2010 DC Recap: Busy, Interested, Afraid and Hopeful

Last week marked another trip to DC to meet with federal legislators to discuss the work we do and patients we serve, as well as review some current legislation which is moving through the House, H.R. 3790. It was a busy trip and I’ve been glad to see some strong momentum on H.R. 3790 since we left DC, with over 20 new representatives having signed on their support.

The trip started on Monday afternoon as my brother and I travelled Boston to DC – all went smooth in that department which is an A+ in my book these days. We arrived at the hotel in time to mingle with other conference attendees and get their perspective on how things are going in their companies. With attendees from all over the country you get a very unique perspective on what impact national issues are having on them (both macro-economic conditions and more healthcare specific policies) as well as what localized issues they are being impacted by, like their state Medicaid changes or issues with their private insurance partners. The general consensus seems to be there are a lot of headwinds on success at the moment, but those companies that are working hard, trying to be innovative and focusing on servicing their patients and referral source are finding modest success – which is all we can ask for or expect these days.

Tuesday’s conference featured a number of great sessions, including appearances by several elected officials; Congressman Jason Altmire (D-PA) and Senator Amy Klobuchar (D-MN), additionally Congressman Heath Shuler (D-NC) spoke on Wednesday morning. Also presenting were members of both the Republican and Democratic National Congressional Committees; the sole focus of each being to elect members of their respective parties to Congressional seats. Each laid out a specific set of strategies, broad game plan, and dove into the weeds a bit to discuss some of the specific seats they are targeting and where they feel they have strong potential in the upcoming mid-term elections. Obviously the surprise election of Scott Brown in MA was a topic of conversations amongst presenters and attendees alike – general consensus being, if MA elects a Republican to the Senate, what other surprises are in store for 2010?

Without a doubt the most interesting presentation of the day came over lunch when Jonathan Blum from the Centers for Medicare and Medicaid Services (CMS), the agency which oversees and implements Medicare policy and lives underneath the broader umbrella of Health and Human Services, presented information on the Medicare “Competitive Bidding” program to a fairly hostile audience. The ‘Competitive’ Bidding program has been roundly criticized since it was initially crafted; however remains a dangerous and potentially immensely destructive piece of legislation.

The essence is this; DME providers will submit bids to Medicare on products and services they will provide to beneficiaries in a given area, lowest bidder wins, those who don’t win can no longer service Medicare beneficiaries in that region. Perhaps good when you’re buying paper cups for state government, not so good when you’re talking about complex healthcare services, delivered in the home and designed to save tremendous amounts of money by keeping recipients out of skilled nursing facilities and reducing hospitalizations. Once enacted the program promises to create oligopolies who have a financial disincentive to provide high quality care – they have a guaranteed contract and the majority of their potential or existing competitors have been entirely shut out of the market…great idea, can’t you wait to be serviced by a company that ‘won’ a competitive bid in your area?

So it took some bravery for Mr. Blum to attend; he did his best to defend what is an inherently flawed and broken program, and he made clear that despite all objections, fallout, and forecasted issues, that they are committed to moving the program forward – logic be damned, we’re doing it! There was ample time for Q&A, during which Mr. Blum reiterated his belief in the wisdom of the program as well as his pledge that the agency was committed to enacting it ASAP and without further delay. It was a frightening look at the decision making and analytical skills that are driving governmental policy and it gives me great pause as a citizen to know that our appointed officials are acting in such an arrogant, short-sighted and egotistical fashion. The general attitude was “we know better than you” and “who cares if some businesses fail or patients lose access.”

Tuesday evening was a great group dinner with all the attendees from NEMED, approximately 13 of us. Also there was Ms Wheelchair MA 2009, who delivered an eloquent speech to the conference that day and provided great first person testimonials during our Hill visits on Wednesday.

Wednesday we started by meeting with the office of Senator Scott Brown and were privileged to get several minutes with Senator Brown himself who was jovial in his basement hallway offices (temporary as Senator Kennedy’s offices are refurbished for his arrival) and was very receptive to our overall message, which was essentially this; homecare is the most cost effective and patient preferred healthcare setting, don’t destroy the landscape through bad legislation and expect overall costs to go down, they will inevitably be driven higher as more patients require care in institutional and residential settings. From there we were on a whirlwind of meetings with all of the following; Senator Kerry, and Congressmen, Lynch, Delahunt, Markey, Burgess, Frank, and Capuano. We are still pushing MA Congressman Lynch, Capuano and Markey to join with 173 bi-partisan members of the House and support H.R. 3790, time will tell if they get on-board – though there were assurances to at least take a hard look at it.

From there it was to the airport and home…overall another great trip and worthwhile experience. We continue to build strong relationships and work towards a much greater understanding of the issues impacting our companies, our patients and our employees – and how those issues relate to overall healthcare spending, the federal budget and to the complexities of the current healthcare reform debate which is winding it’s way through the House and Senate.

One of the highlights of the day had to be sitting in Congressman Lynch’s office waiting for our meeting and watching TV as President Obama deliver a comprehensive address on the healthcare reform process. It was not the content of the delivery which struck me, but the fact that I was sitting in a Congressman’s personal office in DC, watching the President, a short way up the road, address the nation on one of the very issues I was there to discuss, healthcare. Much remains to be hashed out, but to say it has been an interesting environment in healthcare over the last 18 months would be a wild understatement. We remain both hopeful and fearful of the eventual legislation which comes forward, but one thing we have proven we won’t remain is quiet. You can count on us continuing to work to protect our patients’ access and telling the story of the great work done day in and day out by our industry…we have far too much pride to handle it any other way!

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