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Kicking off 2016 with congressional meetings in Washington D.C.

Loebsack, John, Jay and Tom RThe House gaveled in to begin the 2016 legislative session this past week. VGM’s John Gallagher was in Washington D.C. meeting with industry leaders to strategize industry initiatives moving forward, the HME industry champions in Congress, and key committee staff. In the omnibus bill at the end of last year there were a lot of Medicare issues not included that must resolved early in the year. John has reported back that offices are now working diligently to find a new pay-for that was used elsewhere in 2015 and also working closely with each other moving forward. As an industry we must continue to make our voices heard moving into 2016, and we are off to the right start in the effort of mitigating the rural rollout of competitive bidding.

The Darkest Hour is Just Before Dawn – Competitive Bidding Rural Relief and CRT Legislation Excluded from Omnibus

December 1944, Belgium – Low on supplies and ammunition, U.S. troops had been able to stop cold everything that had been thrown at them from all directions. Through the winter temperatures, the fighting never stopped. The troops received word that the German commander demanded U.S. troops honorably surrender in an effort to save them from total annihilation.

The German commander received this reply from General McAuliffe and the U.S. troops, “NUTS!” On December 26 General Patton’s 3rd Army broke through the German lines, allowing supplies to be flown in and the wounded to be evacuated.

The story of “The Battle of the Bulge” as told today.

We need to take inspiration from this story and apply to our life. Late last night, our hopes and dreams were deflated as the omnibus bill was released. Industry leaders were up all hours of the night scouring the omnibus bill for any mention of Medicare relief. What will we say in response? Same as the U.S. troops responded to the German commander. NUTS! We shall persevere!

Click here to read the release from AAHomecare.

We have come so far, and we cannot give up now. We need to continue to educate our legislators on the catastrophic effects these Medicare programs are having on DME suppliers and Medicare beneficiaries. We need to continue building relationships with members of Congress.

So many grassroots activities happened this year. Here are just a few.

Back in March of 2014, MAMES leaders Rose Schafhauser and Greg Lord of Great Plains Rehab together with Tom Powers of VGM and many others held an open house meeting with Sens. Heitkamp and Hoeven and Rep. Cramer. Kay Johnson and other MAMES members hosted a meeting with Sen. Thune to gain his interest. Since these meetings in North and South Dakota, these legislators have been in our corner. Iowa also had support of both their senators after MAMES members Leila Wilkerson, Colleen Brabec, Julie Creery and Kurt Johnson spent many hours on the phone with Sens. Grassley and Ernst offices.

Sen. Crapo has been a key to the process since he sits on the Senate Finance Committee. Thanks to meetings and relationships built by Big Sky AMES and Norco, Sen. Crapo was one of the first cosponsors of S.2312. Montana’s complete congressional delegation signed on following in-district meetings.

The group from ADMEA, led by Don Jones, was able to have numerous meetings with all of the Alabama delegation. PAMES members had many in-district meetings with key legislators including Sen. Wyden and Cathy McMorris-Rodgers. UTMED members and Jay Broadbent built relationships with Sen. Hatch’s office. Doug Coleman and CAMES worked tirelessly with his CO and WY congressional leaders.

Thad Connally and KMESA members held many in-district meetings. Thad recently met with the ever-powerful Senate Majority Leader, Sen. Mitch McConnell. Karyn Estrella and HOMES members successfully met with New England leaders. WAMES leaders met with Sen. Baldwin recently and gained her support. They also had a conference call with Rep. Paul Ryan’s office. The list goes on and on. Other grassroots activities include over 5000 messages in three weeks sent to members of Congress through VGM’s DCLink.

All of you deserve a standing ovation. But these incredible acts cannot be for nothing.

This battle is not over. If CMS and Congress ask us to surrender, we say “NUTS!”

So many meetings…so little time.

With just a few congressional days left in 2015, groups met in Washington D.C. to get some face to face time with key congressional leaders.

Tom, Greg and GrassleyTom Greg and Yoder

Earlier this week Greg Packer of US Rehab and Tom Powers of VGM Government Relations met with over twenty congressional leaders in two busy days. The discussion in all meetings were CRT issues and the expansion to the competitive bidding program.

Today in DC, John Gallagher, Jay Witter and Tom Ryan of AAHomecare are pounding the pavement today. The group will continue the discussions to fix the issues with the expansion of the competitive bidding program.

John, AAH and Loebsack

Elsewhere in the country, in-state meetings and conference calls are being arranged thanks to grassroots efforts.

Last week Norco and Big Sky AMES members met with Sen. Crapo at a fundraising event. Many Big Sky AMES members met at Sen. Daines Missoula office and Rep. Zinke’s office to discuss the rural access issues.


Lastly…over 1600 messages have been sent to senators asking them to sign on to S.2312. Great job everyone. Please continue with these grassroots efforts!

DME Suppliers host key meetings with Energy and Commerce committee members Cathy McMorris-Rodgers (WA) and Larry Bucshon (IN)

Peaks & Plains Medical hosted a wonderful event with Congresswoman Cathy McMorris-Rodgers at their Spokane, Washington office. Yesterday, over a dozen providers across the state were able to attend which was a strong showing of support to direct towards the Congresswoman. With this support Rep. McMorris-Rodgers took great interest in signing on to the H.R. 3229 CRT bill, which will exclude CRT accessory items from competitive bidding. A big shout-out to those in attendance for showing just how important these issues are to the industry!McMorris Rodgers event 11.13.15

Vice President of Peaks & Plains, Leigh McNellis, reports back that the Congresswoman was very supportive about the issues that providers had brought to her. “Washington Providers were given a renewed sense of hope to have Congresswoman Cathy McMorris-Rodgers’ support on keeping access to medical equipment and supplies to rural Washington clients with an engaging discussion of the issues at hand,” said McNellis.

Successful Event in Indiana for Rep. Larry Buschon (R-IN)Bucshon event 11.13.15
The building of a coalition to support the DMEPOS industry is growing well as Rep. Buschon was in attendance at Williams Brothers Healthcare Pharmacy in Washington, Indiana. The Congressman asked wonderful questions along the way as providers discussed competitive bidding, and audit problems coming from CMS. Rep. Buschon was quite concerned with the threat that providers are facing with these cuts. At the meeting, the Congressman agreed to be helpful on all issues and said he would reach out to Congressman Price’s office to support the up-coming bidding relief bill. The Congressman was a cardiothoracic surgeon prior to his election to Congress. With a doctors knowledge of just how the health system operates is also another great asset to have to the industry’s initiatives!

Congrats to both Williams Brothers, Peaks and Plains, Great Lakes State Association and PAMES for hosting successful events!

Congressman Dave Loebsack visits VGM

VGM had the honor and privilege of a visit from U.S. Rep Dave Loebsack (D-IA-2) on Wednesday. He met with Mike Mallaro, CFO of VGM, John Gallagher, VP of Government Relations, and Tom Powers of Government Relations.

Congressman Loebsack was one of the first to sign on to H.R. 284. He has always listened to the concerns of the DME industry and has supported all of our efforts to make changesCongressman Loebsack

All Health Care is Local

WATERLOO, IA – Just like the old political adage that “all politics is local,” we as an industry believe that all health care is, and should be, local. Unfortunately, CMS fails to see the truth in this simple concept.

I still remember, from a masters course I took many years ago, a quote from the always quotable newsman Walter Cronkite. Mr. Cronkite once famously said, “America’s health care system is neither healthy, caring, nor a system.”

He was half-kidding, but I believe he would be shocked to learn that one of the keys to fixing today’s health care problems is in jeopardy. That key lies in the simple concept of keeping mom at home where she wants to be, at a fraction of the cost of keeping mom somewhere else.

This simple concept is based on local collaboration between doctors, clinicians, hospitals, and DME providers to provide access to consistent high-quality and affordable care that delivers on its promise of healthy outcomes.

Because all health care is delivered locally, the health care system in the home should be designed and implemented locally. It is at the local, community level where we are most likely to innovate and implement new health care delivery solutions.  The competitive bidding (suicide bidding) system designed by CMS is, as Mr. Cronkite said, neither healthy, caring, nor a system.  It truly is designed to eliminate the local provider.

So how do we as DME providers ensure that healthcare truly remains local? How do we as the DME industry ensure that mom has access to high-quality and affordable care where she wants it most? We do it by ensuring that CMS adheres to all 30 National Supplier House DMEPOS Supplier Standards. In particular, that CMS adheres to the very first standard of its own bidding system.

Standard number one of the Medicare DMEPOS Supplier Standards states that “a supplier must be in compliance with all applicable federal and state licensure and regulatory requirements.”

We as industry stakeholders need to work at the state level to ensure that each and every state has a licensure law to ensure that health care is local. If you agree, you may be asking yourself, “How do we do this?” I am happy to tell you that you need go no further than your own computer.  Go to  to access our State Licensure Tool Box.  Here you will find helpful information on how to begin the licensure process in your state.

Step one is to reach out to your state association. If you’re not a member, now is the time to join. At your state association you might find that your state already has licensure (such as Tennessee, Alabama, Maryland, Colorado and others), or that your state association has already begun the effort and all you have to do is roll up your sleeves and join in.

What should a good DMEPOS state licensure look like? Glad you asked. The VGM State Licensure Tool Box will provide all the information you need. But for the purpose of this opine, and to save you some research effort, a good licensure bill should include the following:
• Brick and Mortar Requirements  – A DME licensure bill would require providers to have a brick and mortar location in your state, staff and regular office hours;
• Accreditation – DME providers would have to be accredited with this DME licensure bill;
• Reciprocity – Reciprocity with surrounding states 50 to 100 miles
• DME involvement in policy – A DME licensure bill would allow DME to have a seat on state boards and commissions.

An effective provision found in our industries new “binding bid” bills (HR 284 and S 148) addresses state licensure to our benefit and that of the beneficiary in future bidding. See the specifics below.
‘‘(G) REQUIRING STATE LICENSURE AND BID BONDS FOR BIDDING ENTITIES.—With respect to rounds of competitions beginning under this subsection on or after the date of enactment of this subparagraph, the Secretary may not accept a bid from an entity for an area unless, as of the deadline for bid submission—
‘‘(i) the entity meets applicable state licensure requirements for such area for all items.”

Whenever stakeholders are fully engaged in a shared vision, results follow. We encourage all—providers, local health and education practitioners, policy makers, hospital and clinic administrators, public health workers and local community leaders and boards—to the table.
With effort in every state and state association, there is no reason why we can’t succeed. Together we can make a difference. With a commitment to achieving DMEPOS Licensure in every state, we can help make sure the American health care system in the home ”remains local, and is truly healthy, caring and a system that works.

John Gallagher is vice president, Government Relations, VGM & Associates, Waterloo, Iowa.

Visit our State Licensure tool box in the DC link.

AA Homecare and VGM come together to discuss strategies and goals for 2015

Tom Ryan and Robert Steedley of AA Homecare braved Iowa’s cold temps  to visit with their allies at VGM to discuss priorities, strategies and action plans for 2015. The feeling is mutual that there is great potential for movement in our direction this first quarter of the 114th Congress. In order to see any changes for the betterment of the medical industry, our messages need to be concise and unified.