Sunday, May 30, 2010

Aging in Place

Aging! It just happens. Suddenly Congress has taken notice of this. Is it a problem? The Senate appears to think aging is and so do I.

The Senate Special Committee on Aging held a hearing aptly called “Aging in Place.” I am not sure if their efforts will lead to any new legislation to work with this population, which has been slowly growing very grey. However, Iare very pleased because Ifeel this is where they can certainly do some good.

Aging means that more people are enrolling for Social Security and Medicare. The Senate is seeking a means of “lowering Medicare costs.” How much being spent and wasted is of concern to both the payers and the recipients? Available dollars are rapidly diminishing.

I would like to offer some ideas to help bring the costs down. One recommendation can be licensing DME/HME providers. To participate, a provider must show they are health care professionals and are familiar with all the legislations in place. Accreditation is a good start. I feel that all DME/HME providers should be licensed. When a dealer is caught doing something illegal, the license can be suspended or revoked. The amount of money this would cost is many times less that the fraud and abuse which is sucking out lots of dollars.

If you can, speak to the HLA at your Senator’s office in DC and request they will send you all the pertinent information they can. Use this in your discussions with other health care professionals, since all facing the same restrictions.

Become Lean

America has the reputation of having the largest “overweight” population. I want to see how HME providers can help reduce his problem.

I met with a provider from the Midwest who started a very interesting program. He spoke to several health care providers in his community to discuss how to attack this growing situation. They decided to jointly sponsor a “become lean” Saturday morning event in the provider's showroom. They set up the showroom with several weighing stations. They put up a display of small home scales with the prominent price sign. They ran some advertisements and to their very pleasant surprise in the four hours scheduled they saw nearly 100 people.

They have repeated this program every few months and it has proven to be a good traffic builder and a great many of the people who attended have remained as customers.

Speak to some local physicians, dietary personnel and nurses to work with you. America has become weight conscious and this presents an opportunity.

Health Care Bill (part three)

Lowest common denominator! It appears that the government, rather than looking for a way to improve the services available for Medicare recipients, is looking for the cheapest way out. When the fees for supplies were first announced they were based on the best quality equipment available. A walker was reimbursed originally as if the patient received a Lumex, an Invacare unit or an equal. But, unfortunately too many dealers found that they could provide a cheap offshore knock-off and still receive the same fee. Why? There are no standards!

Now there will be more and more competitive bidding programs all through the market. Every Medicare patient will now receive the very bottom of the barrel products, the lowest common denominator. This is wrong. American citizens deserve better.

With a competitive bid there should have very strict standards and a floating schedule of fees. If the provider provides a cheaper unit, they should receive a lower reimbursement. We owe it to the country to not allow Medicare fall to the lbottom of the barrel.

You have to join the battle to put an end to some of the ludicrous proposals. If you are not a member of your state DME association or a national association, you must become one. They are fighting to protect you and unless you are on board with them they will not be able to succeed. Get on the bandwagon and fight against Medicare becoming the “lowest common denominator.”

Health Care Bill (part two)

Yes, as we are all aware, the Comprehensive Healthcare Reform Bill was passed by Congress and signed by the President. It will create some new opportunities for DME/HME providers. The opportunity that Isee comes from the fact that perhaps as many as 32 million citizens, who do not have any healthcare coverage today, will soon have it. They are all potential customers.

This will be happening in 2014, so you have a few years to build a stronger base. One way is for prvidersto make their location a hub for healthcare supplies. Holding regularly scheduled open house days in your showroom, checking blood pressure, blood sugar, washing wheelchairs and holding seminars offering weight reduction programs are some of the things you know. There is no end to the disciplines you provide. Make these become magnets to draw customers to your showroom.

Make yourself and members of your staff available as speakers to all civic and church associations in your community. Provide the coffee and doughnuts at their meetings. All you want in return is to have a table in the rear where you can hand out goodies and literature. This is a simple way to build sales, goodwill and make your company name a prominent one in the community. Use the local newspapers and radio or even TV to announce your open houses. Advertise your products in conjunction with preferred vendors. There is is so much is available to help you build your company, so take advantage of that. This will attract all of the potential new customers, keep your regular customers happy and build new and larger sales by the goodwill it will develop.

Health Care Bill

Heath Care Bill

The new legislation to provide health care for all has become a problem for DME/HME dealers. They have asked how to respond to questions from their customers. A number of the phone calls I received the last few weeks indicates there is a great degree of misunderstanding about this legislation. This has happened as a consequence of the large number of misleading comments that have come from both the right and the left.

People are going to their DME/HME provider because they are seeking answers rather than political opinions. Our main concern is that what ever you may say or write regarding this law might be offensive. This is the last thing you need. No provider can afford to lose a customer!

Being aware of this you should consider taking the role of supplying information. Instead of making the mistake of trying to give answers to your customer, explain what you understand. Customer “A” might be far to the left and customer “B” to the right. Explaining legislation is difficult. You cannot answer most questions, since many newspapers and magazines are not able to.

One of the providers we saw at Medtrade said he had been invited to speak to the men’s club at the church he attends. Even though he was hesitant, he went. There he made a lot of friends because as he reviewed segments he showed many misleading "horrors." Yes, what they heard was correct but not with all of the facts. Far too many comments were taken out of context!

Before you start, inform your customer that you and your company find yourselves facing many unfair reductions in reimbursements and even having some being taken away. This will bring you to the same level as them.

Politics is a dirty business, but by showing the actual wording of the legislation your customer will appreciate what you say. Then their understanding can be based on facts. For that you will receive their thanks.

The first point to make is the government has stated that health care benefits will remain the same. That is so, but what we see is that the dollars for each service may be different.

Question: Will my taxes go up?

In 2013, couples earning more than $250,000 or individuals $200,000 annually will see an increase of 0.9%. If you have to take some money out of your health savings account other than payment for medical expenses, that sum will be taxed 20% instead of 10%. Today you can take a tax deduction if your medical expenses exceeded 7.5 % of your income, in 2013 that will increase to 10%.

Question: I belong to a Medicare Health plan, will that be changed?

Traditional Medicare providers have always received payments, which are little less than the plans get. This will be changed and new standards will be set for the plans. Under the new legislation they must spend at least 85% of the money they collect from premiums. However, co-payments will be the same for both.

Question: Can I get the same coverage Congressmen receive?

Starting in 2014 members of congress will have to buy state-run insurance.

Question: We understand that illegal immigrants can get the same coverage I do?

The new law specifically states that they (illegal immigrants) are prohibited from buying health insurance.

Question: Part of my earnings is being in a health plan provided by my employer, will that continue?

You will not be obliged to join a new government or other plan. You will be able to maintain what you have currently. Children under the age of 19 are covered and if your employer has a different family plan, now adult unmarried children will be covered until 26. Ask your employer for more information on this topic.

Question: I have been turned down for a pre-existing condition, will that change?

If you have been unable to obtain insurance for six months or longer you will be allowed to purchase into a so-called high-risk program, which sets limits for out of pocket costs. In 2014, insurance will be available. On the same topic, if you have paid your premiums health plans cannot limit what you spend starting in 2014 for your entire life.

Question: I see that as I age the cost of my insurance goes up, will that continue?

A limit of not more that 3 times the premium charged to a young person can be tacked on as one ages? (Note: this is confusing because we do not know the minimum).

Question: Will I be able to choose the health plan I want or will I be forced into one?

Each state, starting in 2014, will prepare a list of those plans they accept. You will be allowed to choose the one you desire and your annual out-of-pocket expenses will be limited.

Question: I work for a very small company. Will they be able to provide health insurance?

If your employer already has a policy in place there will be no change. A company with less than 25 full time employees will receive a tax benefit of 35% of the premium they pay. In 2014 this will go up to 50%. Starting next year small companies can apply for a grant to be able to provide coverage. Employees with companies that do not provide health coverage, an exchange will be established in 2014 that will allow those employees with moderate or even low incomes to obtain coverage.

We could go one with many more Q & As, but the idea of this is for you, the DME/HME provider, not to find yourself in a discussion with your customers that will hurt your relations with them. This can involve you in politics and that is not the same as giving a neutral opinion. When a tricky question comes up, provide them with the telephone or e-mail address of the HLA (health legislative assistant) in either the Senator or Representatives office. If you do not have this information, contact AAHomecare or your state association and they will provide it to you.

Question: Where will the money come from to pay for all of this?

This is the hardest to answer; the government believes that they can save close to $400 billion while still protecting citizens over the next 10 years. Point out that your customer can change their plan annually. There will be standards for both the plan and the participant. Coverage for prescriptions will see the doughnut hole change and the recipients obtain even larger discounts, Children up to the age of 26 will be covered in the family plan.

What you want to impress is there will be a limit to out-of pocket cost and a great many Americans who currently do not have coverage will now be able to obtain the same.

Istrongly recommend that you contact your state DME association and AAHomecare for more information. Please support them by becoming a member if you are not one now. By working together with these associations they will protect you and your company.

Whatever you do please do not allow yourself to get caught becoming a politician. Your role is to direct your customer elsewhere without losing their goodwill.
Welcome to Shelly Sounds Off. Shelly Prial has 60 years of experience in the home medical equipment industry and is an icon who has earned the respect of thousands of providers. Shelly Sounds Off will regularly provide his insight on the current issues facing the HME industry and will offer strategies and tips for providers who are eager to expand their business and improve the care of their patients.