"We need to position ourselves as healthcare professionals, not retail merchants, which anybody can be."

Wednesday, July 31, 2002

Tom Antone had planned to retire May 17.

But as you might expect from a lawyer who spent many years working 12- and 14-hour days representing home medical equipment providers and other healthcare companies, getting out on time is easier said than done. Antone officially pulled down his shingle June 30, closing, for the most part, a legal career that included serving as assistant secretary for health legislation at the U. S. Department of Health and Human Services (DHHS) and a stint as president of NAMES (1985-1989), where he helped draft the Six-Point Plan that revamped reimbursement for DME into the fee-schedule format still used. As an exit interview, HME News talked last month at length with Antone, 54. Here's what the ever-opinionated barrister had to say about where the industry has been and where it may be going:

Competitive bidding

Antone believes competitive bidding is "terrible public health policy," but if it's inevitable, he would favor bidding to set the winning prices which any supplier could then agree to accept, rather than a model that picks a few winning suppliers only. In a winner-take-all scenario, a handful of companies gain too much power. If one believes in the free market concept of competitive bidding, you've got to believe in the free-market concept that competition is good for service. Unfortunately, it costs more to administer Medicare and Medicaid the more providers you have, and it's clear that federal and state policy makers are looking to maximize savings despite potential bad collateral consequences. "As a result I fear that down the road the the country will have only a handful of companies with the ability to serve that many patients because others will go out of business or vow never to serve Medicare and Medicaid again."

Inherent Reasonableness

"I understand the final regulation for IR is undergoing review in the DHHS. From there, it goes to OMB, so we could have a final rule on IR in two to four months. Even if competitive bidding were stalled, or if it passes and CMS has some lead time to set up and implement it, they could start invoking IR to reduce reimbursement. Think about that. By the time competitive bidding is implemented, the base off which everyone is competing may already have been reduced by IR."

CMS Administrator Tom Scully

"I don't think Tom is friend or foe. He is an objective policy official charged with thoughtfully shepherding Medicare and Medicaid during financial crisis. He can't cut the budget without cutting the budget. He can't leave things the way they are. He may not love competitive bidding as a concept, but what else is there. The industry has not come forward with any counter proposals for meaningful savings."

Fraud and Abuse

"We need to position ourselves as healthcare professionals, not retail merchants, which anybody can be. This requires standards, criteria and other barriers to entry - like every healthcare industry has except DME. But much of the industry opposes mandatory licensure or other credentialing with teeth. We even seem to regard voluntary accreditation as optional, even though it is an established hallmark of every other health profession. We have not nurtured our reputation. As a result, federal and state officials perceive us as paying lip service to the idea that we are health professionals."


"I love the concept. It created a unique voice that heretofore had not existed on Capitol Hill. It speaks for the entire homecare industry, not just DME, home health or home infusion individually. If we let the debate be modality by modality, we are continually pitted against ourselves in the annual fights over limited healthcare funding. The real public policy debate ought to be whether the country funds more homecare but less institutional care. Can we take care of three patients at home for the cost of one patient in a nursing home? A unified homecare voice is better positioned to promote this debate." 


"Government rules were intended to be applied reasonably but are now being applied rigidly to deny claims there are no reasonable grounds for not paying. It's idiocy to claim that you are not entitled for reimbursement for a year's worth of oxygen claims because the patient signed but failed to personally date the initial delivery ticket. That's placing form over substance. It's budget policy, not sound healthcare policy." HME