Editorial: Not funny

The cartoon [appearing in the April HME News print issue] is no joke. Take a look at the article on page six in which Rep. Dave Hobson of Ohio “lectures” HME industry boosters for their failure to change the name of the game. Anybody who's lobbied against competitive bidding has likely felt uncomfortable with the nomenclature. Indeed, how can any red-blooded American argue against the notion of competition? It's anathema to our identity as a people. And yet for years, that's exactly what the industry's been doing, arguing high and low that competitive bidding is bad for Medicare beneficiaries. The industry is cognizant of the power of terminology. In the mid-1990s the industry stopped referring to its constituents as durable medical equipment dealers and started identifying them as home medical equipment providers. For some strange reason, as the Polk County and San Antonio competitive bidding demonstration projects geared up, no one thought to substitute competitive bidding for a term more conducive to the industry's argument. As Hobson points out, the better, more persuasive term is ‘selective contracting.' It may be too late to start playing that tune; competitive bidding is ingrained in the industry's vernacular. The damage is done. But the damage does beg the question in hindsight: Why wasn't more done to change the rules of engagement so the industry didn't have to wage a fight against a concept that, nominally, is as appealing as motherhood and apple pie. In this issue, we've also reported on a Missouri provider's attempt to persuade legislators that investment in home medical equipment and services yields big dividends since home care is much cheaper than hospital care. There is persistently a missing link in this argument. While it's obviously true that an oxygen concentrator that rents for $200 per month is far cheaper than paying for someone to stay in a nursing home, which costs $3,000 per month, there's invariably little in the way of data to prove that the provision of a concentrator prevents nursing home stays. What data would support this? From a layman's perspective — and remember, ultimately, the industry must persuade laymen (members of Congress) — consider a study like this: Take 100 COPD patients with similar blood gas levels. Put 50 on a long-term oxygen therapy. Let 50 function with supplemental oxygen. Track the costs incurred by both groups over a year. If the industry's hunch is true, and the oxygen patient incurs far fewer costs, well then there's something to crow about. Has this study been published yet? If it has, why isn't everyone talking about it? If it has not, why hasn't one been proposed?