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By Robert Steedley
Robert Steedley is vice chairman of the American Association for Homecare

Earlier this month, the home medical equipment sector had the opportunity to present the case against competitive bidding at a hearing before the House Ways and Means Health Subcommittee. The American Association of Homecare was represented, as was NAIMES. Both did a great job articulating the critical issues and concerns for providers and patients.

But unfortunately, as we have seen over and over, we also saw a split message presented to Congress. Also testifying was an Ohio provider who praised the bidding program and a group purporting to represent Medicare beneficiaries that also supports the current Medicare bidding system.

As I watched the video of the hearing, I tried to put myself in the place of the members of Congress listening to testimony. What were they thinking? Did they see a united sector working dynamically to improve a flawed program? Or did they see two very different points of view from within HME that left them wondering if one side is just whining? And then what comes next? Those members of Congress have to decide, even if the decision is to do nothing.

All of this left me deflated and angry, knowing about all the hard work that goes into HME meetings with members of Congress and their staff, the clear dangers that the bidding program presents to patients, the phone calls and emails. Plus there are a lot of humble, quiet providers who have worked tirelessly behind the scenes to furnish the best care possible to beneficiaries—while Medicare continues to make that job harder and harder. This shows a real disconnect between all this work to improve homecare policy on one hand and the efforts to derail the whole effort by a small handful of companies. Is AAHomecare in the minority? Does the HME sector want bidding to this bidding program to continue? These are the questions that every provider needs to answer now.

Any further dissent or split message is, in my opinion, a death sentence to a lot of HME providers, which will have terrible consequences for home-based care in America. And I don’t believe the burden should be on AAHomecare to get everyone on board. I want AAHomecare to spend its time and resources influencing policy that benefits the HME sector—not trying to corral its members or other providers.

How long can we tolerate a passive, hands-off attitude among HME providers? When is enough enough?

As an HME provider, I implore every HME company to get in the fight now! Membership with AAHomecare is the best course for supporting this fight. But if you choose not to be a member, at least don’t work against the very organizations and people who are working on your behalf. You can help by holding other providers accountable for their actions.

Time is short and our options are narrowing. But in the face of those factors, many people in our sector are throwing their full weight behind efforts to fix the bidding problem and preserve access to cost-effective care for our seniors.

Dave Bargmann
Social media consultant for Duckridge Advisors

While it’s a great thing that more and more companies are jumping aboard the social media bandwagon every day, most providers in the home medical/durable medical (HME/DME) arena still aren’t really grasping the point of doing so and, therefore, missing out on huge opportunities to engage the target audience (patient, referral source, etc.).

OK, so your DME organization may have a Facebook page with the bare minimums filled in and consider your organization social media savvy. That, folks, is not embracing social media.

There’s a finite distinction between social media marketing, and marketing via social media. Social media marketing requires a specific strategy, and most importantly, content designed for each individual platform.

Simply using social media to send out traditional “old school” marketing will not do the trick. When a provider distributes information on social networks, it is not social marketing, specifically if the provider is simply sending information on its latest products for sale, feeding miscellaneous news to its Twitter stream or asking people to simply “Like” your company on Facebook or “Follow” it on Twitter on a weekly basis. This becomes a one-way street that is simply forcing information out, versus engaging your patients and referral sources.

What you need to create is a two-way conversation!

While there are not that many DME providers on Twitter from my analysis, I follow as many that pop into the “Who to Follow” area (Twitter accounts suggested for you based on who you follow and more) and find most are doing social media without attempting to be social. Twitter is perfect for providing 140 characters that can engage your followers in conversation. And produce the end goal of being social via a very cost-friendly medium.

One-way social media marketing draws attention to the fact that you don’t know how to properly utilize this particular space, and that you haven’t taken the time to learn it, or find someone qualified to do it for you. This may gain you followers from the adult film arena, but not from your target audience!

Even more importantly, old-school marketing using new-wave techniques can have the tendency to be viewed as spam, and I haven’t met many that appreciate spam in any form.

Keep in mind, there is absolutely nothing wrong with using traditional marketing to get the word out about your offerings. Press releases, advertising, visits to referral sources, etc. are still extremely valuable for your overall marketing initiative.

Is your marketing sociable…or unsociable?

These days, you have to consider that traditional marketing was a one-way street. Providers would produce a press release, take out an ad in an industry-related or local newspaper or buy billboard space. Their customers would then view it in one of the aforementioned forms, then decide what, or if, they would do anything with the information. Then, based on analytics derived from history, a percentage would respond to the marketing techniques. But there was one important point…the customer could not talk back to these forms of marketing.

Now they can. Social media, in contrast to traditional marketing, is a two-way street. DME providers can still use Twitter and Facebook to distribute the same information they always have, but today, the customer now has the ability—and the willingness—to talk back.

This version of marketing actually permits your customer to tell you how your message is being received. Yes, you heard that correctly. They will tell you if it is right…or wrong! And while this can lead a DME owner to be scared stiff, it provides a lot of new functionality for providers to connect with their audience in new ways not available previously.

Remember, social media is not meant to replace the human touch or interactions with your customers. It provides forums to enhance the patient experience in ways never before available.

However, in the end, if you’re not listening, responding to and engaging with your followers via social media, you’re missing the point, and ultimately, a larger opportunity.

Elizabeth Hogue
private practice healthcare attorney

Section 302 of the Affordable Care Act (ACA) includes provisions related to Medicare payments to providers of services and suppliers that participate in Accountable Care Organizations (ACOs). Providers of services and suppliers who participate in ACOs will continue to receive payments under Parts A and B of the Medicare program, but will also be eligible for additional payments if they meet certain requirements related to quality of care and cost savings. The Secretary of the U.S. Department of Health and Human Services has published final regulations establishing ACOs as early as April of 2012.

The final regulations generally provide as follows: The ultimate goal of ACOs is to reward better value, outcomes, and innovations instead of just volume.

The purposes of ACOs are to:

  • Promote accountability for a patient population;
  • Coordinate items and services under Parts A and B of the Medicare Program; and
  • Encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery.

Groups of providers of services and suppliers that meet criteria specified by the secretary may work together to manage and coordinate care for Medicare fee-for-service (FFS) beneficiaries through ACOs. ACOs that meet quality performance standards established by the secretary will be eligible to receive payments for “shared savings.”

Patients who are assigned or “aligned” with physicians who participate in ACOs are not required to receive services from such physicians or from any other participants in ACOs. Patients who are aligned with physicians in ACOs still have the right to freedom of choice of all types of providers. CMS emphasizes this fact in commentary to the final regulations governing ACOs as follows:

“It is important to note that the term ‘assignment’ for purposes of this provision in no way implies any limits, restrictions, or diminishment of the rights of Medicare FFS beneficiaries to exercise complete freedom of choice in the physicians and other health care practitioners and suppliers from whom they receive their services. Thus, while the statute refers to the assignment of beneficiaries to an ACO, we would characterize the process more as an ‘alignment’ of beneficiaries with an ACO, that is, the exercise of free choice by beneficiaries in the physicians and other health care providers and suppliers from whom they receive their services is a presupposition of the Shared Saving Program.”

The following types of providers are eligible to participate in ACOs:

  • ACO professionals, i.e. physicians in group practice arrangements
  • Networks of individual practices of ACO professionals
  • Partnerships or joints venture arrangements between hospitals and ACO professionals
  • Hospitals employing ACO professionals
  • Such other groups of providers of services and suppliers as the secretary determines appropriate (emphasis added)

According to the commentary to the final regulations, ACO participants are defined as any Medicare-enrolled provider or supplier, including pharmacists.

Eligible groups of providers of services and suppliers must meet the following requirements to participate in ACOs:

  • Must be willing to become accountable for the quality, cost, and overall care of at least 5,000 Medicare FFS beneficiaries assigned to it.
  • Must enter into agreements with the secretary to participate in the program for at least three years.
  • Must have formal legal structures that allow receipt and distribution of payments for shared savings to participating providers of services and suppliers.
  • Must include primary care ACO professionals i.e. physicians and advance practitioners that are sufficient for the number of Medicare beneficiaries assigned to the ACO and ACOs must provide the secretary with information about participating ACO professionals.
  • Must put clinical and administrative systems in place and define processes to promote evidence-based medicine and patient engagement, to report on quality and cost measures, and to coordinate care.
  • Must demonstrate to the secretary that they meet criteria related to “patient-centeredness,” such as the use of patient and caregiver assessments and individualized care plans.

Reports related to quality must address care transitions across healthcare settings, including post-hospital discharge planning and follow-up by ACO professionals.
ACOs may also be responsible for excess expenditures.

At this point, ACOs seem to involve great opportunities as well as great risks. hme

Elizabeth E. Hogue, Esq., is a private practice healthcare attorney in Burtonville, Md. Reach her at 877-871-4062.