Are we near the 'tipping point' for HME?

Malcolm Gladwell compared his book, "The Tipping Point," to the biography of an idea--the idea that every successful trend, idea, program, product or accomplishment had an exact moment in time when it passed the point where it might well fail and moved on instead to become accepted, successful and seemingly inevitable. Up to that "tipping point" in time, it could have gone either way. Gladwell compares an evolving idea or plan as a sort of epidemic. It can simply peter out or, if it is strong enough and reaches enough people in a defined time frame, it can spread like a wildfire. The tipping point is the moment of critical mass, the threshold, the boiling point, a place where the unexpected becomes expected, where radical change is more than a possibility. It becomes a certainty. We in the HME industry believe that home-based medical care should be an accepted, promoted and well-funded reality in our modern society. It befuddles all who are involved in it that home medical care does not seem to have reached the "tipping point" and, in fact, seems to be sliding backward toward oblivion in a torrent of downward spiraling reimbursements from both government and private payer sources. Like Merrill Matthews in a recent Wall Street Journal article (Aug. 15, 2007), we believe that the policy and price mavens at CMS need to review "Cost Controls for Dummies" to understand that you can't take billions of dollars out of a competitive service-based system and expect it to be better--or even survive. Matthews points out that the only thing accomplished by simply reducing government funding for any particular aspect of medical care in our largely federally-funded system is to increase lack of access and move toward rationing. So what makes me think that we in HME may not be destined for the dust-bin of history? It certainly is not the responsiveness of the provider community to the onrushing new sets of CMS rules. There are still thousands of HMEs that have not even picked up a phone to start working on accreditation, which is going to happen even after the "competitive acquisition" stupidity ends. It is not the headlong rush to become more efficient and get a better hold on costs and seek out new profit opportunities. Most providers are still doing things the same old way they were a few years back. While there are lots of reasons to worry, I am, instead, very optimistic and believe we are close to the "tipping point" where home based medical care and HME begin to be widely recognized as the solution to the huge problem facing CMS, our Congress and our country. I feel that way for two reasons: * First, we are now, finally, coming together as an industry and working in a coordinated fashion to deliver our message to key members of Congress. We are letting them know that we value their support and, most importantly, giving them the ammunition (political donations) that they need to fight for us when the going gets tough. We are helping them understand that the developing entitlement based fiscal crisis in the United States--mostly healthcare related--threatens the balance and stability of our republic. The status quo and near-blind bureaucratic cost hacking is not going to fix it. Finding a workable solution is a Herculean task, requiring calm statesmanship, careful attention to detail and a knowledge of economics, human nature and healthcare issues and modalities. We believe that key leaders can help us posit a policy to start converting a larger and larger part of this prohibitively expensive procedure- and facility-based healthcare system into a relatively low-tech and much less expensive homecare-based system. This cost difference is provable and real, but the change can't happen in a limited access, closed, rationed and non-competitive big-business based homecare environment, which is where CMS is now pointing the industry. We need an open, small-business, local, highly competitive (based on services provided and quality of equipment) homecare equipment industry in order to move forward with this change in health care. * Secondly, I have an abiding and unshakable faith in the independent HME provider to adapt and persevere. Most are "on a mission" for their patients, employees and families, and they aren't going to give up. These caring entrepreneurs in HME along with a handful of other ancillary healthcare provider types are the answer to our healthcare cost crisis, and they will hold on for however long it takes for that to be recognized by others. The "tipping point" may not yet be in sight for home medical equipment providers, but I bet it is just over the horizon. Van Miller is CEO of The VGM Group in Waterloo, Iowa.