Moving the HME Industry Forward

Legislative/Advocacy

Some Things Never Change

December 16, 2013

BIRMINGHAM, AL – When I first began visiting with politicians regularly in 1975, one of the first things I learned is that most of them were happy to pass legislation offering something the voters wanted, but were less willing to levy sufficient taxes to pay for it.

They also routinely ignored basic economics. Offering a desirable product or service for free, or at a greatly reduced price, tends to increase the demand for that product or service.

The second lesson was that those who spent the most money always achieved better results obtaining favorable decisions affecting their product or service.

The Affordable Care Act (ACA) is just the latest case in point. How can you fault providing health insurance for everyone? Who wouldn’t want the option of waiting until the house is actually on fire to buy fire insurance? That’s the same principle as forcing insurance companies to cover previously existing conditions at standard premiums.

With employment so hard to find for recent college graduates, isn’t it nice to be allowed to keep them on their parent’s policy until they are 26 years old? People continue to get pregnant; shouldn’t maternity benefits be required for every policy issued, even if there is no chance that some families or groups would ever use them?

The problem, of course, is that all these changes require both an increase in funding and a larger supply of health care providers to make them available. Little or nothing has been done to increase either, with the inevitable result that all of us who have always had more-or-less suitable insurance coverage must pay more to keep it and wait longer for necessary care. Predictable, but unintended consequences, continue to be ignored, and those consequences will get worse until effective changes are made to address the issues.

Funding for keeping insurance premiums reasonable in the face of mandatory increased benefits depends on enrolling millions of healthy young people. But they are the group mostly likely to notice that the Web site fiasco (which would have seen heads roll in the private sector) also is fraught with security issues, none of which have even been acknowledged, much less addressed. Even completing a form to examine options exposes all of your private financial and health data to several forms of abuse, including identity theft.

With the single exception of encouraging preventive care, which produces benefits very slowly over a long period of time, not a thing has been done to actually reduce the cost of providing health care or to improve accessibility. Mandated expenses continue to grow, unreimbursed paperwork requirements and absolutely ridiculous audits continue to grow and add costs, and nothing of any significance has been done to encourage training more health care practitioners to expand the use of lower cost providers when appropriate, or to improve the distribution of providers.

Very little has been done or planned to expand the emulation of proven cost-effective practices, to require the use of best practices, eliminate questionable or useless treatment, or encourage self-care and good health habits.

Regardless of the changes that will be made eventually, it seems to me that the HME industry could do a better job making the case that we can save money now, with little or no investment. Just take the industry’s long-offered advice on reducing fraud, reduce paperwork requirements to match what is done in the real world, and move most audits to pre-pay—with a guarantee that if you are paid pursuant to a pre-pay audit, you are guaranteed that you will not be subject to post-payment audits on the same claims.

The savings that would result might even be enough to allow surviving many rate reductions, and can certainly make a case for being the safest, most cost-effective, patient-preferred method for delivering care. We just need more participation from providers, patients, caregivers, and referral sources to help us make our case with votes, since we don’t have the money required to be competitive with other health care players. Is that too much to expect?

Michael W. Hamilton is executive director of the Alabama Durable Medical Equipment Association, Birmingham, Ala.