Many people in the HME industry interpret the announced retirement of Rep Bill Thomas (R-Calif) as the end of Congress’ attempts to reduce reimbursement. After all, Thomas (who is Chairman of the House Ways and Means Committee) has been the visible head of numerous efforts to restrain the industry. But before breaking into a rousing chorus of “Ding, dong, the wicked witch is dead,” consider these five reasons why the chairman’s retirement may not be cause for celebration.

1) The majority of his “attacks” were based on recommendations from the White House and CMS (in both Democratic and Republican administrations). Those recommendations will continue. CMS is in the position to secure a prominent—or ambitious—member of Congress to champion cuts under the guise of reducing fraud and abuse or containing costs. And CMS has much more “supporting” data than the industry has to counter them.

2) Thomas alone could not have enacted any of the actions the industry believed were most deleterious. He was joined by other members who were ready allies in the “fight against fraud and abuse,” the real or perceived “overpayment” issues, and the unknown impact of policies the industry supported. Most of those members will be back to make their mark, perhaps as Thomas’ successor to “watchdog for the Medicare Trust Fund.”

3) Image, unfortunately, is still a problem for the industry. The stench of a few bad providers continues to stick to decent and honest businesses. For the past 10 years, it seems, every time the industry made headway with policymakers, a report from the Inspector General or General Accounting Office dashed it. The industry has constantly been forced to divert energy and focus from positive initiatives to damage control. This has kept advocates in a defensive, not offensive position.

4) The Medicare Trust Fund is in no better shape today than it was when the seemingly endless barrage of attacks on the industry began. Even though spending on HME is a small percentage of the Medicare budget, it remains an easy target. While the industry is better organized to work with Congress and the administration than it was 5 years ago, it still lags far behind in sophistication, communication, message, and financial resources. Presidents and Congress will be looking for every possible cut in Medicare expenditures for the next decade.

5) Thomas was a master at exploiting the industry’s weaknesses by keeping many issues swirling at once—it was difficult at best to remain focused. This will continue to be a problem as CMS works to implement Congressional mandates, the never-ending budget process grinds on, and consumers unhappy about reimbursement complain to Congress.

What now? The industry will lose a worthy adversary with Thomas’ retirement. But it would be folly to stop pushing forward or to think the problem is “solved” because one—albeit vocal—member of Congress retires.

It remains crucial that the industry actively polices itself. Among other steps, providers who know a competitor is deliberately breaking the law should be calling the Inspector General. Efforts to improve the image of providers as legitimate professionals in the health care industry must continue. Accreditation, certification, quality standards, continuing education requirements, and excellent customer service remain the best tools to blunt those who would say that all providers are dishonest.

The industry must continue to support impartial analyses of the true cost benefit implications of a strong, healthy HME network. Efforts must continue to ensure that HME providers are just that, health care professionals—not mere vendors to the health care industry. And the industry must continue to work with CMS as partners in the creation of new regulations.

In a way, the industry owes Chairman Thomas a debt of gratitude. His actions, questions, and accusations forced the industry to do many things that might otherwise have been ignored, such as accreditation, adoption of a voluntary Code of Ethics, and development of professional standards. The formation of special interest coalitions that work together to make sure that Congress and the administration are hearing the same thing from all affected parties came out of the chairman’s often used tactic to play one industry source against the other.

The retirement of Thomas will provide a brief opportunity to pause, take a deep breath, and refocus while continuing to build relationships with policymakers and members of Congress.

Farewell, Mr Thomas. If you ever need HME services, an honest, trained provider will be happy to assist you. DP

Cara C. Bachenheimer, JD, is vice president of government relations for Invacare Corp, Elyria, Ohio. David T. Williams is a political and legislative strategy consultant.