Wayne E. Stanfield

Winston Churchill once said, "The appeaser is the one who feeds the alligator, hoping he will be eaten last." The HME industry and suppliers have become appeasers somewhat by force. We have been left little choice in many matters relating to our business. We have accepted unprecedented fee cuts without much of a fight. Doing so has appeased the payors, but they, like the alligator, have returned to the hand that appeases them.

I looked at the quote from Churchill and turned it around a little. "If you keep appeasing the alligator, he will eventually eat you." In our case, the alligator takes on many forms, but all of them want to eat us by forcing thousands of small businesses to close; by forcing us to accept fees that do not meet our cost of doing business; by asking us to provide service and support for equipment well beyond the point where payment ends; and by making rules for participation that most companies simply cannot meet.

There is no other industry, not even another segment of our own health care industry, that has to work so hard just to be paid for our services. The sources of our revenue would not themselves accept the terms under which we are expected to perform.

There are a few axioms of business that we fail to follow: know your costs; accept only business that is profitable; and refuse to accept customers when the payment outcomes are unknown.

Now this is where the alligator comes back in. As providers and businesses, if we continue to appease the payors by accepting lower and lower fees, and more draconian rules, we will certainly be eaten in that we will not survive. We cannot sustain operations in an environment where we are expected to lose money. As long as we keep saying yes to managed care contracts and Medicare fees that won't allow a profit, the alligator will keep coming back until we are gone.

I, for one, am tired of just saying yes out of fear. Fear of losing referrals, fear of unsettling patients and doctors, fear of the unknown. It is time we started responding as businesses rather than caregivers. The days of taking some patients at a loss and making it up on the rest are over. It's time we said NO: no to competitive bidding; no to capped oxygen; no to any sales below cost of product and overhead; no to managed care contracts with fees that are too low; and no to state Medicaid fees that are too low.

And don't just say NO to the patient, recruit the patient by explaining why and ask for their help. Recruit physicians and referral sources by explaining and asking for their help. Tell your Congressman NO. Tell your Governor NO. Tell the managed care executive making millions in stock options—NO! Join the grassroots effort by becoming your own lobbyist. Visit with your Congressman and build a relationship that allows you to be heard.

Wayne E. Stanfield, a former air traffic controller, has been in the DME industry for 20 years. He is president and CEO of the National Association of Independent Medical Equipment Suppliers (NAIMES), as well as the executive director of the Home Care Alliance of Virginia Inc, a provider network with 63 locations in 11 states.