1 / 34

Springfield Legislative Update

Stay informed about healthcare initiatives and their impact on the HME industry. Gain insights into government policies, legislation, and regulations affecting the healthcare market.

bassj
Download Presentation

Springfield Legislative Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SpringfieldLegislative Update Presented by: Collin Brecher VGM Government Relations

  2. Collin Brecher The VGM Group, Inc. Legislative and Regulatory Analyst Email: collin.brecher@vgm.com Office: (319) 274-8656 Cell: (319) 830-5996

  3. Today’s Agenda • What is the government saying about healthcare? • What kinds of initiatives is the government talking about doing in healthcare? • How can the HME industry take advantage of these trends? • Assessing the 2018 elections and impacts on Congress • HME is gaining traction on Capitol Hill and in Baltimore. • Letters, legislation, regulations, oh my…

  4. Let’s Get Political • Industries across the entire landscape of the healthcare market are facing big challenges. “Since 2009 hospice reimbursement has endured a series of reductions... A majority of hospices surveyed indicated that they experienced a moderate to severe effect from the cuts…” – National Hospice and Palliative Care Organization “We will continue our fight to reverse these unwarranted cuts and protect access for patients, and we expect to refile promptly in district court.” - American Hospital Association “APhA remains concerned Medicare beneficiaries are not able to receive medications and services from the pharmacy of their choice because of often overly-restrictive networks by Part D plans.” – American Pharmacists Association

  5. Costs are driving the narrative Source: CMS Office of the Actuary

  6. How does DME compare? $3.6 Trillion $55.7 Billion Source: CMS Office of the Actuary

  7. A deeper dive into DME spending $75.1 Billion $55.7 Billion Source: CMS Office of the Actuary

  8. Healthcare is Extremely Political • Every side of the political isle wants positive healthcare outcomes... • Often times our political differences lead us down different paths of getting there. • Right Version: “People getting sick is their fault… if we gave them a high deductible health plan, they’ll quit smoking and stop eating fast food.” • Left Version: “The health system is to blame. Providers make more money once people get sick. If we change the way we pay providers then they will have to figure out how to just make people healthier.”

  9. What direction does health policy need to go? Prevention Reaction Cutting costs Reducing payments Easy to do Investing up front Keeping individuals in the home Hard work!

  10. One of the few successes at CMS • Independence at Home Demonstration Project Selected primary care practices will provide home-based primary care to targeted chronically ill beneficiaries for a three-year period. Participating practices will make in-home visits tailored to an individual patient’s needs and coordinate their care. • The CMS analysis found that, for the second performance year, Independence at Home participants saved Medicare more than $10 million – an average of $1,010 per beneficiary – while delivering higher quality patient care in the home.

  11. Medicare Cost Shift Study by Brian Leitten

  12. State Association Medicaid Meetings MAMES members attended meeting with Iowa Medicaid Director PAMES group prior to Oregon Medicaid meeting The group also met with Sen. Murray’s Tacoma office PAMES group at the Washington Medicaid meeting

  13. Craig Douglas- VP of Payer Relations • Craig is willing and able to assist you with any payer related issues, including but not limited to: • Offering advice to help you get in network with a payer • Analyzing a proposed fee schedule • Reviewing contract language • Helping to prepare talking points for conversations with private payers or state Medicaid officials

  14. Amazon gains wholesale pharmacy licenses in multiple states • According to a review of records by the St. Louis Post-Dispatch, Amazon has received approval for wholesale pharmacy licenses in at least 12 states, including Nevada, Arizona, North Dakota, Louisiana, Alabama, New Jersey, Michigan, Connecticut, Idaho, New Hampshire, Oregon and Tennessee. • The North Dakota license suggests that Amazon could also distribute medical devices or medical gas, according to the license issued Feb. 24.

  15. If you're in the durable medical equipment distribution business, you should be scared. Amazon is coming for you" Another recent article on how Amazon is trying to get into the DME market: The author specifically says that "If you're in the durable medical equipment distribution business, you should be scared. Amazon is coming for you" https://finance.yahoo.com/news/hedge-fund-billionaire-explains-amazon-wont-get-pharma-005219035.html

  16. This political analyst disagrees • What do suppliers have that Amazon doesn’t? • Hands-on service • Knowledge • Quick repairs and new equipment

  17. Model Licensure by State Point of Service • Provide licensure of home medical equipment providers and to provide for the development, establishment, and enforcement of basic standards that will ensure quality home medical equipment products and services. The board shall establish, by rules and regulations, standards by which a home medical equipment provider shall be licensed. • Must have a principal place of business outside this state shall maintain an office or place of business within this state unless such location is located in a bordering state and whose physical location is within _____ miles of state line and meet the requirements of this act. • Any provider accredited by organizations recognized by the Health Care Financing Administration and/or The Center for Medicare and Medicaid Services may submit documents evidencing current accreditation and shall be presumed to comply with the requirements of the board. Licensing of a Home Medical Equipment Provider that has been accredited by organizations shall become effective upon written notification from the board’s staff that the accreditation meets the standards set out in the rules and regulations promulgated pursuant to this section.

  18. HME Legislative Priorities • The grassroots efforts from suppliers is translating to real results

  19. H.R. 4229-Protecting Home Oxygen & Medical Equipment Access Act • Reinstate the blended reimbursement rate during the nationwide rollout of competitive bidding. This would return rates to the levels of January 2016. • Correct the additional rate cuts for oxygen in rural areas caused by outdated 2006 budget neutrality offset for oxygen. • Oklahoma Sponsors: Reps. Mullin, Lucas, Cole, and Russell 156 supporters as of 10/18/18 Rep. Loebsack (D-IA) Rep. McMorris-Rodgers (R-WA)

  20. Where do Bay StatersLive at Under CMS’ America?

  21. Where do Bay StatersLive at Under CMS’ America?

  22. 138 total sponsors in approximately two weeks

  23. 30 Senate signatures

  24. Complex Rehab Technology Bills • H.R. 3730 – Excludes manual wheelchairs accessories from competitive bidding. • CMS fixed the powerchairaccessoires, this fixes the rest. • H.R. 750 – Separate benefit category • Separates DME and CRT into two categories • Allows for separate coverage policies, coding, and standards for CRT.

  25. Make Me Whole Again • H.R. 6980 – Breast Cancer Patient Equity Act • Creates Medicare coverage for custom breast prosthesis • Medicare covers it all… except custom. MakeMeWholeAgain.com

  26. Let’s talk about grassroots… • Does it really work? Is it worth my time? • That is what HOMESand VGM are here for! • Let’s talk about a few success stories…

  27. Industry Support Champions House Senate Heidi Heitkamp (D-ND) John Thune (R-SD) Greg Walden (R-OR) Cathy McMorris Rodgers (R-WA) Dave Loebsack (D-IA) Chuck Grassley (R-IA) Mike Crapo (R-ID) Ron Wyden (D-OR)

  28. Grassroots Basics • Engage Your Elected Officials (State and Federal) • Pick up the phone, request a meeting, invite them to your store, get to know their staff members in your town and in D.C. • Be a polite pest. • Put aside your personal politics, they act to represent you, your patient and business • Goal #1: Get them to the “aha” moment • Goal #2: Follow up with an action item, not just “help us.”

  29. Grassroots Basics • Engage Your Patients • We all have a million stories, let’s share them! • Not many know any better • DME Day at the State Capitol • Engage the Media • The media likes stories about senior’s access to care being threatened. • Television stations, newspapers, radio programs, ect.

  30. Industry Matters - VGM Podcast

  31. Thank you! Collin Brecher The VGM Group, Inc. Legislative and Regulatory Analyst Email: collin.brecher@vgm.com Office: (319) 274-8656 Cell: (319) 830-5996

More Related