Moving the HME Industry Forward


All Health Care is Local

January 19, 2015

WATERLOO, IA – Just like the old political adage that “all politics is local,” we as an industry believe that all health care is, and should be, local. Unfortunately, CMS fails to see the truth in this simple concept.

I still remember, from a masters course I took many years ago, a quote from the always quotable newsman Walter Cronkite. Mr. Cronkite once famously said, “America’s health care system is neither healthy, caring, nor a system.”

He was half-kidding, but I believe he would be shocked to learn that one of the keys to fixing today’s health care problems is in jeopardy. That key lies in the simple concept of keeping mom at home where she wants to be, at a fraction of the cost of keeping mom somewhere else.

This simple concept is based on local collaboration between doctors, clinicians, hospitals, and DME providers to provide access to consistent high-quality and affordable care that delivers on its promise of healthy outcomes.

Because all health care is delivered locally, the health care system in the home should be designed and implemented locally. It is at the local, community level where we are most likely to innovate and implement new health care delivery solutions.  The competitive bidding (suicide bidding) system designed by CMS is, as Mr. Cronkite said, neither healthy, caring, nor a system.  It truly is designed to eliminate the local provider.  

So how do we as DME providers ensure that healthcare truly remains local? How do we as the DME industry ensure that mom has access to high-quality and affordable care where she wants it most? We do it by ensuring that CMS adheres to all 30 National Supplier House DMEPOS Supplier Standards. In particular, that CMS adheres to the very first standard of its own bidding system.

Standard number one of the Medicare DMEPOS Supplier Standards states that “a supplier must be in compliance with all applicable federal and state licensure and regulatory requirements.”

We as industry stakeholders need to work at the state level to ensure that each and every state has a licensure law to ensure that health care is local. If you agree, you may be asking yourself, “How do we do this?” I am happy to tell you that you need go no further than your own computer.  Go to  to access our State Licensure Tool Box.  Here you will find helpful information on how to begin the licensure process in your state.  

Step one is to reach out to your state association. If you’re not a member, now is the time to join. At your state association you might find that your state already has licensure (such as Tennessee, Alabama, Maryland, Colorado and others), or that your state association has already begun the effort and all you have to do is roll up your sleeves and join in.  

What should a good DMEPOS state licensure look like? Glad you asked. The VGM State Licensure Tool Box will provide all the information you need. But for the purpose of this opine, and to save you some research effort, a good licensure bill should include the following:
• Brick and Mortar Requirements  – A DME licensure bill would require providers to have a brick and mortar location in your state, staff and regular office hours;
• Accreditation – DME providers would have to be accredited with this DME licensure bill;
• Reciprocity – Reciprocity with surrounding states 50 to 100 miles
• DME involvement in policy – A DME licensure bill would allow DME to have a seat on state boards and commissions.

An effective provision found in our industries new “binding bid” bills (HR 284 and S 148) addresses state licensure to our benefit and that of the beneficiary in future bidding. See the specifics below.
‘‘(G) REQUIRING STATE LICENSURE AND BID BONDS FOR BIDDING ENTITIES.—With respect to rounds of competitions beginning under this subsection on or after the date of enactment of this subparagraph, the Secretary may not accept a bid from an entity for an area unless, as of the deadline for bid submission—
‘‘(i) the entity meets applicable state licensure requirements for such area for all items.”

Whenever stakeholders are fully engaged in a shared vision, results follow. We encourage all—providers, local health and education practitioners, policy makers, hospital and clinic administrators, public health workers and local community leaders and boards—to the table.  

With effort in every state and state association, there is no reason why we can’t succeed. Together we can make a difference. With a commitment to achieving DMEPOS Licensure in every state, we can help make sure the American health care system in the home ”remains local, and is truly healthy, caring and a system that works.

John Gallagher is vice president, Government Relations, VGM & Associates, Waterloo, Iowa.