The rehab industry is starting 2009 in a much different place than where it began in 2008. Complex rehab has been permanently exempted from any future rounds of DME competitive bidding, but payment levels were reduced 9.5 percent in January. While 2009 promises to be a busy year filled with opportunities, it will also require the industry to be united to successfully address the challenges that remain ahead. A new administration took office last month, and health-care reform is a top priority. What are the opportunities and what actions will be necessary for the industry to move forward in 2009?
Change Perception of Industry Through Promotion of Higher Standards
In assessing our opportunities, it is important to look at what roadblocks need to be removed to enable the industry to keep the focus on being a cost-effective part of the overall health-care solution.
Regardless of the type of equipment or service your company provides, many in Congress hear about pockets of fraud in certain areas of the country and paint the entire industry as fraudulent. To proactively change this perception, AAHomecare has retained a public relations firm to promote the industry’s support for tougher and more effective measures to combat fraud and abuse.
The success of this PR initiative is extremely important to finally get out from under the cloud of government mistrust the industry has experienced in recent years. Promotional materials and other resources will be available to help articulate the industry’s zero tolerance for fraud. This effort should build a relationship with the new administration based on mutual trust and support of its health-care reform objectives.
Parallel Exemption from 9.5% Reduction
In an effort to secure a parallel exemption for complex rehab, consumer groups and other stakeholders are continuing to articulate, via letters and other communications to key committees on Capitol Hill, the changes that have resulted from the 9.5-percent funding reduction.
While support for the exemption has been building, the biggest challenge has been identifying an appropriate legislative vehicle for the exemption. Numerous consumer and industry organizations have communicated their support for the exemption, which has kept the issue fresh in the minds of policy-makers. Yet it is important for all stakeholders to convey to legislators the impact of the reduction based on your own experience. Past successful lobbying campaigns included active participation from all stakeholders — consumers, clinicians, providers and manufacturers. Attaining this exemption will require nothing less.
New Administration Health-Care Priorities
The new administration has placed a high priority on reforming health care and Medicare. While (at press time) the new administration had not released its own detailed proposal, the information provided during the campaign provides a framework for the anticipated reforms.
One of the primary reform objectives is to expand health-care coverage to significantly reduce the number of uninsured. Clearly, if Medicare or some other government-backed health-care system is available to more Americans, that should be a positive for the industry, as long as adequate coverage is provided.
In addition, the new administration has proposed spending in excess of $50 billion on health-care information technology (IT). This would hopefully provide the resources necessary to adopt and fully integrate e-health records and e-prescribing protocols into the health-care system. This provides opportunities for the industry to increase operational efficiencies and reduce costs.
E-prescribing also provides a real opportunity to work with the new administration on the development of a platform that could both strengthen front-end review of claims data, while at the same time provide more certainty to the documentation process once the claim is paid by Medicare.
Yet another opportunity for the industry is the new administration’s focus on improving the use of prevention and management of chronic conditions to help control health-care costs. Clearly, the industry has a positive cost-effectiveness message to articulate, which puts the industry in a position for future growth in the continuum of care.
Unified Industry Voice
The industry has been successful in achieving positive outcomes in the past due to a strong, targeted and unified message to Capitol Hill and/or regulators at The Centers for Medicare & Medicaid Services. While the rehab community itself has been instrumental in identifying the issues and developing the message to help move the industry forward via NCART, NRRTS, RESNA and AAHomecare’s Rehab Council, a stronger collaboration will strengthen our ability to continue to take the industry to the next level.
Each organization has a unique role to play in crafting and articulating a message that complements the overall industry objective, but closer collaboration will send a clear, strong message to Congress and prevent policy-makers from using our differing views as a reason to do nothing. Ensuring our industry organizations have the resources to convey a unified message will take that convenient excuse off the table, and yield an environment where the industry can move forward and succeed.