The November elections have changed the face of Washington, and during this season of change another new face has appeared on the political scene. In September 2006, Tyler J. Wilson joined the American Association for Homecare (AAHomecare) as its chief executive officer. He replaces Kay Cox who stepped down in February.

Despite less than 2 months on the job, Wilson agreed to chat with Dealer/Provider. We hoped to get a sense of his mood and likely strategies as the industry enters a pivotal year. There is no doubt that Wilson joins AAHomecare during a challenging time in the history of DME—with a new Congress controlled by the Democratic party and the competitive bidding final rule just around the corner.

Dealer/Provider: How did you hear about the job opening (for CEO) at AAHomecare? What convinced you to pursue this opportunity?

Tyler J. Wilson: I became aware through an executive recruiter. At the same time, I was looking for a different opportunity. AAHomecare interested me because I had a good run at the American Orthotic and Prosthetic Association (AOPA) and I was looking for a new challenge; broader public policy issues and a position that was more in the public eye. AAHomecare provides the bigger public policy opportunity. DME is a $35 to $40 billion industry compared to orthotics and prosthetics, which is a $3 billion one. From the vantage point of AAHomecare, I brought good credentials. I advanced AOPA generally in the field and hope to enhance the voice of AAHomecare.

D/P: At Medtrade—your second day on the job—you compared the information barrage at the show to “drinking from a fire hose.” You’ve been at AAHomecare for over a month now. Do you still feel that way?

Wilson: There were some good aspects and not so good aspects of attending Medtrade in my first week. I met a lot of the personalities in the industry and got to see a lot of the products firsthand. But to answer your question—I have since dried out.

D/P: You were previously executive director of AOPA. What did you learn during your 6 years there that can be readily applied to the home care industry?

Wilson: Broadly speaking, government relations. In terms of AAHomecare, we want to take a more prospective, as opposed to reactive, approach on the issues. I was very successful at AOPA in building membership and revenues. At AAHomecare, we need to build and expand membership. We also have to develop sources of non-dues revenue. AAHomecare also needs to do more than government relations. We have to develop some benefits for members beyond government relations to encourage new members to join.

D/P: When you look at the legislative record of the past 5 years, what has gone right and what has gone wrong for the industry?

Wilson: I do not have a wealth of information about the home care experience, but my sense has been that the industry has not always been unified. And when you go on Capitol Hill, you have to remember that you are competing for the same dollars sought by many others. The people on the Hill want to hear one voice about home care issues.

D/P: The final rule on competitive bidding has been delayed, so obviously the full extent of its effects will not be known for some time. But what about the legislation that AAHomecare has helped to introduce, which is designed to blunt some of the anticipated effects of competitive bidding?

Wilson: The 109th Congress is coming to an end, and it is clear that HR 3559 won’t be passed this year. We plan to have the legislation reintroduced in the 110th Congress and, in light of the election, are looking to find some new lead sponsors of the bill. And then we’ll fight to have it enacted. As for the final rule, we have submitted our comments about it.

D/P: In the November 2006 issue of Dealer/Provider, Cara Bachenheimer and David T. Williams said the industry should seriously consider a more combative relationship with the Centers for Medicare and Medicaid Services (CMS)—including lawsuits and embarrassing television advertisements—what do you think of this kind of strategy?

Wilson: I think to be effective every industry has to have several weapons in its arsenal. Sometimes you must have toe-to-toe meetings. Other times you have to offer a conciliatory voice and be cooperative. My approach is to take a more cooperative rather than combative approach. When I worked in the automotive industry, my association had occasion to sue the government, but in that case it was the only recourse and the last recourse. Also, the courts give great deference to the interpretations of government agencies [whom they see as the experts]. And you have to keep in mind that you still may have to work on other issues with the same officials you are planning to sue.

D/P: The power mobility cuts that went into effect on November 15 have rocked the rehab industry. What are you doing to help get these reversed? Note: This interview took place just before CMS revised certain PMD fees.

Wilson: Generally, with any issue, there are multiple prongs of attack. The first is the formal mechanism, such as public comments. The second are the informal mechanisms, such as meeting with officials. If these methods fall on deaf ears, then have the option of going to Capitol Hill and meet with legislators. For example, on power mobility, the industry met with US Health and Human Services Secretary Mike Leavitt and Senator Rick Santorum (R-Pa) to discuss this issue. Regardless of the issue, this is how the system works. And we also use a grassroots approach. For instance, we had a member from Montana who met with Montana Senator Max Baucus, the incoming chairman of the Senate Finance Committee, to discuss this issue. On any issue, there are various pressure points and points of contact that we use, and it varies issue to issue.

D/P: Recently, the Office of Inspector General (OIG) issued a study that reached vastly different conclusions about Medicare oxygen reimbursement from the one reached by AAHomecare’s Morrison Informatics study. To what do you attribute these vast discrepancies?

Wilson: The Office of Inspector General released a study—“Medicare Home Oxygen Equipment: Cost and Servicing”—which focused on a very limited subject…concentrators. Our study looked at oxygen therapy in total. Only about 28% of oxygen [costs] are tied to equipment costs. Our big contention is that the Office of Inspector General did not take into account service. We had a meeting with OIG and the Senate finance staff. The office of inspector general report gave a misimpression of the issue. Our study was conducted by a respected research organization.

D/P: Do you think that the industry has done enough to enlist consumer groups in its battles?

Wilson: We would rather call them patient groups. We need to have as broad a coalition as we can. For example, the oxygen stakeholder summit this past Summer, we included oxygen patient groups and AAHomecare addressed the issue in a comprehensive way. We must enlist more of those types of groups. At the last Medtrades, we raised funds at our humanitarian dinner and gave them to patient groups who needed them. We also included oxygen patients at our Washington fly-in.

D/P: What is your number one priority in 2007?

Wilson: First we will be sitting down and figuring out where the industry needs to go on a number of legislative and regulatory fronts. A lot is going on in rehabilitation and respiratory issues. We need to do a better job promoting the value of home care. We are going to reach out to Congress. We are going to make sure policy makers understand that home care is part of the solution and not part of the problem.

D/P: In light of the November 7 election, are you optimistic for the future of the home care industry?

Wilson: We are optimistic. This is an industry that has always had a bipartisan approach [to issues], and the new majority in Congress claims it is going to pursue a bipartisan approach. I think that’s good. In terms of the election, we have always worked well with the Ways and Means Committee, and we will continue to work with it. We have been working closely with Charlie Rangel (D-NY, the incoming chairman of the Ways and Means Committee) during his transition. The nature of Medicare is that we don’t have the luxury of working with one party.

C.A. Wolski is a contributing writer for Home Health Care Dealer/Provider.