Page 6 - HME Business, June 2017

Editor’s Note
The Next Cut
What happens when the next reimbursement cut comes? And the next?
Volume 24 Number 6 June 2017
Editor Products Editor
Publication Design Production Coordinator
Director of Online Product Development
Group Publisher
David Kopf
(949) 265-1561
Sydny Shepard
Wendy Byle, Byle Design Charles Johnson
Marlin Mowatt Karen Cavallo
(760) 610-0800
I’ll admit it: when I first heard the news that the Senate gave the thumbs up to Rep. Tom Price’s (R-Ga.) appointment as Secretary of Health and Human Services, I did a little happy dance
in front of my laptop. Moreover, Seema Verma’s appointment as Administrator of CMS further drove home the fact that the industry finally had some allies in the agencies responsible for over- seeing a Medicare program that still represents a sizable share of many providers’ income.
I even went so far as to write a column to the effect that the pair would hopefully help usher in an era in which CMS realizes that HME providers can be a valued solution that helps cut program costs while improving outcomes.
Now I’m not so sure. My confidence in that notion is a little shaken. Why do I say that? Last month, per the CURES Act, CMS updated the blended, 50/50 reimbursement rates for July 1 to Dec. 31, 2016 claims in rural and non-bid areas
— but CMS startlingly based its recalculation on the July 1, 2016 rates, rather than the Jan. 1, 2016 rates. (See “CMS Proceeds with Controversial Rural Rate Plan” on page 8 of “News, Trends & Analysis” to read more.)
That decision was in direct contradiction to at least the intent the CURES Act, whose authors had planned for the recalculated reimbursement to be based on the Jan. 1, 2016 rates. The differ- ence between the rates based on Jan. 1, 2016 and July 1, 2016 is significant and will quickly add up for providers, especially rural providers. If you’re in any doubt of how large the difference is, check out the chart on page 8, as well as the American Association for Homecare’s analysis of the rate plan, which is available in region-by-region Excel files (a link to which is provided in the article).
It’s no wonder that AAHomecare President and CEO Tom Ryan called CMS’s decision what it really is: a “slap in the face” to the providers, advocacy groups and lawmakers that had worked to so hard to pass the CURES Act.
Once again, we see CMS clearly has made an end run around legislative language, in much the same way it did with complex rehab accessories. As you might recall, CMS included CRT accessories as part of its expansion of competitive bidding. However, when Congress passed the Medicare Improvements
for Patients and Providers Act in 2008, one of the law’s provisions carved CRT out of the competitive bidding program. CMS’s excuse was that the law only specified the chairs, not their accessories — despite the fact that those “accessories” are thera- peutically necessary parts of the chairs. Notice a pattern? CMS is like a loophole-seeking missile.
So where are Price and Verma in all this? It’s only fair to recognize the fact that CMS is incon- ceivably huge bureaucratic machine, and regula- tory decisions don’t happen overnight. At the
same time, President Obama signed the CURES Act into law in December; Price and Verma were tapped as nominees in late November; CMS began announcing details on its CURES Act implementa- tion plan in January; and Price and Verma assumed their roles in March. It’s been a while since the pair assumed their respective roles. If CMS was able
to remove all the Round 2019 information from
its site just days after announcing its Round 2019 plan, wasn’t there sufficient time halt this rate plan and revise it so that it was based on the correct set of rates? I can’t say. I don’t work at CMS.
What I can conclude from all this is that Price and Verma are not fairy godmothers. While they might be in a position to the help the industry, whatever help they can offer won’t be all-encom- passing, and it certainly won’t happen on a fast turnaround. And in the case of CMS’s rural rate plan, it might not even happen at all. Those rural providers might be stuck with a slap in the face.
This tells me that the industry must continue to act independently and push for legislative fixes for it problems. The more it works in the House and Senate, the more it will secure industry friendly laws. It also tells me that providers must continue pushing toward revenue diversification, because Medicare is looking less and less like a solid foundation for a business. Providers must continue pursuing retail, private payer and facilities-based care so that they can establish the kinds of busi- ness strategies that will protect them from the next cut and the next.
David Kopf Editor
HME Business
Steve Ackerman
President Spectrum Medical
Jeffrey S. Baird, Esq.
Chairman of the Health Care Group of Brown & Fortunato, P.C.
Rob Baumhover
Director of Retail Services for VGM Retail Services
Georgie Blackburn
Vice President, Government Relations and Legislative Affairs BLACKBURN’S
Todd Blockinger
Senior Director of Sales The MED Group
Rob Boyeye
Executive Vice President of HME Brightree LLC
Sandra Canally
President
The Compliance Team Inc.
George Coppola
Director of Marketing CAIRE Medical
John C Eberhart
President Eberhart Home Health Inc.
Brian LaDuke
Vice President, Marketing for North America Invacare Corp.
John Letizia
President of Laurel Medical Supplies Inc.
Joe Lewarski
Vice President of Global Respiratory and Sleep Drive Devilbiss
Ron Resnick
President Blue Chip Medical Products Inc.
Tom Ryan
President and CEO AAHomecare
Wayne Slavitt
Founder and CEO Mobül: The Mobility Store
Wayne van Halem
President and Founder The van Halem Group LLC
EDITORIAL ADVISORY BOARD
INFRASTRUCTURE SOLUTIONS GROUP
President & Group Publisher Group Publisher Group Circulation Director Group Marketing Director Group Social Media Editor
Chief Executive Officer Chief Operating Officer Chief Technology Officer
Executive Vice President Executive Chairman
REACHING THE STAFF
Kevin O’Grady Karen Cavallo Irene Fincher Susan May Matt Holden
Rajeev Kapur Henry Allain Erik A. Lindgren
Michael J. Valenti Jeffrey S. Klein
Editors can be reached via e-mail, fax, telephone, or mail. A list of editors and contact information is at www.hme-business.com.
Email: email is routed to individuals’ desktops. Please use the following form: firstnameinitial,lastname@1105media.com. Do not include a middle name or middle initials.
Telephone: The switchboard is open weekdays 8:30 a.m. to 5:30 p.m. After 5:30 p.m. you will be directed to individual extensions.
Dallas Office: 14901 Quorum Drive, Suite 425, Dallas, TX 75254 (972) 687-6700; Fax: (972) 687-6799; www.1105media.com
Corporate Phone: (818) 814-5200; Fax: (818) 734-1522
6 HMEBusiness | June 2017 | hme-business.com
Management Solutions | Technology | Products