's Note: Dave McCausland's letter asking for support of the Save Homecare Now campaign follows in its entirety. We hope you'll join him at capwiz.com/aahomecare/mlm/signup/.
All,
I sincerely hope that I'm being "Chicken Little," believing that the sky is falling when it really isn't. However, I've been in the home care industry for almost 30 years now and I can't recall a time when I saw the situation as dire as it is right now.
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We've got Medicare implementing all kinds of programs that will reduce reimbursement and increase the cost of doing business in the home care industry with competitive bidding at the top of the list. Most recently Medicare proudly proclaimed that competitive bidding of DME will reduce Medicare expenditures by over $17 billion over 10 years (based on my math that equates to a cut of over 15%).
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We've got many state Medicaid programs in financial crisis desperate to find ways to delay payments and cut costs. Multi-month lag on payments and payments with promissory notes is not out of the question.
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We've got Medicare implementing a variety of prepayment and post-payment audits that are causing providers an extraordinary burden. Imagine getting a letter requesting documentation on hundreds of patients over an extended period [of] time, just to prove that you have all the documents the auditor "deems necessary" for you to have been reimbursed!
In addition, it is not at all unheard of that a provider will be placed on 100% prepay audit/review for new claims while they're being audited for their historic claims. If this happens the provider's cash flow comes to a screeching halt. Their expenses continue but the money to pay those expenses is held up for months! Sadly, some providers cannot survive.
I know that the home care industry has its share of problems and rotten apples. At the same time, it also includes some of the most dedicated folks I've ever had the pleasure to work with, and I sincerely believe that the programs being implemented punish the innocent far more than the guilty.
In addition, even with all the problems that may exist in home care, I still believe that it is an essential part of the solution to our health care challenges and a key component for the future of health care ... so long as it is allowed to survive and thrive.
Left unchecked, I don't see how we can avoid a situation where the quality of goods and services, and the access to those goods and services, will be dramatically reduced. Ultimately, the consumers of these goods and services will suffer most.
Yet, how do we get our message across when home care as an industry (whether it be goods or services, DME or HHA) has one of the smallest voices in the health care industry and other players are more than willing to throw dirt at home care?
Our current situation reminds me of a quote that has been credited to both Thomas Paine and Benjamin Franklin: "If we do not hang together we will most assuredly hang separately." We may have different interests/involvements/allegiances in home care; but, we are all stakeholders (providers, referral sources, clients ...) and we need to band together to overcome the common threats we are facing.
For that reason I just signed up for the Save Homecare Now Campaign, and I hope that you'll consider doing the same thing. It's being coordinated by AAH but the message is applicable to any home care stakeholders (AAH member or not).
Below is the link if you're interested in signing up to be an "advocate for home care."
capwiz.com/aahomecare/mlm/signup/
Thanks for taking the time to let me get on my soap box. I hope that you're all doing well and look forward to any opportunity to see each and every one of you.
Kind regards,
Dave
J. David McCausland