Editorials and Articles of Interest to the DME Community.
Grassroots Advocacy is activism that originates among concerned constituents who rally behind issues they feel are not being resolved or addressed by government officials with the power and responsibility to act. Grassroots advocacy involves some level of political activity, with members of society interacting with elected or appointed officials in an attempt to draw attention to their cause. It also involves organizing and educating the community to get more constituents involved in the process. Grassroots advocacy involves writing or calling officials, and attending meetings and events with elected officials.
Grassroots advocacy also means concerned constituents joining together to increase their strength in their effort to push for change. From the formation of the National Association of Independent Medical Equipment Suppliers (NAIMES) in April 2007, we have focused on one main theme, “grassroots advocacy”. We have always believed that all politics are local and that changing political minds must begin at home in local districts. We have talked about how “relationships at home equals grassroots power”. We realized that without suppliers working as their own lobbyists and developing a personal relationship with their Representatives and Senators, we would have no chance to change the path of public policy for the DME industry.
In a way, grassroots advocacy is a “game” we must play and now we have to take this “sport” to another level. Grassroots advocacy is a “contact sport” because without contact with elected and appointed officials, we are ineffective as individuals and as an association.
Since most of us are sports fans of some kind, let’s put grassroots advocacy in to sports terms.
THE BASICS OF THIS GAME:
- The equipment we need to play this sport is a pen, a computer, and a telephone.
- The playing field is your local district and state.
- There is usually one of two away matches in Washington, DC annually.
- Occasionally there will be a round played in the courts.
- The game starts when you and the constituent community feel that laws and policy decisions that are being made are inconsistent with the greater good of the community.
- Play involves writing, calling, emailing, and meeting with your elected officials to change their position on a particular issue.
- There may be multiple rounds in each game, sometimes involving multiple issues.
- The game may last from months to years, or sometimes until there is a change in the players on the opposing team.
- You and your team are allowed to make power plays by bringing in outside consultants, lobbyists, and patients to increase your influence.
- In order to win the game, you have to cause your elected official to change their position, AND act on that change.
- A stalemate occurs when you receive a positive response from your elected official, but they fail to take action to change the laws or policies.
- Stalemates occur often, and to move forward more advocates must be brought into the game by you and your support groups.
- When your opponent’s team members fail to respond to your requests, they can be removed from the game through the election process.
- The game is over when either the laws of policies are changed, or the DME team is too weak to continue.
RULES OF THE GAME
- Never miss an opportunity to meet lawmakers when they are at home in their district.
- Never assume that you can’t influence your lawmakers thinking.
- Join your state DME association to increase your playing power.
- Join one or both of your national trade organizations to receive technical guidance about the game and the rules.
- Write, Email or Call your elected officials whenever the team leaders “ring the bell”.
- Ask each of your fellow DME colleagues to join the DME groups to make the teams stronger.
- Attend state and national trade group events to insure you are well versed on the issues.
- Do not quit the game because you lose one round. The game is only over when all of the rounds are finished.
- Knowledge and information is the critical element necessary to make your play more effective.
Though tongue-n-cheek, the point is that the DME industry is losing the fight to change the direction of politics and public policy because we don’t have enough suppliers involved in grassroots advocacy. We are too small to impact our lawmakers without having more suppliers involved, and more financial resources. In an article a few years ago NAIMES suggested that suppliers should “get into politics or get out of DME”. Now many suppliers will be getting out of DME involuntarily due to competitive bidding and onerous Medicare audits.
Could we have changed this path had we had more suppliers involved? Maybe, but we do know that we will not change the minds of our political leaders going forward unless we have 10 to 20 times as many suppliers involved in the grassroots process. No trade organization representing DME suppliers can change the path of our future without members. In fact, without members, we have no reason to exist. With just a few hundred suppliers out of a pool of over 15,000 belonging to either national trade group, the time is rapidly running out for suppliers to join in the “contact sport” of grassroots advocacy.
Written by Wayne Stanfield
Tuesday, 03 August 2010 20:22
In recent years, policymakers in Washington, D.C., have been trying to cut health-care costs, especially in Medicare, the federal health-care program for senior citizens and people with disabilities. The spending cuts and reforms have left many of the nation’s 46.5 million Medicare beneficiaries wondering: "What does this mean for me?"
For many of these Medicare beneficiaries and their families, what it will likely mean is that it will be harder to obtain access to the home medical equipment and services they need to stay healthy and independent in their own homes -- and out of a nursing home or hospital.
Even though spending on home medical equipment is less than 2 percent of the total Medicare budget, and even though reimbursement rates have been cut deeply and disproportionately over the years, Washington bureaucrats are attempting to squeeze even more out of this small, cost-effective sector.
One of the most troubling and misleading schemes scheduled to take effect soon is the Medicare "competitive" bidding program for home medical equipment and services, which includes oxygen therapy, wheelchairs, hospital beds and other durable medical equipment used in homes.
This flawed bidding program will eliminate most of the home medical equipment providers in the bid areas and even the whole country, even if they bid low to provide home medical equipment and services. That became clear when the program was first implemented in 2008 in 10 areas around the country. Congress halted the program due to numerous problems and flaws, such as Medicare contracts awarded to unlicensed home medical providers and companies with no experience in providing certain types of home medical equipment. However, in re-implementing the bidding system, the Medicare program did not make the changes needed to protect home care patients and providers.
As it stands, the Medicare bidding program encourages suppliers to make "suicide bids" in order to continue to serve their patients. Because Medicare is the primary payer for senior citizens and people with disabilities who use home medical equipment, Medicare can use economic coercion to force home care providers to submit to unsustainably low bids needed to "win" one of the few contracts offered. In the end, this Medicare bidding scheme will actually discourage competition in the home medical equipment and services sector, reduce access to care for patients, cause over 100,000 job losses and put thousands of providers out of business. The bidding process is complete in nine metropolitan statistical areas in the U.S. and will begin on January 1, 2011. The bidding for Round 2 of the ill-conceived program will be started in 2011 in 91 more areas that represent the majority of the Medicare population.
The sad irony is that this misguided program will actually increase costs over the long run. With fewer available providers of home care equipment and services, many patients will be forced into far more expensive post-acute care alternatives, such as hospitals or nursing homes, which will simply shift costs to other parts of the health-care system.
When it comes to caring for patients in the home, there is no need for a tradeoff between quality and affordable care. Home care is both cost-effective and the preferred method of care by senior citizens and patients because it provides them with independence and allows the opportunity to be close to family and friends. The more patients rely on quality health-care equipment and services at home, the less the U.S. will have to spend on longer hospital stays, emergency room visits and nursing home admissions.
Providers of home medical equipment and services across America are proposing a more fiscally responsible alternative to the "competitive" bidding scheme. The National Association of Independent Medical Equipment Suppliers (NAIMES) and thousands of local providers of home care equipment and services proudly support H.R. 3790, a bipartisan bill in Congress that would preserve access to home care and provide a cost-effective alternative to the misguided Medicare "competitive" bidding program for durable medical equipment. So far, the bill has 254 cosponsors in the U.S. House of Representatives, with broad bipartisan support. Cosponsors include key House leaders who agree that there are concerns with this flawed program.
H.R. 3790 would replace the troubled bidding program while ensuring that the projected cost savings of the program are met through a series of payment reductions for home medical equipment providers across the country. This important bipartisan bill will preserve high-quality home care services and equipment for Medicare patients and prevent job losses and the needless closing of businesses across the country during an already difficult economy.
The Medicare population should be gravely concerned about the bidding scheme, which will delay access to necessary medical equipment, reduce the quality of the medical equipment provided and place additional economic strain on the nation's small business community.
Citizens can join the effort to replace competitive bidding with a more sensible program by letting their elected federal officials know of their concerns. Eliminating more than 90% of the suppliers at a time when demand for home medical equipment is increasing seems to make little rational sense.
Wayne Stanfield is President and CEO of NAIMES, a national trade association and grassroots advocacy organization serving the DME industry.
Industry Commentary: 'Not One Penny More!'
By Wayne Stanfield, president and CEO, National Association of Independent Medical Equipment Suppliers, Halifax, Va.
The DME industry paid dearly, 9.5 percent or about $7.8 billion over 10 years to delay the “suicide” bidding program in 2009. That’s 25 percent more than the projected $5.8 billion savings from the program as scored by the CBO in 2002.
Earlier this year the CBO scored H.R. 3790, the bill to repeal the program, at a cost of $9.6 billion over 10 years. This score was based on the 2008 bids that set fees at 26 percent under Medicare.
Friday [July 30], the CBO rescored H.R. 3790 at $20 billion in savings, which means DME will have to offset this amount to end bidding before it goes into effect January 1, 2011.
While Congress does not have to use this exact figure, it WILL have to offset the cost of making the bill budget-neutral. Rarely is a lower number used.
When the May score came out, NAIMES used data provided by the CBO to calculate the $9.6 billion cost. The result was to give up 1.6 percent of the CPI increase each year for 10 years as an acceptable offset. The NAIMES Board at that time said “minus 1.6 percent CPI-U—and not a penny more.”
After the $20 billion score on Friday, the Board restated their position. The industry simply cannot afford to pay to offset this amount. To continue to offer more money to pay for ending this program sends the message that we are overpaid. Every time we reach into our pockets, Congress reaches into our pockets.
The low-hanging fruit spoken of so often as the reason we keep getting tapped is gone; the tree is bare. We have paid until suppliers are closing in significant numbers. We have taken cuts in this industry for 20 years, including serious cuts in the past two years.
No one likes to draw lines in the sand, but this time it has to be done. According to most experts and DME leaders, Round 1 will collapse under the weight of problems. If that is the case, then the program will end itself without us paying.
Quoting Rich Mckeown, president and CEO of Leavitt Partners, and chief of staff for former HHS Secretary Michael Leavitt, “The train has left the station. I have no doubt that competitive bidding is here to stay. There will be some who will adapt and thrive in this new structure and some will just go away. Every time there is change there is opportunity.”
If we are to believe this prediction, offering to pay anything to stop competitive bidding will be fruitless. His crystal ball should be better than ours.
NAIMES will never quit fighting to end bidding, but we will fight in other ways without agreeing to pay more than we can afford.
