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Rate relief

May 08, 2021 2:58 PM | Anonymous member (Administrator)

Let’s talk about rate relief. Everyone agrees that Medicare and other third-party party payers must recognize the huge costs increases that the HME industry has been forced to absorb during the pandemic, and which will persist after the PHE.

The HME industry is better known and has an improved reputation because of our response to the covid crisis, but unlike most other entities supplying health care services, we have little fixed cost and no ability to increase our charges to cover increases in variable costs, as our rates are fixed by the payers.

Medicare rates, on which most third-party payer rates are based, remain at levels set by an admittedly flawed bid system that contributed to the loss of more than 40% of HME locations is Alabama in the past ten years. We are presently asking our legislative delegation to support continuing the slight rate increases granted because of the PHE after the PHE ends—and that’s the message we ask you to convey now.

All we are asking for is to keep rates the same as they are now, with a 50/50 blended rate for rural and 75/25 blend for non-bid, non-rural. The blend is based on 2016 rates and average regional bid rates.

Industry leaders have agreed to look for the greatest possible increases we can get our Congressional champions to support and that can be sold to Congress. The lowest amount under consideration for bid areas is a 90/10 blend, effective as soon as possible, while an effort already underway continues to develop a sustainable bidding system that won’t risk wiping out more providers.

All affected national organizations and most local trade associations are doing a good job lobbying for agreed-upon goals. One of the weakest parts of this process is meaningful support from constituents. There is a great need, in my opinion, for a greater number in two groups—those who will regularly take part in making calls and sending emails in quickly in response to requests for such support for a named effort, and those who will make a consistent, concerted effort to get acquainted with members of Congress and key members of their staff and keep our issues on their minds regularly.

Neither group would need to lobby in the traditional sense. Others will define and explain the issues, keep members and staff apprised of current events affecting our issues, such as “Dear Colleague” letters and legislation, and do all or most of the talking at meetings. Given the huge, undeniable effect on our industry by all governments and rule-making, rate-setting regulatory bodies, such as CMS, it’s amazing how few are willing to budget and time or treasure in helping with these efforts.

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