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HMEs, HHAs and DC WITH MICHAEL DECARLO Q: As an HME supplier, does the merger of AHCA into AAH mean my voice in Washington is diminished? A. Whether the HME voice in Washington is now diminished is a measure of the HME industry's belief in the importance of its issues to the national interests and the industry's expectation of successful representation. The original merger of associations that created AAH came at an important time when common political issues reinforced the cooperative use of resources and combined lobbying efforts. The concern, then and now, is how those resources will be allocated and whether there can be combined lobbying efforts on fundamentally diverse issues. Competition for time and attention in Washington is fierce. Legislative and regulatory agendas, position papers and press releases are not effective without obtaining access to legislators and regulators and engaging them with the importance of your issues. Once policy makers give you their time and attention, the message must be focused on the top priorities - and therein lies the rub. Because the HME industry itself is diverse, representing its issues is already difficult. Adding nursing services issues and a different regulatory and legislative agenda complicates the organization's development of an effective lobbying strategy. Should the HME member accept, in a given year, that the financial and political capital of the organization be spent on home nursing issues? Your voice is only diminished if you don't participate and allow your issues to be buried. The challenge for leadership is efficiency - to find, or to create, issues more important for the purpose of staying united than the parochial issues exert for pursuing separate courses. I'm still waiting for the advocacy of a new, unified health-at-home benefit proposal. Michael DeCarlo is a Washington, D.C., healthcare attorney. Reach him at 202-775-4736 or decarlom@dsmo.com.

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