HAMMOND and GRIFFITH, IN – George S. Kucka (pictured) tried working for other companies, even facilitating acquisitions for Walgreens in Arizona, Florida, New Mexico, Illinois, and Indiana. A penchant for “not working and playing well with others” eventually led to the purchase of Fairmeadows Home Health Center in 2002, where Kucka has served as president for the last 18 years.
During that time, and as far back as 1992, Kucka has been a familiar face at Medtrade and in the advocacy circles of AAHomecare where he has taken on many roles, and still has a seat on the Board of Directors. Fairmeadows has two Indiana locations in Hammond and Griffith, and the vertically integrated company sells oxygen and respiratory equipment, while also renting respiratory equipment to nursing homes, doctors’ offices, dentists, and individual patients.
It’s a lot of work, but advocacy still remains firmly on the radar for Kucka. Medtrade Monday sat down with the HME veteran to get his thoughts on the current business environment, prospects for foiling competitive bidding, and the value of staying involved with advocacy.
Medtrade Monday: How has business been over the last few months?
Kucka: We’re kind of a unique HME company in that we’re vertically integrated. We actually sell oxygen and respiratory equipment, and rent respiratory equipment, to nursing homes, doctors’ offices, dentists, and to individual patients. We have essentially two divisions. We’ve got a commercial business which is business to business, and then we’ve got the HME traditional patient business. In March, April, and May there were no elective surgeries being done. The nature of our business is we rely on that to have patients going home who need support. So that business has really quieted down.
Medtrade Monday: How quiet has that gotten?
Kucka: We have consignment closets for nebulizers and ambulatory aids, and normally we would place anywhere from 80 to 100 nebulizers a month, and those are down to 10 because people are not going to doctors. We probably put about 150 ambulatory aids out a month, and now that’s down to maybe 20 or 30. It’s eased up a little bit now that they’re back to doing surgeries, but the way the press has everyone so scared, people are afraid to go to the hospital. The hospitals are still slow here. The doctors are slow. People aren’t going to the doctors. And then in our nursing home business, a lot of our oxygen for them was for portability. They go to the doctor, they go to the community room, to lunch, or visit family. Well now everybody is locked down, so they’re not going anywhere. They’re pretty much tied to their stationary oxygen unit. There’s very little portable oxygen being moved through the nursing homes. We are still doing repairs, renting concentrators and liquid vessels, but it’s not like it was prior to the virus.
Medtrade Monday: What about sleep medicine?
Kucka: We do a lot of sleep business, or we had. We were doing maybe 50 to 55 PAPs a month, but now that’s down to about 25 because people are not going to sleep studies. They’re just afraid. They are also reluctant to come into the office for setups. We’ve got a very strict protocol for people coming in. We’ve got four questions that we ask them on the phone, and if they answer yes to any of those questions, they can’t come in. Our staff has got all the PPE that they need to handle that. But like I said it’s been quieter because people are just afraid.
Medtrade Monday: Why did you get involved with advocacy?
Kucka: I’ve always been a big supporter of joining the associations, because especially as a smaller company, it’s not that easy to keep in touch with what’s going on and keep your finger on the pulse of the industry. Through association work and through meeting people from all over the country and working with them on a regular basis, it’s helped keep me on top of my game and on top of what’s going on. The only reason we as a company are probably alive now is because I was actively fighting competitive bidding for a number of years. I realized it was not going to go away, so we started buying smaller companies.
Medtrade Monday: What happened when competitive bidding finally hit your door in Indiana?
Kucka: When it did come around, and we didn’t get a bid, as I knew we wouldn’t, we had a critical mass to build on going forward, so that’s where we are now. We lost pretty much fifty percent of our business once competitive bidding came around. Now we’re at a size where we can survive, but it’s tough. Especially in light of the Wuhan virus, it’s become more of a challenge than normal.
Medtrade Monday: What is on your mind now as far as advocacy priorities?
Kucka: I would like to see competitive bidding go away. I’m a little dubious about the initiatives to postpone competitive bidding. I believe that the rates that came in on this bidding are what they [CMS] want. I don’t think they want to postpone it, and I don’t understand that because I can’t believe that these bids are going to be lower than the other ones. But who knows how CMS thinks? But that’s legislation I would like to see pushed forward eventually to reverse competitive bidding.
I think the fact that they [CMS] opened it [competitive bidding] up to any willing provider is indicative of the fact that they know it’s not working. People are having access problems. I’m not sure if they are really satisfied with the type of response they’re getting from providers now. They’re comfortable sticking with it, but that needs to be reversed. In Indiana we’re trying to fight.
Medtrade Monday: What are the Indiana-specific battles you are fighting?
Kucka: They [the govt] want to move Indiana Medicaid reimbursement rates to Medicare rates February 1st of next year, and we’re trying to fight that. We pretty much had them convinced that that would be an access problem prior to the virus in our conversations, but then we got shut down for about four months. And all of a sudden in July they announced unilaterally that they’re going to go to those rates February 1st. Right now we’re in a public hearing time where people can call in and give their comments.
We’re trying to reach higher up to see if we can’t get somebody’s attention to explain the access problems that are going to result from this move. The Medicaid population of course is completely different than the Medicare population. They have different demands, different mobilities. It’s tough to translate their rates into Medicare rates. That’s the current advocacy that we are involved in right now. I think it’s going to involve some legislation because it doesn’t look like we’re going to get this done through rules.
Medtrade Monday: Why are you still holding out hope for a competitive bidding reversal?
Kucka: There’s a rainbow to this Wuhan virus situation. It seems to have made people more aware of what we do. We are keeping people out of the hospital, we are helping to support them in that regard. It’s taking pressure off of the hospitals. I’m hoping that that is going to help our argument to show that there’s more value to what we’re doing than what we’re being recognized for. That was one of the reasons why we developed the definition for HME services. It’s a multidimensional situation. It’s not just a piece of equipment or a wheelchair or a concentrator; there’s a lot of support that goes with it. We’re not unique, but we’re a very small company and yet I have 36 licenses, accreditations, and certifications that I have to maintain on a regular basis. Every one of those is attached to a dollar amount…I’m hoping that this situation is going to help amplify the fact that we have value.