After a visit from Senator Orrin Hatch, Jay Broadbent continues his mission to balance business and activism.
Suppose you could command the undivided attention of one of the most powerful and influential members of the United States Senate for half an hour. Might you, in that brief span, be able to persuade him to champion legislation rescuing the home health care industry from the clutches of national competitive bidding, oxygen rental caps, and other dire, regulatory threats?
Jay Broadbent certainly gave it his best shot this past May when he played host to five-term Republican lawmaker Orrin Hatch, the senior senator from Utah and a member of the Health, Education, Labor, and Pensions Committee—who paid a courtesy call at Alpine Home Medical Equipment in Salt Lake City.
During the 30 minutes he was there, Hatch toured the 18,000-square-foot office-warehouse-service complex, which includes a spacious showroom full of mobility products, beds, oxygen systems, aids for daily living, rehab equipment, and supplies of all sorts. “It was a golden opportunity for the senator to see how heavily invested we are in terms of equipment and staffing,” says Broadbent, founder and president of the 9-year-old company, now operating with 42 employees and at four additional locations across the state.
Hatch’s arrival entailed a minimum of fanfare. “He got out of his car, and I escorted him and his small entourage of aides inside,” Broadbent says. “As we walked, it was evident that Sen Hatch possessed extensive knowledge about the home health care field, and I was impressed by the intelligent questions he asked about my company and the challenges we’re facing.”
Broadbent reveals that he and Hatch discussed several Medicare hot-button issues. “I let Sen Hatch know that I felt these cost-cutting policies from Washington have not been thought through, that they appeared to have been adopted with hardly any regard for their impact on us at the provider level, and that the impact was likely going to be devastating for smaller companies,” Broadbent recounts.
Hatch listened intently and offered earnest, affirming nods in response, he adds.
Patients Spoke Up The Hatch visit concluded with a mini-townhall meeting wherein the senator heard from a number of Medicare oxygen and wheelchair patients worried about their ability to continue accessing quality services in the era of national competitive bidding. “It was really helpful for the senator to meet like this with the patients,” Broadbent says. “It put a human face on the problems these policies are going to soon create. I feel that Sen Hatch left our office with a much stronger appreciation of what is really at stake here.”
The lawmaker seemed to be most moved by the words of a patient who 3 years ago suffered a seizure that left him with a permanent need for oxygen support. “The patient talked about how he feared national competitive bidding would force him into using a provider of lowest-quality products and services, since there may not be any providers offering better quality after this policy takes effect,” Broadbent summarizes. “The patient was frightened that losing the access he has now to quality products and services could mean more health problems for him.”
Although the visit by Hatch was over in a flash, it required several years of groundwork by the politically active Broadbent. The starting point was making the acquaintance of Hatch’s legislative staff in the course of periodic Capitol Hill visits organized by the American Association for Homecare and other trade associations representing the DME/HME industry.
Alpine Offers Lifts for Crucial Product Diversity Executives at Alpine Home Medical Equipment, Salt Lake City, have their fingers crossed that Congress will act to undo (or at least render less harmful) national competitive bidding, the 36-month oxygen rental cap, and other recently authorized Medicare cost reforms.
However, the Salt Lake City-based company isn’t putting all its eggs in one basket. To ensure survival, Alpine Home Medical Equipment has also adopted a strategy of service-line diversification as a hedge against a potentially bleak future.
One relatively new service line the company introduced is lifts for homes and vehicles. Previously, Alpine Home Medical Equipment referred all its powered wheelchair and scooter customers in need of lifts to other companies. But after fielding enough complaints about problems with those referral sources, Alpine Home Medical Equipment decided to start a lift division of its own. “We had to stop and ask ourselves why we were giving away this business when it was clear that the demand for it was there and we had all these patients wanting us to provide lifts,” says Scott Naylor, MPH, rehab manager. “It also seemed like a natural extension for our existing, very successful business in powered wheelchairs and scooters.”
Today, Alpine Home Medical Equipment offers lifts from primarily two manufacturers—Bruno and VMI. “It was the quality behind these makes that convinced us to focus on them,” says Alpine Home Medical Equipment’s founder and president, Jay Broadbent. “It took a while to determine which were the best of the best. Largely, it was a process of trial and error: going to the trade shows, looking at what was available, evaluating their engineering and choice of materials, and—when we thought we had found a quality product—testing it out in real-life situations to see how it would hold up.”
Broadbent advises HME dealers and providers to steer clear of any lift built of cheap parts—brackets, in particular, because brackets of poor quality tend to bend or suffer stress fractures over time. “Parts that don’t fit together well or that don’t look like they’ve been precision-engineered are a dead giveaway that you are probably up against a product of poor quality that is not going to perform to the user’s satisfaction,” he says.
Good quality lifts are identifiable as such also because they come backed by extensive support from their manufacturers, according to Broadbent. Training is one such form of support. “Without proper training from the factory,” Broadbent says, “you are not going to be very successful handling the product.” Training, he adds, typically covers product maintenance and repair, as well as marketing.
Jump In Even though lifts are no less pricey these days ($1,800 to $3,500 continues to be the typical manufacturer’s suggested retail price or MSRP range), third-party reimbursements remain a rarity. “In nearly all instances, it is private pay, but a few payors—the Veterans Administra-tion, our state’s workers’ comp system, the Muscular Dystrophy Association, and some others—do occasionally reimburse,” says Broadbent. “They weigh reimbursement on a case-by-case basis. The ones they authorize tend to be cases where the lift is determined to be absolutely essential to the wheelchair user’s ability to return to work.”
Broadbent doubts, however, that lifts will receive thumbs-up from a broader cross-section of payors. “Not with the current reimbursement climate,” he scoffs. “Medicare and others are looking to exclude items from coverage, not include them.”
Naylor, meanwhile, thinks the biggest mistake dealers and providers make with regard to lifts is putting off entry to the lift market or, if they have already entered, pursuing it only half-heartedly. “You are going to be turning away dollars if you don’t offer lifts with your wheelchairs and scooters,” he cautions. “There is plenty of demand for the product, and it is demand that is only going to grow as the population ages, yet continues wanting to enjoy active lifestyles.”
One of the Hatch aides with whom Broadbent developed a solid working relationship was Pattie Deloatche, whose duties include keeping the senator up to speed on health care issues. In fact, it was Deloatche who broached the possibility of having Hatch visit Alpine for a tutorial on the struggles faced by the typical provider. Not surprisingly, Broadbent thought it a terrific idea. “The big challenge was finding a day and time for the visit that would fit Sen Hatch’s busy schedule,” he says.
Very little in the way of preparation was required on Broadbent’s part to actually receive the senator, other than to invite patients. Because of seating limitations, the number of participants had to be held to 35. “We tried to fill the audience with patients we knew could do a good job articulating their views,” says Broadbent, noting that not all of the patients in attendance that day were his. “Tom Bradley, the owner of Peterson Medical, a local friendly competitor, volunteered to send some of his patients to lend support. It was a good idea to have those other voices, because it gave extra credibility—it became less an event for Alpine Home Medical Equipment and more an event for the community.”
Reason to believe Hatch departed that day with much to ponder. Broadbent thinks, if nothing else, the senator carried back to Washington a deeper appreciation for what his colleagues in the House of Represent-atives aim to accomplish with their bipartisan Medicare Durable Medical Equipment Access Act of 2005 (HR 3559 introduced by Reps David L. Hobson [R-Ohio] and John S. Tanner [D-Tenn], a measure intended to remedy the most problematic provisions of national competitive bidding). “We stressed to Sen Hatch that we urgently wanted him to not only vote for, but to sponsor in the Senate a companion bill to HR 3559,” Broadbent explains. Hatch was noncommittal about sponsorship, but pledged “to look into it.”
Recent word from Hatch’s office gives Broadbent reason to believe Hatch may be leaning in the direction of sponsorship. “I was told we’re making some good progress on that front. But I can understand the senator wanting to be deliberative about this; he wants to make sure he hears both sides of the story.”
Rich Smith is a contributing writer for Dealer/Provider.
After a visit from Senator Orrin Hatch, Jay Broadbent continues his mission to balance business and activism. 
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