In the year that was and the year ahead, all things point to Congress

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Friday, December 21, 2018

The tide is finally starting to turn for the HME sector. In 2018, CMS added more than $1.5 billion to the Medicare benefit and to suppliers’ bottom lines, mainly in rural America, thanks to the HME-related IFR released in May, along with the ESRD/DMEPOS Final Rule unveiled in November. These actions represent the most significant reimbursement relief for HME since the bidding program’s inception.

While this relief for HME was granted through regulatory action, it may never have seen the light of day without a strong push from Capitol Hill. Our supporters in Congress weighed in with CMS and Health and Human Services repeatedly over the last two years, with multiple strongly supported sign-on letters in the House of Representatives and Senate asking for higher reimbursements for all non-bid area suppliers, as well as asking CMS to address problems in the bidding program methodology. In addition to these efforts, many legislators reached out directly to CMS in support of our policy priorities.

How much of an impression did Capitol Hill make on federal regulators? Office of Management and Budget Director Mick Mulvaney, being questioned about the status of the IFR at a House Appropriations Committee hearing in April 2018, noted that he’d “probably received more calls about this than any other rule.” Twenty-one days later, the IFR was finally released.

Renewing the fight in the 116th Congress

While that relief for rural suppliers for the next two years will help stabilize access to HME in those areas, the failure to address reimbursement rates for other suppliers in the gap period before the next round of the bidding program takes place is unacceptable. I know many advocates in our industry are again ready to engage Capitol Hill on challenging business environment we face under razor-thin or even negative margins on most products in the bidding program.

While I believe we’ve made a compelling case detailing the impacts on both providers and patients in our advocacy efforts, some parties on Capitol Hill and CMS discount our claims as anecdotal. To overcome those attitudes, we are looking to work more closely with hospital groups and other clinicians who have raised concerns about the bidding program and its impacts on the patient discharge process. Support from these high-credibility healthcare stakeholders will carry significant weight with legislators and regulators.

We also plan to work with these influential groups and our champions Capitol Hill to advocate for real-time monitoring practices by CMS that capture the true impacts of reimbursement cuts. I believe that a transparent monitoring program that utilizes both quantitative healthcare data, as well as qualitative inputs such as feedback from case managers and patients, is essential to getting more substantial relief for HME.

Pushing back on new bidding categories

One new issue we may be addressing in the next congressional session is the potential addition of ventilators and back- and knee-brace products to future rounds of the bidding program. CMS is reviewing comments from the HME community and patient groups on that issue, and if the agency continues down that path, we will work with Congress to see that new products aren’t added to the bidding program at a juncture when CMS is still working on implementing the next round. Ventilators are an especially bad fit for the bidding program, given both the specialized service requirements for products, as well as the potential consequences for the vulnerable patient population that depends on these life support systems.

Expanding our advocacy network

We still have a strong starting base to advocate for more extensive relief with 123 House members who co-sponsored H.R. 4229 returning to Congress in 2019. Interestingly, the rate of turnover for H.R. 4229 co-sponsors in the 115th Congress was identical to that for the House as a whole, at 22%.

With 100 new members in the House and 10 in the Senate, and the need to continue to ramp up our outreach efforts in areas where it hasn’t been traditionally strong, we have an opportunity to build even more awareness and enthusiasm for our policy priorities in 2019 and beyond. This past year, AAHomecare initiated a Congressional Accountability Program that recruits individuals in the HME who commit to regularly contacting their legislators on our priority issues. We currently have contacts designated for 70% of the House and 91% of the Senate and plan to continue growing the program to get as close to 100% as possible in 2019.

There is one new member of Congress who is already well well-versed in the value of HME and the challenges facing our industry: Congressman Dan Meuser, a former executive with Pride Mobility who claimed Pennsylvania’s 9th District by a 20% margin. Given Dan’s background in helping to build Pride Mobility into a major HME manufacturer and employer, as well as a highly successful record as Pennsylvania’s Secretary of Revenue, I am certain he’ll be a very effective leader on Capitol Hill for years to come.

Get in the game

While we’ve made great strides in changing perceptions of HME and building support for our policy priorities in Congress over the last few years, I believe we’re just scratching the surface of what we can accomplish on the advocacy front. If we are going to succeed in building on our recent policy wins in the 116th Congress, we need to continue to grow the ranks of passionate and persistent HME advocates to directly engage their senators and representatives.

If you are interested in adding your voice to these efforts, please consider joining us at AAHomecare’s next Washington Legislative Conference, May 22-23, 2019. You’ll join hundreds of your HME peers to learn about our issues and join in meetings that we will schedule for you with Senate and House offices. AAHomecare is working to deliver better reimbursement rates and sensible regulatory policies for our industry at both federal and state levels. We hope that you will join us as we continue to battle—and win—for HME.

Tom Ryan is president or the American Association for Homecare. Follow him on twitter @TomRyanHME.