Faced with declining reimbursement rates, many home medical equipment (HME) providers are looking for ways to increase revenue, sometimes by adding new product categories.
Others are conducting patient population analyses to find ways to better serve their existing patients. Going deeper rather than broader lets them increase revenue while making patients' lives easier. Two clinicians and an HME provider share how this can work with patients who use continuous positive airway pressure (CPAP) and continuous glucose monitoring (CGM) products.
"It comes down to the diagnosis code," says Patricia Reni, respiratory clinical program manager and respiratory therapist with McKesson Medical-Surgical. "What are the diagnoses that you service? And what products do those diagnoses require?"
"Providers will ask what the Healthcare Common Procedure Coding System (HCPCS) code is — what they can bill for," says Jeannette Podlogar, a clinical support manager at McKesson Medical-Surgical who focuses on diabetes. "They're so hyper-focused on this that they lose sight of the fact that those same customers are going to Walmart or Amazon and ordering a variety of other things."
Competitive bidding & falling reimbursement rates
HME reimbursement amounts have fallen, often drastically, due to the Centers for Medicare & Medicaid Services (CMS) Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP), which rolled out widely in 2013. Mandated by Congress in 2003, the CBP uses bids from suppliers as the basis for reimbursement amounts in designated competitive bidding areas.1
According to Stanford and Northwestern University researchers, "spending on DME products included in competitive bidding fell by 47.2%, and [...] this effect persisted over time."2 Data from the American Association for Homecare show the change in reimbursement for top HCPCS codes under the CBP.
Here's a sample of these falling reimbursement rates:3
At the same time, AAHomecare notes that the COVID-19 pandemic has exacerbated acquisition and operational challenges for HME providers.
Perhaps not surprisingly, declining reimbursements have pushed down the number of HME providers. For example, according to the Council for Quality Respiratory Care, HME suppliers in the ten most populous states (which are the most affected by competitive bidding) dropped 47% between 2013 and 2017. By comparison, the number in the 15 smallest-population states, where competitive bidding is less of a factor, dropped 18%.4
Patients who now-closed HME providers had served have to get their supplies somewhere. Many providers are capturing those patients — and increasing revenue from their existing patient base — by thinking strategically about all of a patient's needs instead of focusing on a single HCPC code. They realize that patients with chronic conditions like diabetes and obstructive sleep apnea (OSA) often have comorbidities and that they can help address those conditions.
When you analyze your patient population and think creatively about how you can better serve the entire patient basket, you can help increase revenues and worry less about declining reimbursement rates. In other words, the key is to work smarter, not harder.
Infographic: Make your HME the one-stop shop for patient referrals
As HME reimbursement rates drop, you can help boost revenue by focusing on patients, not just reimbursement codes. Here's how to make your HME the one-stop shop for patients needed CPAP and CGM products.
Up-caring for patients with obstructive sleep apnea (OSA)
For patients with OSA, up-caring begins in the room where the respiratory therapist teaches a patient to use their CPAP machine.
"Providers should consider displaying items in that room that catch the patient's eye, but also help provide them with a more comfortable way of using the equipment — all in the hopes of improving outcomes," says Reni.
Here are a few examples of potential companion products CPAP patients may benefit from:
- Nine out of 10 CPAP users sleep in chairs at home, so a comfortable lift recliner can help them sleep better
- Those who do sleep in bed probably set their CPAP machines on an already crowded nightstand. A CPAP table between the mattress and box spring provides a better, more secure option
- Wherever they sleep, CPAP users (and their loved ones) are often irritated by the sounds of tubes rubbing together. Tubing sleeves eliminate the noise and help reduce condensation
- Some studies have shown that essential oils such as lavender help people sleep better5
- Mask cleaners and mask wipes are essential to keeping CPAP components as clean as possible during daily use
Though many of these products are available outside of traditional HME providers, big box retailers can't provide the same guidance a respiratory therapist can. "You have respiratory specialists on staff; utilize them," Reni says. "They're already becoming known within the pulmonary field in your community; consider ways to increase their recognition even more."
Continuous glucose monitoring patients need a wide variety of products
Podlogar recommends that HME providers have regular conversations with diabetic patients. "Every six months, have a conversation with them about what else is going on with their health," she says. "That's the only way in this market to increase the value of that customer and the best way to increase your value to that customer."
Of course, diabetic patients can have a host of comorbidities. Hypertension and metabolism disorders are most common, but heart disease, respiratory ailments, obesity and osteoarthritis are also high on the list.6
Here's a sampling of products diabetic patients might need:
- Diabetic patients need to inspect their feet daily because 15% of diabetics experience foot ulcers.7 An inspection mirror can help
- Support hose and socks help with circulation but consist of material that may break loose and get into a wound
- Many diabetics have mobility issues and can benefit from assistive devices like walkers, raised toilet seats and grab bars (including suction-cup grab bars for the shower)
- Pill bottles and travel kits allow diabetics to keep track of their medications, insulin needles and other supplies both at home and on the road
- Some diabetics experience recurrent urinary tract infections and can benefit from nutritional supplements that improve the pH balance in the bladder
Many retailers carry products like these, but the selection is often limited. "Although you can get those things at Walmart, it's in a very small section, whereas HME providers have access to everything we at McKesson have," Podlogar says. "And, when they buy from us, they also have clinical resources available to them."
She also points out providers can offer next-day, direct-to-consumer shipping without carrying items in inventory. "They put their order in, and we ship it from our warehouse with their name on it," Podlogar says. "There's no inventory; there's no financial investment to offer these products."
One HME provider's experience
Going deeper instead of wider has paid off for BritKare Home Medical, based in Amarillo, Texas. CEO Josh Britten says the company's three brick-and-mortar locations make it easy for CPAP patients to get the care and the supplies they need.
"We have employees, customer service reps, that at any point, are ready to help a patient that's having issues," Britten says. "Not every patient that comes in will be a revenue producer. However, if we take care of them that first time, we believe they'll continue to come back and continue to get resupply through us throughout the year."
Britten acknowledges it takes training to get employees to shift from a reimbursement mentality to a cash-pay mentality. Still, he says the investment pays off, sometimes through sales in other parts of the showroom.
Patients also benefit from the company's approach. "Our compliance rate for CPAP is the highest in the state, and I think it's directly related to our availability to help patients," he says.
BritKare, which was once a full-line DME provider, has dropped several lines of business in recent years, including wound care and trach supplies. However, it's now in the process of adding a focus on CGM — again aiming to generate revenue through reimbursements and cash sales.
"Anything that we can do that just adds a little bit of value, I think, is where DME brick-and-mortar is going to fit in in the future," he says.
HME providers have options to help offset declining reimbursement, including:
- Expanding product categories as they consider an entire patient basket
- Expanding their accessories selection in a given category
- Going deep in a particular product category to become the expert in that category within their geography
With slight and ongoing strategic shifts in business models, providers can help successfully navigate the winding roads that lie ahead for them.
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Disclaimer: McKesson is providing HCPCS/ CPT codes based upon information provided by the product manufacturers. McKesson does not make representations about the accuracy of this information. The HCPCS/ CPT codes do not indicate coverage or payment under any federal or state health care program. The entity that submits claims to any federal or state health care program has the responsibility to verify the accuracy of HCPCS/ CPT codes it submits for payment purposes.
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