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June 8, 2009 Volume 15, Number 24

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Table of Contents
- Round One to Be Implemented in January 2011
- Message No. 1: Stop Competitive Bidding
- PAOC Sets ‘Right Tone’ on NCB, but Will CMS Fix Flaws?
- Pull the IFR, Says HELP Committee's Brown
- AARP Endorses 'Empowered at Home Act'
- AAH Elects New Officers; Zelenko Tapped at PAMS
- Cape Medical Builds Better Mousetrap; Integrated Medical, OT Thank Vets
- Heard at AAHomecare's Legislative Conference

For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com.

Special Alert
Round One to Be Implemented in January 2011
BALTIMORE--A tentative timeline for competitive bidding shows Round One, scheduled to be rebid this year, will not be implemented until January 2011.

The timeline, released Thursday at a meeting of the Program Advisory and Oversight Committee, shows some detail of CMS’ schedule for the Round One rebid as follows:

Spring 2009
Pre-Bidding Supplier Awareness Campaign Began
Today's PAOC Meeting

Summer 2009
Announcement of Bidding Schedule/Schedule of Education Events
Bidder Education Campaign Begins
Bidder Registration Period to Obtain User IDs and Passwords Begins

Fall 2009
Bidding Begins
CDRD (Covered Document Review Date) Process Begins

By the CDRD, bidders must have their packages submitted in order to qualify for review of missing financial documents. That date will be the later of the date that is 30 days before the end of the bid submission due date or 30 days after the start of the bid submission period.

By the 45th day after the CDRD, CMS will notify bidders of missing documents with a certified letter. Bidders will have 10 business days from the date of the certified letter notification to submit the missing documents requested.

Note: Bidders must submit covered documents prior to the deadline in order to be eligible for notice of any missing documents.

Winter 2009/Spring 2010
Bid Evaluation
Announcement of Single Payment Amounts
Contract Process Beings

Summer 2010
Contract Suppliers Announced Contract Suppliers Education Campaign Begins

Fall 2010
Beneficiary, Referral Agent and General Supplier Education Campaign

January 2011
Program Implementation

Headline News
Message No. 1: Stop Competitive Bidding
WASHINGTON--HME stakeholders went to Washington last week with a message. Lots of messages, in fact.

In 300 Capitol Hill visits, more than 250 providers and others attached to the industry asked senators and representatives to stop competitive bidding, reform Medicare’s oxygen payment system, repeal the 36-month cap, restore the 9.5 percent cut to complex rehab and adopt the American Association for Homecare’s 13-point anti-fraud plan.

“Nobody’s here because times are good,” said AAHomecare President and CEO Tyler Wilson. “Most of us think HME is under assault. People feel their backs are against the wall. Everyone is fighting mad, and all of us are looking to change the direction Medicare is heading.”

On the list of asks, however, competitive bidding was the headliner for most participating in AAHomecare’s lobby day, held in conjunction with the association’s Legislative Conference June 1-3.

“Our mission from Florida was really to talk about competitive bidding,” said Rob Brant of City Medical Services in North Miami Beach, Fla. “What is happening with oxygen affects us, but if we don’t get some help on competitive bidding, we’re dead.”

John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, agreed. “Nine out of 10 DME providers are targeted for elimination,” he said during a bidding discussion panel. “Everyone likes to think, ‘Maybe I can be that one guy.’ But you know what? You can’t all be that one guy. Companies are going to fall."

The industry got some sympathy from Rep. Betty Sutton, D-Ohio.

"The way in which the [competitive bidding] program was carried out left a lot to be desired," she told the conference. "The application process was exclusive and muddled. The bidding process ... disenfranchised qualified providers while reducing access to needed devices and therapy."

Although the program was eventually delayed, Sutton noted, "to many of us in Congress it seems that CMS took the letter of the 2008 delay but not the intent, which is the most important part."

Earlier this year, Sutton spearheaded a sign-on letter asking CMS to halt the bidding program before the Interim Final Rule took effect April 18. The letter, which garnered signatures from 84 members in the House, pointed out that of thousands of providers in the initial bidding areas, only 376 were deemed to have met the bidding program requirements.

"That seems absurd," Sutton said. "As a growing number of seniors enters the Medicare program, it's important that we take care to maintain an adequate number of qualified providers to address demand for care in the home."

A June 2 letter from Sen. Sherrod Brown, D-Ohio, urging HHS Secretary Kathleen Sebelius to rescind the IFR should give the industry another boost. (See story this issue.)

Brant lamented, however, that the legislators from his state were not all as supportive. While some said they didn’t want bidding to go forward, others said they thought changes to the program could make it work. “And some said if you want it to stop, you’re going to have to pay for it,” Brant said.

Providers did get a bit of good news at a June 4 meeting of the Program Advisory and Oversight Committee when CMS announced it wouldn’t implement the new Round One until January 2011. That gives the industry some “stall” time to continue efforts to get the program stopped, Brant said.

But even if CMS tweaks the program, he added, “the bottom line is if you lose a contract, you’re out of Medicare.”

Summed up AAHomecare's Wilson, “It’s critical that we hold Congress’ feet to the fire and talk about killing the program and driving a stake through its heart.”

At Odds over Oxygen
Wilson was equally adamant on the subject of oxygen reform, urging conference attendees to push the New Oxygen Coalition's long-term reform plan versus the Home Oxygen Patient Protection Act (H.R. 2373).

Introduced last month by Reps. Tom Price, R-Ga., and Heath Shuler, D-N.C., the HOPP Act would repeal the 36-month cap and restore oxygen payments for the period of medical need.

While he applauded Price's efforts--this is the third time the Georgia physician has introduced the bill--Wilson said AAHomecare believes the best strategy to protect both oxygen patients and providers is to enact the reform, which is the measure that's "got legs."

Expected to be introduced in the next few weeks by Rep. Mike Ross, D-Ark., a former pharmacy and HME owner, the reform bill--currently being written into legislative language--is budget-neutral, meaning it wouldn't cost more than the current benefit. The legislation would repeal the cap, exempt oxygen from competitive bidding and recognize home oxygen services.

According to Mike Reinemer, AAHomecare vice president, communications and policy, "The under-appreciation of the service-intensive nature of oxygen therapy [has] given policymakers ammunition to cut oxygen in Medicare, time after time. That has to end.

"The HOPP Act, which AAHomecare has supported for many years now, cannot by itself achieve all the changes that need to be made."

Many providers at the conference felt differently. "Im feeling the hurt [from the cap] now," said one HOPP Act supporter who asked to remain anonymous, "and I need the cap repealed now."

Another in favor of the HOPP Act, Andy Simmons Jr. of Cornerstone Medical, Atlanta, questioned the association's strategy. Health care reform is moving fast, he said, and with no oxygen reform bill in hand, "Congress already thinks the benefit is overpaid and they want to cut us some more.

"We have a message and we have a bill," Simmons said of H.R. 2373. "Wouldn't it be best to go in on two fronts?" he asked, adding that providers could lobby for the HOPP Act now while continuing to work for long-term reform.

But past AAHomecare Chair Tom Ryan of Homecare Concepts, Farmingdale, N.Y., responded, saying the "political reality" is that with the HOPP Act, which would restore payments to pre-Deficit Reduction Act levels, "you're adding more money into the system when there's no more money to be had ... I don't think going back to the way it was is a horse that's going to run."

It was provider Tammy Johnson, owner of Ablecare in Georgetown, Ky., who got the last word on the matter. "I agree with the gentleman from Georgia," she said, referring to Simmons. "I'd rather have two bullets in my gun."

HOPP Act supporters came away from the lobbying effort with more than 30 cosponsors for the bill. View the list on the congressional Web portal.

See the AAHomecare Web site for a summary of the oxygen reform proposal.

Have you obtained a DMEPOS surety bond yet? To vote in HomeCare's monthly Web poll, visit www.homecaremag.com.


PAOC Sets ‘Right Tone’ on NCB, but Will CMS Fix Flaws?
BALTIMORE--Industry representatives said they left Thursday’s meeting of the Program Advisory and Oversight Committee cautiously optimistic that their concerns about the myriad issues surrounding national competitive bidding had been heard.

There was, however, no doubt that CMS is intent on implementing the project, they said.

“I thought the meeting reviewed a number of important issues related to the operation of the program,” said Walt Gorski, vice president of government relations for the American Association for Homecare and a PAOC member. “I think we have a way to go, but clearly, the tone of this meeting was a step in the right direction.

“Keep in mind that CMS has no discretion. They have to move forward with this program under the mandate of Congress,” he pointed out, noting that only Congress can repeal the bidding project.

The 17-member PAOC was formed to advise CMS on the restart of the bidding program, with Round One now set to be implemented in January 2011 (see top story). The bidding window will open this fall.

The meeting included information on how CMS believes it has improved the online bidding system; program requirements and bidder responsibilities; financial documentation; licensure, accreditation and subcontracting requirements; new supplier issues; and mail order for diabetic testing supplies.

Seth Johnson, vice president of government relations for Pride Mobility Products, Exeter, Pa., said he, too, was somewhat encouraged by the session.

“Overall, I thought that Jonathan Blum, the new director of [CMS’ Center for Medicare Management], set the right tone and made it clear that the new administration wants to work with the industry in an open and collaborative manner,” Johnson said. Blum chaired the all-day meeting.

Cara Bachenheimer, senior vice president of government relations for Elyria, Ohio-based Invacare, was more cautious in her assessment.

“The PAOC did a really good job of pulling out some of the fundamental things CMS needs to address,” she said. However, she added, “It’s difficult to tell if CMS is going to take the PAOC seriously. That’s a question mark. It is very much an outstanding issue whether CMS is willing to resolve what consumers and providers see as fatal flaws in the program.”

While a number of serious issues remain, the meeting showed the agency at least seems open to hearing the concerns, other stakeholders said.

PAOC member Doran Edwards, MD, of Advanced Healthcare Consulting in Columbia, S.C., said the agency is working to elevate the caliber of bidders by requiring that they be licensed in the state where they are bidding to provide services before they place their bids. He also noted the bidding process should be more user-friendly. And he hopes some low-ball bids will be eliminated by requiring back-up documentation such as invoices and also by prohibiting the transfer of contracts when winning bidders sell their businesses.

New providers bidding for an area where they have never had a presence before will have some added restrictions, Edwards said. In addition to being accredited and holding a surety bond (both of which are required of DMEPOS providers by Sept. 30 and Oct. 2, respectively), they must be licensed where required, provide a plan of care and show they can handle the workload.

“These are all positive steps, and these are improvements that need to be done,” Edwards said.

Serious Issues Unresolved
Several critical issues that have not been resolved relate to awarding contracts to providers who have no experience in that product category or no presence in a competitive bidding area, and how CMS determines capacity for the CBAs.

“[The PAOC] clearly felt very strongly that you can’t possibly award a contract to someone who has no experience in that area,” Bachenheimer said.

During a public comment period, the point was hammered home by provider Rob Brant of City Medical Services in North Miami Beach, Fla., who told the group that someone new to the CPAP business, for example, would likely formulate a bid based only on what the equipment costs.

A bidder unfamiliar with sleep therapy would not take into account the total cost of providing the services, Brant explained, noting that only a provider experienced in providing CPAPs--those who are “learning to live with” Medicare’s new policies--would understand all the requirements, which now encompass multiple patient visits.

Another point of controversy was the financials requirement.

According to Brant, the PAOC "raised the issue about three years of financials being reduced to only one," he said. "The PAOC felt that this will allow unqualified companies without long-term history the ability to continue to place unrealistic low bids in order to win and make a name for themselves in the marketplace or to sell their business.”

But the day's central discussion focused on capacity, said meeting attendee Dave McCausland.

“Certainly the most discussed, debated and contentious topic of the day was ‘capacity,’ how CMS calculated capacity and how much a winning bidder could really grow and in how long. A major point of concern was situations where a winning bidder had little if any history for a specific product, within a specific competitive bidding area, and they were believed, assumed, expected to manage 20 percent of the market capacity,” said McCausland, senior vice president of planning and government affairs for The ROHO Group, Belleville, Ill. That’s “not really reasonable,” he said.

At question is how CMS calculated capacity in the initial Round One. The agency determined the number of winning bidders based on their stated capacity to grow their business, but stakeholders have argued the numbers of providers who won contracts to service the CBAs were way too few.

“They miscalculated the number of providers needed to service the beneficiaries in the competitive bidding area,” Johnson said. “They didn’t have enough to fill up the capacity bucket.”

During the comment period, McCausland suggested that CMS establish a minimum threshold “of demonstrated, historic capacity within the pool of bid winners, just like they have a threshold for a minimum percentage of small provider winners.”

Capacity “remains an issue to explore,” said AAHomecare’s Gorski, adding that and numerous other issues related to access and quality could be addressed as the PAOC meets again in the summer.

Johnson said CMS official Joel Kaiser noted the competitive bidding Interim Final Rule addressed only those changes stipulated under last year’s Medicare Improvements for Patients and Providers Act; the slowed timeline for Round One allows CMS to work with the industry.

In that time, Johnson said, “clearly, providers need to continue to educate their legislators on the negative impacts of competitive bidding and the effect on the beneficiaries they serve. That advocacy effort needs to continue.”

Working with the industry is what the PAOC intends to do, Edwards said. “We will try to remove the landmines before all this rolls out,” he said.

But Bachenheimer said she hopes the program will never roll out. “Nothing is set in stone as far as I'm concerned," she emphasized. "Obviously, we want to get rid of the program.”

An overview of the PAOC and a list of committee members are available on the CMS Web site.

Pull the IFR, Says HELP Committee's Brown
WASHINGTON--With Congress scrambling to put together health care reform--a draft bill circulated Friday by Massachusetts Democrat Sen. Edward Kennedy’s health committee would guarantee all Americans health insurance--stakeholders are uncertain how HME will be treated as the reform takes shape.

But Sen. Sherrod Brown, D-Ohio, told HHS last week DMEPOS competitive bidding shouldn't be a part of it unless the program is fixed.

In a June 2 letter to HHS Secretary Kathleen Sebelius, Brown said he was concerned because CMS has not made the changes necessary “to avoid the problems that occurred during last year’s bid process.

“In both the Cincinnati and Cleveland markets, two-thirds of the DME providers that bid to serve the areas were rejected,” Brown wrote. “Moreover, many of the bid winners did not have a physical location proximate to the service area, nor did many of the winners have a track record of the product and services [they] won …

“These counterproductive bid results occurred in all of the bid areas, not just Ohio’s, and are the reasons Congress delayed the bid program last year.”

Brown also told the HHS secretary that CMS should consider implementing an “any willing qualified provider” provision to “avoid massive business closures and consumer access problems.”

Brown, who serves on the Senate Health, Education, Labor and Pensions (HELP) Committee, which Kennedy chairs, urged Sebelius to rescind the competitive bidding Interim Final Rule “and understand how the bid program must be changed to be successful.”

The text of Brown’s letter follows in its entirety:

Dear Secretary Sebelius:

On January 16, 2009, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register an interim final rule on the durable medical equipment (DME) competitive bidding program. The rule took effect on April 18, 2009, and is related to Congress’ July 15, 2008 enactment of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

I am writing because I am concerned that CMS has not made changes to the competitive bidding program to avoid the problems that occurred during last year’s bid process. In both the Cincinnati and Cleveland markets, two-thirds of the DME providers that bid to serve the areas were rejected. The job losses associated with such extreme business disruption contravene the goal shared by the Obama Administration and Congress to stem U.S. job loss during these challenging economic times.

Moreover, many of the bid winners did not have a physical location proximate to the service area, nor did many of the winners have a track record of the product and services [they] won. Furthermore, many of the winners were not in compliance with state licensure requirements.

These counterproductive bid results occurred in all of the bid areas, not just Ohio’s, and are the reasons Congress delayed the bid program last year. We wanted CMS to reconsider some of the fundamental decisions that drove these outcomes.

I understand that when CMS issued the January 16, 2009 interim final rule, it was developed without input by affected parties. I urge you to take a close look at this rule and meet with affected parties and gain their input on how the bid program should be modified to avoid the problems of the 2008 bid program. For example, CMS should consider implementing an “any willing qualified provider” provision to avoid massive business closures and consumer access problems.

While the MIPPA provisions addressed near-term concerns with the program, we expected that CMS would conduct a more thorough, collaborative rulemaking process given the overwhelming level of Congressional and stakeholder concern during initial implementation. Congress intended that CMS actively engage all stakeholders to make substantive changes to the bid program before any further implementation of the program, including rulemaking.

I urge you to consider rescinding the January 16,2009 interim final rule and engaging stakeholders to understand how the big program must be change to be successful. I would be glad to discuss my concerns with you more in depth, and I look forward to working with you on this important issue.

Sincerely,
Sherrod Brown
United States Senate

AARP Endorses 'Empowered at Home Act'
WASHINGTON--At the same time AAHomecare was on Capitol Hill last week, so was the AARP.

The behemoth consumer group said it was pushing members of Congress to get behind the “Empowered at Home Act” (H.R. 2688) sponsored by Reps. Frank Pallone, D-N.J., and Diana DeGette, D-Colo., which would provide incentives for states to expand access to home and community-based services. AARP has also endorsed a bipartisan companion bill in the Senate sponsored by Sens. John Kerry, D-Mass., and Charles Grassley, R-Iowa.

According to the group, more than one million Americans are living in nursing homes, but many would prefer to receive the services they need in their own homes, where they would be more comfortable and save the health care system money in the long run.

“Unfortunately, many Americans who want to be cared for at home can't because of a costly institutional bias in Medicaid, which pays for nearly two-thirds of the country's nursing home residents,” an AARP statement said. “While state Medicaid programs are required to provide nursing home care, home and community-based services that are often less expensive are optional, leaving them first in line to be cut in a poor economy.

”AARP is working with members of Congress to end this bias that forces too many Americans out of their homes and costs us all too much.”

Research by AARP's Public Policy Institute has found 89 percent of people 50-plus want to remain in their homes as they age. Greater access to home and community-based services, along with the help of properly supported family caregivers, could make this goal possible for hundreds of thousands of people who otherwise face life in costly nursing homes, according to the group.

AARP estimates that on average, Medicaid can care for three people with home and community-based services for the same cost as one person in a nursing home.

More information is available in an AARP fact sheet.

Newsmakers
AAH Elects New Officers; Zelenko Tapped at PAMS
WASHINGTON--The American Association for Homecare has elected a new slate of officers for 2009-2010. Voted in during the association’s annual Legislative Conference Tuesday, new officers are:

• Chair: A.J. Filippis, president and CEO, Wright & Filippis, Rochester Hills, Mich.
• Vice Chair: Georgetta Blackburn, VP, government relations, Blackburn’s, Tarentum, Pa.
• Treasurer: Tom Ryan, president and CEO, Homecare Concepts, Farmingdale, N.Y.

Six new board members, whose terms will run from 2009 to 2012, include:

• Ron Bendell, president, VGM & Associates, Waterloo, Iowa
• Carter Fuller, President, Fuller Rehabilitation & Consulting, Ringold, Ga.
• Chris Kane, COO, Pacific Pulmonary Services, Novato, Calif.
• J.C. Kyrillos, senior vice president of sales and marketing, ResMed, San Diego
• Joel Mills, president and CEO, Advanced Home Care, High Point, N.C.
• Malachi Mixon, chairman and CEO, Invacare Corp., Elyria, Ohio

The association also named incoming council chairmen as follows:

• HME-RT Council
Joel Marx, Medical Services Company, Cleveland, will take over for outgoing chair Joe Lewarski, Invacare, North Ridgeville, Ohio.
The incoming vice chair is Robert Steedley, Barnes Healthcare, Valdosta, Ga.

• Medical Supplies Council
Randy Carson of Smith and Nephew, St. Petersburg, Fla., will replace Karen Kaczmarek of KBK Consulting, Boca Raton, Fla.

• Medical Gases Council
Continues to be chaired by Ruth Ann Ellison, Apria Healthcare, Canonsburg, Pa.

• Rehab and Assistive Technology Council (RATC)
Continues to be chaired by Tim Pederson, WestMed Rehab, Rapid City, S.D. The incoming vice chair is John Letizia, Laurel Medical Supplies, Edensburg, Pa.

• Regulatory Council
Continues to be chaired by Kimberlie Rogers-Bowers, Apria Healthcare.

• State Leaders Advisory Council
Continues to be chaired by Rose Schafhauser of MAMES, with Carol Napierski of NYMEP as vice chair.

Zelenko Tapped at PAMS
PITTSBURGH--Tammy Zelenko, president and CEO of Bridgeville, Pa.-based AdvaCare Home Services, was voted in as president of the Pennsylvania Association of Medical Suppliers at the state association's annual convention in April. A 21-year veteran of the home care industry, Zelenko purchased AdvaCare in 1999 and has grown the respiratory and sleep company to three Pennsylvania locations and two sleep labs. (For a rundown on the business, see "A Grand Plan," HomeCare, July 2008.) Zelenko also serves on Harrisburg, Pa.-based PAMS' legislative and continuing education committees.

Barker Hires On at MRC
NEW YORK--Joseph Baker has been hired as president of the Medicare Rights Center, a national nonprofit consumer organization that works on access to health care for older adults and people with disabilities. Baker served as a senior policy advisor in the administrations of New York Govs. David Paterson and Eliot Spitzer. “We are thrilled to have Joe Baker take the helm of the Medicare Rights Center at a time when fundamental reforms to our health care system are on the national agenda,” said MRC Board Chairman Bruce Vladeck, former administrator of the Health Care Financing Administration (CMS' predecessor) in the Clinton administration. Baker replaces Robert M. Hayes, who stepped down in February after seven years as president and general counsel.

HME Company Newswire
Cape Medical Builds Better Mousetrap; Integrated Medical, OT Thank Vets
SANDWICH, Mass.--The Cape Medical Supply team has won the 2009 SCORE “Build a Better Mousetrap” award from the Sandwich, Mass., Chamber of Commerce. Founded in 1977, the company has added stores in Plymouth, Falmouth and most recently Hyannis, Mass. According to the award announcement, "In addition to innovative and meticulous business practices, Cape Medical Supply is known for generously supporting the community through sponsorship and participation." In 2008, the company won the Cape Cod Business Philanthropy award from The Planned Giving Council of Cape Cod. CEO Gary Sheehan called the Mousetrap award "a tremendous honor."

Integrated Medical, OT Thank Vets
CUYAHOGA FALLS, Ohio--With more than 125 physical therapists, occupational therapists, speech therapists, nurses and social workers in attendance, Integrated Medical themed its annual educational seminar for area medical staff around the military and veterans. Speaking at the event, held May 29 preceding the Memorial Day weekend, Liz Stevens, an occupational therapist with Santera Rehabilitation, Bristol, Tenn., contributed her services and asked instead that a donation be made to local charities. Integrated Medical donated $1,000 each to the Paralyzed Veterans of America and the Disabled American Veterans in her name. The 10-year-old DME has Ohio locations in Cleveland, Kent, Mansfield and a new retail store in Mount Vernon.

In Brief
Heard at AAHomecare's Legislative Conference
WASHINGTON--As usual, HME providers, manufacturers and speakers attending the American Association for Homecare's Legislative Conference last week had plenty of subjects to talk about, and plenty of opinions:

On HME’s message to Congress:
“We’re not really fraudulent. We’re not overpaid. We’re a small percentage of the whole pie. We’re the solution, not the problem. Health care costs are going up. The demographics are there that home care needs to be there. It doesn’t make sense to eliminate 90 percent of the providers when there’s going to be more demand. I would just like my congressmen to get that.”
--Patrick Hanna, BK Home Medical Services, Tiffin, Ohio

On competitive bidding:
“I’ve been deeply involved in your problems with competitive bidding … The experience in Pittsburgh was disastrous. It appears that the administration is heading for competitive bidding again. Well, it can be done sensibly or it can be done foolishly, as they did it last time … Now is the time to act.”
--Sen. Arlen Specter, D-Pa.

“I think the competitive bidding train is on the track. We have to work to come up with best implementation plan of that through the PAOC … but my real hope is that it won’t turn out OK and it will fall on its face after being implemented. I think it’s a flawed policy, and my hope is that Congress and CMS will see that and enact laws to change it in the future.”
--Joel Mills, Advanced Home Care, Greensboro, N.C.

“My biggest fear is that we will see the same low bidding as we did in Round One.”
--Dave McCausland, The ROHO Group, Belleville, Ill.

“I can’t think of one thing good for the patient about competitive bidding.”
--Joel Marx, Medical Service Co., Cleveland

“There is no tomorrow. There is no coming back. This is a death knell coming toward our industry.”
--John Gallagher, VGM, Waterloo, Iowa

On how CMS perceives the industry:
“You are all overpaid and competitive bidding validated that … There is just a perception that it’s an unethical business.”
--Thomas Barker, Foley Hoag, Washington, and a former CMS staffer

On the oxygen cap:
“The reality is, as people start to struggle and businesses start to fail, where are those patients going to end up? Providers aren’t going to take on a patient with no reimbursement; someone else already got the payment for 36 months. It’s only going to affect the patients.”
--A. J. Filippis, Wright & Filippis, Rochester Hills, Mich.

On support of long-term oxygen reform:
“I’m willing to roll the dice on oxygen reform even with the unknowns in it because I think that whatever would come out of oxygen reform, if it becomes law, would be better than the current state.”
--Scott Lloyd, Extrakare, Norcross, Ga.

"Philosophically, legislatively and business-wise, this is the best horse for us to get on. There are certainly differences of opinion and every one is valid, but we need to be mindful of the timeframe."
--Don Clayback, The MED Group, Lubbock, Texas

On support of the HOPP Act:
“What is real and in front of us is the 36-month cap, and I’m playing off that with the idea of let’s do something now to keep moving forward and … look at oxygen reform down the road. You have to do something to keep everyone in the game so we can achieve that goal, which is to reform the way oxygen is reimbursed.”
--Wayne Knewasser, Premier Home Care, Louisville, Ky.

“The HOPP Act is something I feel like we have right now. I can go to Capitol Hill and talk to my congressmen about something that is already there that they can vote on, whereas reform is something that is coming … I’m also going to talk about reform and let them know it’s coming down the line and we’ll appreciate support for that, too, but right now we need to concentrate on what we have.”
--Tammy Johnson, Ablecare, Georgetown, Ky.

On health care reform:
“Congress has traditionally under-funded the ability to get treated at home … If a patient decides that home care is the best option, why should the government be in a position to say no?”
--Sen. John Cornyn, R-Texas

On lobbying in Washington:
“Certainly I think it’s worthwhile. If we choose as an industry not to do this, we place ourselves at risk. We will never be heard.”
--Jason Jacobs, Barnes Healthcare Services, Valdosta, Ga.

“Between Oregon and Washington, we have had 16 legislative visits. We have written many letters to all of our legislators but we haven’t gotten a strong opinion back as to where they stand. So we are playing a little bit more hardball, and the purpose of this trip is to get a definitive answer as to whether they are supporting our organization’s causes and issues or whether they are not. We hope the response from our legislators when we see them in their offices is going to be more positive.”
--Tom Coogan, Care Medical and Rehabilitation Equipment, Portland, Ore.

On keeping up the effort:
“There is a whole new administration and a lot of new legislative aides, and it’s overwhelming how much work we have to do in explaining to these new young aides in Washington what’s going on. It’s kind of like starting from scratch, but we have to do it.”
--Carol Gilligan, Health Aid of Ohio, Cleveland

To revisit this news any time during the week, go to www.homecaremonday.com.

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