What’s Next?

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By Rhonda F. Turner, MBA, JD, PhD, CFom, BOCPO

Having recently lived through a Texas hurricane, the question "what's next" has understandably become a standard in my life's daily vernacular. However, after a recent conversation with an owner of a post-mastectomy boutique, the phrase took on a whole new meaning to me-of note was her comment that because of the Centers for Medicare & Medicaid Services (CMS) surety bond requirement, she now feels like she is "living in a house of cards."

"Surety" means to take financial responsibility, to make certain. The surety bond's purpose is to combat fraud and abuse and ensure that providers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) maintain ethical and financial responsibility. But the DMEPOS surety bond as currently mandated by federal law imposes an additional stress on postmastectomy fitters, a stress that just may be the tipping point that causes many women entrepreneurs to close their doors.

The Balanced Budget Act of 1997 mandated the surety-bond requirement. For more than ten years, stakeholders in the healthcare professions aggressively fought it. Against all efforts, it finally became a reality in 2009. Its implementation was delayed while the final dollar amount and other issues were clarified, until on January 2, 2009, when CMS issued a final rule requiring DMEPOS suppliers to post a $50,000 base surety bond in order to be allowed to participate in Medicare. New, revalidating, or reenrolling suppliers must have the bond in place by May 4, 2009. All other suppliers, if not exempt, currently have a deadline of October 2009. In addition to the base surety bond, CMS is imposing additional, elevated surety-bond requirements on what it is referring to as "high risk" suppliers.

Breast cancer is the number one cancer affecting women. More than 200,000 women have mastectomies annually. After being diagnosed and undergoing a mastectomy, lumpectomy, or significant biopsy, a woman faces yet another need for treatment. While approximately 35 percent undergo immediate or delayed breast reconstruction, the majority will need the services of a breast-care professional to fit post-mastectomy products.

These professionals are certified fitters of post-mastectomy products: post-op, silicone, and custom-fabricated breast forms and other medically necessary products. These items are included in the surety-bond requirement because a breast form is a prosthesis. The Certified Fitter of Mastectomy (CFm) certification is the only certification that allows certificants to exclusively and independently provide these services. Independent businesses- mostly woman-owned-comprise more than 75 percent of the post-mastectomy industry, and the professionals behind these entrepreneurial ventures provide a medical service not available anywhere else. The bond requirement, in an already financially challenging environment, is equivalent to a boulder tipping the scales opposite a feather. In some cases, the $50,000 bond is equivalent to or surpasses the yearly income of the business.

What can be done? Whose responsibility is it to act?

Educating an industry is a complex task. As a business owner, one is always responsible for seeking out new laws and requirements. But this work is also the responsibility of industry vendors and, ultimately, of the national organizations that require dues and provide representation. The American Association of Breast Care Professionals (AABCP) provides representation for the breast care industry. It helps interpret, update, inform, educate, and, when necessary, speak to state and federal legislators who represent the industry, its needs, and its members.

The post-mastectomy industry has recently faced both mandatory certification and accreditation, and the surety-bond requirement was yet another requirement and financial expenditure.

AABCP members asked for help, and we recognized that it was vital for its members to understand the issue. When the surety-bond requirement finally passed, most post-mastectomy suppliers still did not know what the bond was, why and when it was required, or where to obtain one. Access to a surety bond needed to be inexpensive and simple if it was to be attainable by most breast-care professionals.

Since the post-mastectomy industry is unique in size and scope, the AABCP began negotiations with several bond companies to negotiate a discounted surety-bond rate appropriate for its members. AABCP members can now sign up for an inexpensive and simple surety bond on the AABCP website.

Breast care professionals deserve more than a "one-size-fits-all" offering. The AABCP took action on behalf of its 1,000-plus members, but it was driven by the desire to support and represent the breast-care industry by providing necessary and appropriate benefits as well as a representative voice in Congress and our communities.

Rhonda F. Turner, MBA, JD, PhD, CFom, BOCPO, is president of the AABCP. She can be reached at