No event summed up the changing landscape of HME like the time when Rita Hostak received final local coverage determination (LCD) revisions via e-mail during her Medtrade presentation. With new facts in evidence, Hostak, who heads up government relations for Sunrise Medical, adapted quickly and sorted through the new document on the spot. With the help of attendees, she reported that the automatic “downcoding” to Group I power wheelchairs—if the patient did not meet coverage for a Group II or higher chair—was eliminated.

Medtrade was full of these tidbits of good news mixed with uncertainty and exasperation. Some of that exasperation bubbled to the surface at this year’s Grassroots Central, presented by Dealer/Provider. When I called CMS to request a speaker, Jabal Chase, health insurance specialist for DME policy, answered the call. The CMS office was so close to the trade show floor that Chase had to walk only a few blocks to get to the heart of the lion’s den.

Here’s one actual exchange:

QUESTIONER: Why all the secrecy? Why not put it all out for us so we can see what we have to do?

CHASE: “There is no secrecy. We have open-door forums. We have town-hall meetings where we invite providers to tell us what their issues are and we bring in all the information we have. With competitive bidding, we have an advisory committee that gives us the issues you are facing. It’s not as if there is a closed room somewhere. We give out a proposed rule so providers can comment.”

QUESTIONER: “We don’t even know what products are going to be up for bid, and you’re telling us there is no secrecy?

CHASE: “When the final rule comes out, you will know exactly what the products are.”

Only once did Chase remind attendees that CMS merely executes the policies of Congress. CMS has discretion in many matters, but this is an undeniable truth that underscores the importance of grassroots lobbying.

And speaking of lobbying, the fruits of provider efforts were realized in some big ways. Remember HR 3559? Now up to a respectable 145 cosponsors, the House bill to eliminate onerous provisions of competitive bidding has a Senate companion bill (S 3920) courtesy of Senators Orrin Hatch (R-Utah) and Kent Conrad (D-ND). One look at the August 2006 cover profile for Dealer/Provider (at the www.hhcdealer.com archives—free with no log-on required) shows how Salt Lake City provider Jay Broadbent helped this bill become a reality.

How do we know for sure? Senator Hatch said so in his comments on the Senate floor. “A small provider of durable medical equipment in Utah approached me about how current law will impact him,” said Hatch. “The owner of the company asked me how he can continue to provide great service when his company has been forced to bid to the lowest price possible just to keep from going out of business…I heard from several small medical equipment companies in my home state for several years on this issue, and they made very convincing arguments.”

And don’t forget about the Home Oxygen Patient Protection Act (HR 5513) and its Senate companion bill (S 3814). Those bills would restore Medicare policy for oxygen ownership to what it was before enactment of the Deficit Reduction Act of 2005. Yes, these are not reality yet, and plenty of other concerns are out there. However, these pieces of legislation could form the centerpiece of a modest comeback for the industry.  

Finally, we come back to the old saw of location, location, location. It’s true in real estate, and it just might be true in the HME industry. As a humble editor, I advocated for a Washington, DC, venue change for Medtrade in my July 2006 editor’s message (in solidarity with Dealer/Provider’s Our Turn columnists). However, after Invacare chairman and CEO Mal Mixon made the same suggestion at the AAHomecare Human-itarian Dinner, it may be time to start checking available trade show space in DC.

Wherever it’s held, the words of Senator Hatch should offer some solace. With the help of convincing arguments, patient involvement, and solid data, the industry can hold the line.