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Advocacy helps boost reimbursement & more for HME providers

"A rising tide lifts all boats", says Kris Srinivasan, senior manager of payer strategy for McKesson Medical-Surgical. That's why he works with home medical equipment (HME) advocacy groups like AAHomecare and state associations.

Srinivasan says there are more opportunities in areas such as reimbursement as the country emerges from the pandemic.

HMEs were heroes during the pandemic

In the past, most HME advocacy efforts focused on Medicaid and Medicare reimbursement challenges and the goals of showing value to payers and referral sources.

"Frankly, we exerted a great deal of effort battling a pre-pandemic perception of fraud, waste and abuse — some of it valid, but much of it unwarranted," says Srinivasan.

But it's a new playing field today, with HMEs seen in a more positive light. That change in perception is driven by providers' ability to assist the overburdened healthcare system by providing services in the home to patients.

"We were able to help alleviate backups in emergency rooms by providing throughput that freed up much-needed beds," Srinivasan explains. "By providing quality care outside the hospital setting, we could leave capacity for the neediest patients who required intensive hospital attention."

The time is now to build on that forward momentum and capitalize on the goodwill providers created through their heroic efforts.

"We demonstrated we provide value and can have a positive impact on the care community, and in the process, shattered the outdated image of fraud and waste that used to exist," Srinivasan says.

Already, the benefits are surfacing. For example, the Centers for Medicare & Medicaid Services (CMS) recently opened up competitive bidding to an extended list of product lines — evidence Srinivasan believes that the industry is becoming recognized for bidding more appropriately when determining Medicare equipment reimbursement.

Focusing on key issues in 2022 for Medicare reimbursement rates & more

These renewed advocacy efforts have brought about positive changes in both Medicare medical equipment reimbursement and regulatory policies — and efforts continue.

Working with managed care organizations to achieve higher reimbursement rates is currently a top goal because unlike Medicare and Medicaid, which have set fee schedules, third-party payers can set their own reimbursement amounts.

"That's where we rely heavily on advocacy because if a managed care payer decides to cap rates at less than market value, HME providers can't provide quality care," says Srinivasan. "When reimbursement rates are too low, patients lose access to choice and the care they deserve."

On the regulatory side, audits and prior authorizations are a perennial sticking point, and Srinivasan sees a need to educate legislators so they can better understand the hurdles and create more reasonable, patient-friendly policies related to medical equipment reimbursement. 

"Since most HME customers are typically chronic care patients, it's inefficient to have to jump through hoops every year to obtain prior authorization for someone who might need a ventilator year after year," Srinivasan points out.

And if there's a hitch in the system, the patient might get an unexpected and unwarranted bill related to medical equipment reimbursement.

Working together to make an impact

Strengthened by the recent positive perception of the industry, Srinivasan believes providers can build on this initial success by continuing to deliver high-quality products and services.

He says it's a priority to continue educational campaigns focused on various stakeholders, including payers, prescribers and even patients.

The industry also needs to continue to leverage useful technologies.

"We're a good decade behind, so improving our use of technology offers a significant opportunity to stay relevant," he says, citing e-prescribing, population health management, patient engagement, automated billing and utilization management as a few critical solutions the industry can embrace.

There's more the industry can do than write a check on behalf of key advocacy efforts. As one of AAHomecare's "Diamond" partners, McKesson believes there are benefits of making HME providers' voice heard in the industry.

"Historically, manufacturers and distributors hadn't gotten involved in trying to impact change beyond donating money. But several years ago, we decided to jump in the ring and see how can we help impact key trends, and it's been time and effort well spent," Srinivasan says, adding that he's seeing similar interest from others in the field.

"We can't look at each other exclusively as competitors. We need to collaborate on crucial issues because it will help all of us," he says.

"I would encourage anyone who wants to be relevant in the next few years to realize this is the time to get involved and make an impact as an active voice for our issues, like Medicaid managed care and more. We have to continue advocating on behalf of the patient and do it more efficiently together."

As a starting point, Srinivasan recommends HME providers connect with the industry's advocacy associations, like AAHomecare and other state associations.

To find out more about how we support HME advocacy efforts, check out our advocacy resources.

© 2022 McKesson Medical-Surgical Inc.