WATERLOO, IA – The phrase “Once more unto the Breach Dear Friends” is from a famous speech from Shakespeare’s play “King Henry V”. The phrase means “let us try one more time” or “try again”. We in the DMEPOS industry should well relate to this phrase. The word Breach, by definition means a broken, ruptured, or torn condition or area of a gap (as in a wall) made by battering. This industry should be commended for its efforts over the last 10 to 15 years.
With continued battering, we have begun to open a gap / breach in reimbursements. In recent years the industry has been successful with many things legislatively and regulatorily; from the 50/50 payment Blend for Rural Areas and the 75/25 Blend for Non-Rural Areas, to the two-year (2020-2022) relief from 2% Sequestration cuts, to name just a few.
Sadly, if we don’t continue to “Try again”, all that work over the years to widen the breach could come to a close. Now is the time for all providers to ask themselves; “Am I doing what I can to make a difference?” “Am I making a good faith effort?”
It has been our national association (AAHomecare) and other industry stakeholders (such as VGM) who have led the way into the breach, but it is the strength of the state associations and their grassroots efforts and relationships that have “widened the gap” that allows us to rush forward for additional relief and a brighter future for DMEPOS.
Over the course of the last 15 years, the DME industry has lost over 41% of PTAN rooftops. To be successful, we need strength in numbers. To achieve this, we need to muster and unite the remaining providers. We have learned over the years that where we are strong with state association membership, we are strong with congressional and state legislative relationships. Also, with a strong state associations comes a better working relationship with state (Medicaid) Agencies. None of that is possible if we don’t have boots on the ground at the grassroots / state level.
Over the course of the next 18 months (2023-2024) we will indeed need all our efforts at the Breach. We will need efforts at both the federal and state level. At the federal level we have our Senate Bill ~ S.1294 (Competitive Bidding Relief Act of 2023) that was introduced by Senator Thune (R-SD) and Senator Stabenow (D-MI). This bill provides an extension of the 75/25 blended rate for non-rural areas to Dec 31, 2024. The purpose is to sustain providers long enough to get CMS to decide a final course of action on the competitive bid program (CBP) that has constrained provider reimbursement since 2016.
Hopefully within weeks we will have a House of Representatives companion bill to S.1294. We need co-sponsors for both bills and to accomplish that we need providers and state associations to engage and build relationships with their federally elected officials. To this end, VGM has worked with AAHomecare to build and promote the GAP (Government Accountability Project) program. The idea of the GAP is to work with state associations and ensure the industry has at least one provider that has a regular engaging relationship with their elected official (Senate or House) in the district or state.
The hope is to have multiple providers for each member of Congress. We also intend to work on multiple other bills at the Federal level (Mobility, O&P…ect). At the State level we have had success in the last several years with elimination of State Tax (OK, WA) and Licensure (KY, TN, AL, OK). States need to continue to win on these issues at the same time they are facing challenges from Medicaid, MA reimbursement and Audit Issues.
The Covid Pandemic, if nothing else, taught the healthcare industry and Congress that the cheapest and most effective place to care for patients is in the home. The time is right for our industry to expand the breach and to finally climb out of the pit that is the competitive bidding program. To accomplish this, it’s imperative that we have the strength at the grassroots / state association level.
It is strength in numbers that member of Congress and bureaucrats understand. To join your state association is an easy process. In many cases, yearly membership is less than $1,000 a year. Small wins at the state level will show ROI tenfold. It is time to ask ourselves; “Am I doing what I can to make a difference?” Let’s work together to move forward with the collective rally cry—Once more unto the breach dear friends!
John E. Gallagher is vice president, Government Relations and Regulatory Affairs, VGM & Associates, Waterloo, Iowa.
