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Moving the HME Industry Forward

Legislative/Advocacy

Dr. Price Will Find a Way

by Michael Hamilton • February 13, 2017

BIRMINGHAM, AL - As one familiar with the history of the Medicare program (as an early provider and now a beneficiary and association manager), I am convinced beyond any doubt that the HME industry hit rock bottom in 2016 and has begun a move that will bring us as close as we will ever get to the marvelous first ten years of existence. We have never had an HHS Secretary who knows and appreciates our industry like Dr. Tom Price, and all I have heard about the prospective CMS Administrator has been good. The changes CMS has already made or proposed have been encouraging.

Many experts believe that competitive bidding is too entrenched to be replaced right away, and steps have been taken to define a clear path for improvements to make it acceptable. If that is what happens, the industry can recover and grow, but I believe it is still possible–even likely–that Dr. Price will find a way to implement the Market Pricing Plan (MPP).

CMS has adopted parts of that plan and proposed other changes taken directly from the legislation Dr. Price has introduced. The legislation that allowed the creation of the current “competitive acquisition” program should allow the adoption of the MPP via the creation of new regulations.

Here’s what I believe will happen:
• Secretary Price will freeze rates at January 2016 levels to mitigate further limitations on access and harm to providers.
• He will direct the CMS Administrator to cause the creation of new regulations that incorporate the principles of the MPP, which will require 60 to 90 days to complete.
• The proposed rule will be published for notice and comment, which requires another 60 days.
• Reviewing and responding to the comments will require approximately another 30 days.
• The new rule creating the MPP will be published with an effective date 60 days from the date of publication.
• During this process, the CBIC will have been busy vetting prospective bidders and preparing to accept bids under the revised system.
• The new process will be in place on October 1, 2017, in time to be used to create the fee schedule effective January 1, 2108.

Of course, this is an optimistic view, but also one that can be accomplished if providers continue doing the things that need to be done. On my first lobbying visits to Washington in 1975, when we introduced ourselves to Congressional staff, the reaction was usually “Oh, you’re one of those rip-off artists!” On recent visits, we have been greeted with respect as part of the solution to ever-increasing health care costs.

That turnaround in our image hasn’t been produced by getting rid of all the bad apples, because the government has remained unwilling to do what the industry has told them was necessary to accomplish that lofty goal. It has happened because of a lot of hard work, by a lot of volunteers, and the creation and support of organizations with the expertise needed for such accomplishments.

It has happened because providers have supported Medtrade, gaining information unavailable elsewhere to keep up with the products and services that allow operating successful, efficient businesses.

It has happened because providers have supported AAHomecare, an organization that has served so very well as the industry’s voice in Washington, and the member services organizations who have trained and supported providers in so many ways, including the process of grassroots lobbying.

It has happened because providers have supported the local trade associations who have dealt with local issues so effectively and provided the coordination to make grassroots lobbying timely and effective.

The potential for our industry has never been as great. If you want to be a viable part of a dynamic, growing and exciting industry that does well by doing good, go to Medtrade and learn how to be a better and more efficient businessperson with an appropriate product line for your chosen market. Join and support AAHomecare, your local association and one or more member service organizations. Get or stay involved with your Representative and both Senators. And always be willing to give your own time and money to improving the overall health of the industry.

HME is a great place to be today!

Michael Hamilton is executive director of the Alabama Durable Medical Equipment Association.

The above is an editorial and does not necessarily reflect the opinion of Medtrade and/or Emerald Expositions.