Jeff Baird, JD, showed Medtrade attendees how to fight for hospital referrals without burning valuable bridges. “In a perfect world, the hospital refers discharged patients to the HME supplier who delivers the best care,” says Baird, chairman of the health law group at the Amarillo, Tex-based law firm of Brown & Fortunado. “Unfortunately, we do not live in a perfect world.”
Jeff Baird, JD, stresses the tactful approach to increasing hospital referrals.
Patients have the right to choose the HME provider they want and two patient choice statutes address the situation. The first is 42 USC 1395a(a) and the second is 42 USC 1395x(ee)(2). Baird points out that, unfortunately, HME suppliers cannot bring a lawsuit against the hospital under either of these patient choice statutes. The patient can, but that is unlikely. Instead, Baird suggests four actions that HME providers can take that range from polite to aggressive. The polite approach is for the provider (anonymously or otherwise) to have his health care attorney write a letter, addressed to the hospital, that sets out the law on patient choice and discusses antitrust implications and false claims theories. “We send a letter and cite the statutes, and acknowledge their ambiguities and limitations,” says Baird, “but we try to get the hospital to come to the table and play nice.”
A more aggressive approach is for the provider’s attorney to address a letter to the hospital’s CEO, and possibly with a copy to the hospital’s board chairman and legal counsel. An even more aggressive approach, which Baird dubs the “scorched earth policy,” involves an attorney’s letter to the Department of Justice, Office of Inspector General, and/or the Federal Trade Commission, with a “cc” to the hospital CEO, legal counsel, and board chairman.
Baird acknowledges that an excellent way to prevent a hospital from referring to its own HME operation is for providers to educate customers, potential customers, and physicians about the right of a hospital patients to choose their suppliers. In fact, Baird encourages these tactics and others such as working effectively with discharge planners to gain their trust. “Things change and relationships change,” he points out. Ultimately, a well-worded letter from an attorney could be the shot over the bow that ends the referral wars.
HME Excellence Awards
The HME Excellence Awards ceremony at this year’s Medtrade kick-off party culminated an exhaustive judging process that saw three HME providers take home top prizes in three categories.
Joel Mills and Kay Koch
• The award for best HME Provider went to Joel Mills of Advanced Home Care, Greensboro, NC.
• The award for best rehabilitation supplier went to Kay Koch of Mobility Designs, Atlanta.
• The award for best respiratory provider went to Laraine Forruy of Air Products Healthcare, Conshohocken, Pa. Judges gave Air Products considerable credit for maintaining a top-notch, full-service DME—and for instilling confidence in patients.
African Adventure
Illustrated with rugged images of Tanzania’s Kilimanjaro trail, Jeff Pagels’ true tale of determination jolted Medtrade attendees with a welcome dose of outdoor inspiration. The 19,340-ft Kilimanjaro has a 25% success rate for able-bodied climbers, but no paraplegic had ever been to the top. A quicksand-like scree would ultimately deny Pagels the summit, but it was the journey that counted—and the lessons learned.
Mountain climbing enthusiast Jeff Pagels is founder of the Adaptive Summiteers Association.
With his massive arms, Pagels propelled a three-wheeled manual mobility vehicle, dubbed the “mountain beast,” up various parts of the trail and relied on his sons and other Jeff Baird, JD, showed Medtrade attendees how to fight for hospital referrals without burning valuable bridges. “In a perfect world, the hospital refers discharged patients to the HME supplier who delivers the best care,” says Baird, chairman of the health law group at the Amarillo, Tex-based law firm of Brown & Fortunado. “Unfortunately, we do not live in a perfect world.”
Patients have the right to choose the HME provider they want and two patient choice statutes address the situation. The first is 42 USC 1395a(a) and the second is 42 USC 1395x(ee)(2). Baird points out that, unfortunately, HME suppliers cannot bring a lawsuit against the hospital under either of these patient choice statutes. The patient can, but that is unlikely. Instead, Baird suggests four actions that HME providers can take that range from polite to aggressive. The polite approach is for the provider (anonymously or otherwise) to have his health care attorney write a letter, addressed to the hospital, that sets out the law on patient choice and discusses antitrust implications and false claims theories. “We send a letter and cite the statutes, and acknowledge their ambiguities and limitations,” says Baird, “but we try to get the hospital to come to the table and play nice.”
A more aggressive approach is for the provider’s attorney to address a letter to the hospital’s CEO, and possibly with a copy to the hospital’s board chairman and legal counsel. An even more aggressive approach, which Baird dubs the “scorched earth policy,” involves an attorney’s letter to the Department of Justice, Office of Inspector General, and/or the Federal Trade Commission, with a “cc” to the hospital CEO, legal counsel, and board chairman.
Baird acknowledges that an excellent way to prevent a hospital from referring to its own HME operation is for providers to educate customers, potential customers, and physicians about the right of a hospital patients to choose their suppliers. In fact, Baird encourages these tactics and others such as working effectively with discharge planners to gain their trust. “Things change and relationships change,” he points out. Ultimately, a well-worded letter from an attorney could be the shot over the bow that ends the referral wars.
The HME Excellence Awards ceremony at this year’s Medtrade kick-off party culminated an exhaustive judging process that saw three HME providers take home top prizes in three categories.
• The award for best HME Provider went to Joel Mills of Advanced Home Care, Greensboro, NC.
• The award for best rehabilitation supplier went to Kay Koch of Mobility Designs, Atlanta.
• The award for best respiratory provider went to Laraine Forruy of Air Products Healthcare, Conshohocken, Pa. Judges gave Air Products considerable credit for maintaining a top-notch, full-service DME—and for instilling confidence in patients.
Illustrated with rugged images of Tanzania’s Kilimanjaro trail, Jeff Pagels’ true tale of determination jolted Medtrade attendees with a welcome dose of outdoor inspiration. The 19,340-ft Kilimanjaro has a 25% success rate for able-bodied climbers, but no paraplegic had ever been to the top. A quicksand-like scree would ultimately deny Pagels the summit, but it was the journey that counted—and the lessons learned.
With his massive arms, Pagels propelled a three-wheeled manual mobility vehicle, dubbed the “mountain beast,” up various parts of the trail and relied on his sons and other helpers to pull him when necessary. “I was taught to be independent, but I had help and I have learned that teamwork is also important,” says Pagels. “I did my share and they did theirs.”
Along with his two adult sons, the team consisted of various other family members and climbing enthusiast friends. Pagels also hired 26 Tanzanian porters to cook and carry various supplies for the journey. In addition to satisfying Pagels’ appetite for the outdoors, the climb provided the unique opportunity to befriend and bond with these Africans, and gain insight into the Tanzanian culture.
While the 56-year-old Pagels (who has a complete T-12 spinal cord injury) will not be back on Kilimanjaro, he hopes his fledgling Adaptive Summiteers Association can help other disabled adventurers enjoy the outdoors and realize their dreams. You can find out more about Jeff Pagels by visiting his Web site at www.rainbow-expedition.com.
| Grassroots Central Bush? Kerry? Neither?
A packed house on the Grassroots Central floor at Medtrade watched a spirited panel discussion to decide who would be better for home care: Bush or Kerry? It was a fair fight: three panelists for Bush and three for Kerry. Panelists pointed out that both candidates favor competitive bidding and both would expand services for children in low-income families.  W. Richard Clark from RESP-I-CARE in Kingsport, Tenn.
Predictably, policy differences hinged on the level of overall government involvement in health care. On this topic, there were indeed clear choices. W. Richard Clark from RESP-I-CARE Inc in Kingsport, Tenn, fired the first shot over the bow with a spirited defense of the Bush/Cheney health care philosophy that emphasizes privatization and tort reform. “Government-mandated programs, regardless of where you stand, simply do not work. They are not efficient,” said Clark. “There are countries of socialized medicine that have been held up as examples. Well, I have lived under that system and it did not work. If you wanted good health care, you went to the same office at night and paid extra money under the table. So the free market did in fact flourish even though it was hidden. We have got to move our health care toward patient choice and privatization.” Moderator John Gallagher from VGM & Associates shared his view that both candidates “have no clue what this industry does. If we succeed, it won’t be because of them.” Kerry panelist Francis Burke of Burke Medical Equipment Inc, Chicopee, Mass, agreed that regardless of who won, it was vitally important for the industry to unite for common goals. “Senator Kerry will build on the status quo by expanding existing government programs and by increasing subsidies for employer-based coverage,” said Burke. “We’re not talking about a government takeover.” Instead, Burke stressed that Kerry would reduce the number of uninsured individuals by implementing a reinsurance program similar to the federal flood insurance program. “Many of the uninsured are children and they are our customers,” Burke continued. “I have a business that relies predominantly on pediatrics. Our children/customers are coming to us and from month to month my business is hanging on a hook wanting to know if they are insured. Do they have coverage or not?”  Raul Lopez
Surviving Competitive Bidding
How will you survive when (and if) competitive bidding becomes a nationwide reality in 2007? “The only way we see any possibility of surviving competitive bidding in this business is to diversify your product mix,” said Raul Lopez, vice president of the Florida Association of Medical Equipment Services. Medtrade attendees who visited the “Surviving in a Competitive Bidding Environment” panel at Grassroots Central heard variations on this theme along with other nuggets of advice from panelists such as Denise Fletcher, JD, an attorney with the law firm of Brown & Fortunado in Amarillo, Tex. “If you are not accredited, you will not be a Medicare supplier under competitive bidding,” said Fletcher. “It will take a year to prepare for an accreditation survey, so you need to get on it now.”  Ann B. Howard
It’s Up to You
Ann B. Howard, AAHomecare’s director of federal policy, spoke eloquently of the need for providers to get to know their legislators. It is a common refrain and believers are made one at a time. Howard encouraged attendees to put a human face on HME by showing legislators how providers affect customers. “It is time to start talking to legislators about where your customers would be without you,” said Howard. “Bring members of Congress out on a home visit. Get commitments because you know where money is going to come from to shrink the federal deficit? It will come from Social Security, Medicare, and Medicaid.” |
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